Imagine living your life in a perpetual state of belief that someone was trying to hurt you, or destroy your career. Or, imagine believing, despite consistent denial, that your spouse was being continuously unfaithful.
For some people, this is the nightmare of everyday life. Not because someone really is trying to destroy their life, or that their spouse really is unfaithful, but because these individuals live with an illness called paranoid disorder.
Paranoid disorder is an illness in which the individual experiences a persistent delusion with no other organic cause or psychiatric illness. These delusions must last at least a month before diagnosis, but are usually present much longer before the person seeks help.
Delusions are false beliefs that are strongly held despite evidence that invalidates those beliefs. Delusions are also present in psychotic illnesses such as schizophrenia. The difference between schizophrenia and paranoid (or delusional) disorder is that there are usually no hallucinations present in paranoid disorder.
Also, while those with schizophrenia often have very bizarre and outlandish delusions, the ones common in paranoid disorder typically involve situations that could occur in real life.
Actually, there are several main types of delusions within paranoid disorder. People experiencing eroto-manic delusions believe that a person (usually of higher social status) is in love with them.
Grandiose delusions involve feelings of inflated power, knowledge, identity, or belief in a special relationship to a deity or famous person.
Jealous delusions revolve around the belief that a sexual partner is unfaithful. In persecutory delusions, the belief is centered on the theme of being poorly treated in some way. Often, people with this kind of delusion will repeatedly take complaints of mistreatment to the authorities.
People with somatic delusions (as distinct from delusions of the mind) believe they have some physical defect, disorder, or disease when none is present.
In all cases, paranoid disorder is characterized by a lack of insight. Regardless of evidence to the contrary, these individuals strongly believe their delusions to be real. Facts are misinterpreted to be consistent with the fixed, psychotic belief.
For example, someone who is pathologically jealous of a spouse would misinterpret the spouse’s actions to be consistent with that belief. If the spouse is friendly to a person of the opposite sex, he or she will be accused of being flirtatious.
Likewise, if the spouse is cold toward that same person, he or she will be accused of trying to hide something. Any fact will be twisted to fit the delusion, and it is impossible to rationally change this belief.
This is a very difficult disorder to treat as the individual usually appears quite normal in most respects and can often perform their job with no problems as long as their false beliefs don’t lead to conflict in the workplace.
Also, since people with this condition usually don’t believe that there is a delusion, they often don’t seek treatment. Involuntary treatment is often not an option due to their ability to function in other areas.
Unfortunately, these delusions can sometimes lead to dangerous situations as the individual acts in what they believe to be rational self defense against the forces they perceive around them.
While very little research has been done on specific treatments for paranoid disorder, neuroleptic drugs are usually the treatment of choice. These are the same medications used successfully to treat psychosis and delusions in other disorders.
These show some benefit with this disorder; however, it is often difficult to convince individuals to remain on medication as they do not believe they are ill. Family involvement can sometimes help, but these patients have often alienated all who are close to them.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.
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