Paranoia / Delusional Disorders (Paranoid Personality Disorder)

Paranoia is characterized by a pervasive distrust of others. In the past, it has been classified as a manifestation of a relatively rare class of mental illnesses, known as delusional disorders, but many psychiatrists now regard it as a distinctly separate condition. Regardless of classification, a paranoid personality is beset with delusions that make it impossible to form normal relationships with others.

The cause of paranoia and other delusions is unknown. Their manifestations generally appear in adulthood, but psychiatrists believe they originate in childhood. Mental health professionals theorize that symptoms develop when patients start to attribute their own failings and suppressed negative feelings to outside forces. Thus, a person who is unable to hold a job may become convinced that a neighbor, government agency, or even a space alien is plotting against him rather than face his own shortcomings. This type of thinking also serves as a way to protect an individual from recognizing and dealing with unacceptable impulses.

Diagnostic Studies and Procedures

To determine that delusional or paranoid thinking is not the result of a medical illness, a complete physical examination will be conducted, and standard mental function tests may be given as well. The American Psychiatric Association lists the following diagnostic criteria for delusional disorders:

• The delusion persists for more than one month and involves a situation that might occur in real life, such as being poisoned, stalked, or secretly loved.
• Aside from the delusion and its ramifications, the persons behavior is not obviously strange.
• There is no identifiable organic basis for the delusions.

To be diagnosed as paranoid, a person:

• Harbors irrational and unwarranted suspicions that others are trying to harm or deceive him.
• Is reluctant to confide in others.
• Bears persistent grudges.
• Mistakenly reads hidden threats into benign remarks,
• Is convinced that a sexual partner is being unfaithful.

Medical Treatments

Once a diagnosis has been established, a doctor then tries to determine if the patient has violent intentions. In making this evaluation, she must decide if hospitalization is advisable and, should the patient refuse to go voluntarily, whether or not legal commitment should be sought.

An antipsychotic drug, usually haloperidol (Haldol), may be prescribed in gradually increasing doses for six weeks. If there is no obvious improvement, another antipsychotic drug may be tried. Patients who respond to such medications usually can maintain their improvement with a long-term, low-dose therapy.

Psychotherapy is successful only when the patient sees the doctor as a helper rather than a foe, a trust that is especially difficult to establish with a paranoid person. Individual, or one-to-one therapy, appears to be more successful at achieving this relationship than group sessions.

Other family members may become involved in therapy, but not until the patient knows that the only objective is to help. When psychotherapy works, the patient learns to seek situations that strengthen self-esteem and to avoid those that may reinforce his delusions.

Alternative therapies

Drama or Dance Therapy. These techniques may be employed to provide the therapist with a deeper insight into the personality problem.

Meditation. Delusions originating from a stressful situation may be alleviated by meditation, visualization, or other relaxation therapies.

Pet Therapy. A paranoid person may be able to establish a trusting relationship with a dog, cat, or other animal, paving the way for human interaction.

Self-Treatment

People who harbor delusions or are paranoid almost always need professional help. Once healing has begun, self-help strategies should be directed to finding enjoyable avenues of expression. For example, a person with past delusions of grandeur may benefit from joining an amateur theatre group that provides an outlet for grandiose ideas.

Other Causes of Delusions

Delusions and paranoia may be associated with alcoholism and other addictions, adrenal or thyroid disorders, Alzheimer's disease, brain tumors, stroke, Parkinson's disease, and schizophrenia, depression, and other psychiatric disorders. Some medications and severe nutrition deficiencies cause delusions.