Dear Therapist:

My sister has always thought that everyone was out to get her. She is extremely insecure and very sensitive. Now her paranoia has increased to the point where she is in a fight with everyone in her family. She is furious at me because she thinks I didn’t try hard enough to get her kids into high school. She thinks my husband ruined her kids’ shidduchim. She thinks my brothers are trying to push her husband out of the family business. None of this is even slightly true. I mean completely off the wall with the paranoia. Obviously, she won’t listen to my advice but I have no idea how to deal with her anymore. With her immediate family, it’s really a mess. It’s like the kids are divided into teams between her and her husband. Is there anything I can do to help her or should I just run the other way (which, ironically, would be what she accuses me of) as sad as that may be?

Response:

Unfortunately, it sounds as if your sister has a persecution complex. This may not be something on which you can directly impact in any way. Reasons for your sister’s paranoia can be varied, and she may have a psychotic or personality disorder.

Paranoia is often self-perpetuating. It seems that once your sister begins to believe that someone is out to get her, she becomes hyper-focused and highly sensitized to any clues (however insignificant and unrealistic) that this is the case. These clues become magnified in her mind to the exclusion of other factors. This doesn’t allow her to identify or contemplate ideas that contradict the negative thoughts.

This often leads to self-fulfilling prophecies. The certainty that a person is her enemy can easily lead to that person’s negative reaction, in turn reinforcing your sister’s belief. This is probably the reason for the irony inherent in your recognition that sister’s actions may lead to your abandonment of her. This is doubtless something that she does to people on a regular basis.

Your role depends on a few factors, including your own emotional ability to deal with your sister’s accusations, any instinctive reactions, and your relationship with her. If you can handle her behavior and you can control your responses, there are two things that you can do to try and help her. You can let your sister know that you will always be there for her regardless of her thoughts, feelings, and actions. While not agreeing with her paranoid beliefs, you can let her know that you understand that she feels these strongly, and that they won’t drive you away. Making it clear that you are there for her despite her attempts to push you away may help her to develop a sense of trust around your relationship. She is likely craving a sense of security that will come only from someone sticking with her regardless of what she throws at them. While this may be very difficult—and maybe impossible—to achieve, it can be a lifeline for her in a world where she feels that everyone is against her.

If this does lead to a more trusting relationship between the two of you, there may come a time that you can gently persuade your sister to seek help for her emotional issues. When and how this may occur is something that you’ll hopefully know when the time comes.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317