I think it’s a legitimate to ask how one is to distinguish a common troll from a psychologically disturbed person.
Sometimes trolling is pretty obvious (like the Pakistani homeopathy spammers of yore). Sometimes, not so much. It seems to me that when confronted with that vast grey area of uncertainly, the most reasonable procedure is to assume genuine psychological problems. The worst you’ll get is to look like a fool in the face of a troll. So what? The worst you get by assuming the opposite is to look real “cool” while ragging on someone with serious psychological issues. Personally, I'd rather risk looking a fool than actually being one.
So here’s my advice to JP1283:
You’ve mentioned specific psychological problems (OCD, etc.). You’ve mentioned you have a therapist. Considering the consistency of your posting on these boards expressing fear, it’s pretty clear your therapist isn’t doing right by you.
Sometimes a person has to take the responsibility of their medical treatment into their own hands. For instance, if a therapist isn’t helping, you have to insist they change tactics. You don’t have to be confrontative, but you do have to stick to your guns. People in the medical field often “anchor” themselves to a diagnosis or way of proceeding, and make other cognitive errors that need to be corrected. At these times, it’s up to the patient to be their own best advocate. You need to ask the therapist questions like “Are there other options for me,” and, “If this doesn’t work, what’s the next step,” and, “How is my progress being monitored.” Most of all, you have to tell them truthfully if you think you aren’t being served well by current practice. The medical field is full of intimidating people with impressive degrees, but ultimately it’s up to the patient to ensure they’re being led down the right track.
Skepticism can only get you so far. It doesn’t cure faulty brain chemistry. The drumbeat of this thread should be “lean on your therapist to make a difference.” Clearly they need to be pressed to do better. Unfortunately, it’s entirely up to you to do the pressing. Fortunately, when a patient stands up for themselves, they often get results.