UNIT 2 PARANOID AND DELUSIONAL

DISORDER
Structure
2.0 Introduction
2.1 Objectives
2.2 Concept of Paranoia
2.2.1 Definition of Paranoia
2.2.2 Characteristic Features of Paranoia
2.2.3 Symptoms of Paranoia
2.2.4 Kinds of Paranoia

2.3 Causes of Paranoia

2.3.1 Homosexual Fixation
2.3.2 Feelings of Inferiority
2.3.3 Emotional Complex
2.3.4 Personality Type
2.3.5 Heredity
2.3.6 Biological
2.3.7 Environmental / Psychological
2.3.8 Dysfunctional Cognitive Processing
2.3.9 Medical Causes
2.3.10Associated Mental Illnesses
2.3.11Substance Abuse

2.4 Delusional Disorder

2.4.1 Characteristic Features
2.4.2 Types of Delusional Disorder
2.4.3 Delusions of Grandeur
2.4.4 Motivated or Defensive Delusions

2.5 Delusions and Other Disorders

2.6 Treatment Approaches to Paranoia and Delusional Disorder
2.6.1 Treatment and Cure
2.6.2 Psychoanalytic Method
2.6.3 Cognitive Behavioural Therapy (CBT)
2.6.4 Drug Therapy
2.6.5 Combining Pharmacotherapy with Cognitive Therapy
2.6.6 Psychotherapy
2.6.7 Prognosis of Paranoia and Delusional Disorder

2.7 Let Us Sum Up

2.8 Unit End Questions
2.9 Suggested Readings and References

2.0 INTRODUCTION
This unit deals with paranoia and delusional disorder. We start with the concept of
paranoia, define paranoia and describe the characteristic features of the same. Then we 21
Schizophrenia and Other delineate the symptoms of paranoia and the kinds of paranoia that are obtained in this
Psychotic Disorders
disorder. This is followed by Causes of paranoia wherein we deal with various factors
including feelings of inferiority, emotional complex, personality type, hereditary factors,
biological factors, environmental and psychological factors. We also mention the medical
causes, other mental illnesses and substance abuse as a cause. Then we discuss delusional
disorder. Delineating the characteristic features of this disorder we deal with the various
types of delusional disorders especially the grandiose, erotomaniac etc., and then deal
with the motivated or defensive delusions. Since delusion are obtained in various other
psychiatric disorders, these aspects are then considered followed by the treatment
approach to the paranoia and delusional disorders. We end up with the prognosis of
these disorders.

2.1 OBJECTIVES
On completing this unit, you will be able to:
 Define paranoia and delusional disorders;
 Enlist various types of paranoia delusional disorders;
 Elucidate the Symptoms and causes of the disorders;
 Explain the Interventional approaches for the delusional disorders; and
 Analyse the prognosis.

2.2 CONCEPT OF PARANOIA

2.2.1 Definition of Paranoia
Here the patient becomes a prey to premature delusion. According to Kraeplein, in the
disease the cause of delusion is internal, and no hallucination is involved.
A paranoid disorder is a medical illness, which happens to affect the brain, and causes
changes in thinking and feeling. It’s nobody’s fault when it develops, and certainly does
not mean any personal weakness or failure. It’s an illness just as diabetes and asthma
are illnesses.
It’s not all that uncommon, either Paranoia disorder consists of pervasive, long-
standing suspiciousness and generalised mistrust of others. Those with the condition
are hypersensitive, are easily slighted, and habitually relate to the world by vigilant
scanning of the environment for clues or suggestions to validate their prejudicial ideas
or biases.
Paranoid individuals are eager observers. They think they are in danger and look for
signs and threats of that danger, disregarding any facts. They tend to be guarded and
suspicious and have quite constricted emotional lives. Their incapacity for meaningful
emotional involvement and the general pattern of isolated withdrawal often lend a quality
of schizoid isolation to their life experience.
Despite the pervasive suspicions they have of others, patients are not delusional (except
in rare, brief instances brought on by stress ). Most of the time, they are in touch with
reality, except for their misinterpretation of others’ motives and intentions.
Paranoid Personality Disorder patients are not psychotic but their conviction that others
are trying to “get them” or humiliate them in some way often leads to hostility and social
22 isolation.
The word paranoia comes from the Greek word indicating madness and the term Paranoid and Delusional
Disorder
was used to describe a mental illness in which a delusional belief is the sole or most
prominent feature. In original attempt at classifying different forms of mental illness,
Kraepelin used the term pure paranoia to describe a condition where a delusion was
present, but without any apparent deterioration in intellectual abilities and without any
of the other features of dementia praecox, the condition later renamed “schizophrenia”.
Notably, in his definition, the belief does not have to be persecutory to be classified as
paranoid, so any number of delusional beliefs can be classified as paranoia. For example,
a person who has the sole delusional belief that he is an important religious figure would
be classified by Kraepelin as having pure paranoia.
Even at the present time, a delusion need not be suspicious or fearful to be classified as
paranoid. A person might be diagnosed as a paranoid schizophrenic without delusions
of persecution, simply because their delusions refer mainly to themselves.

2.2.2 Characteristic Features of Paranoia

People with this disorder do not trust other people. In fact, the central characteristic of
people is a high degree of mistrustfulness and suspicion when interacting with others.
Even friendly gestures are often interpreted as being manipulative or malevolent.
Whether the patterns of distrust and suspicion begin in childhood or in early adulthood,
they quickly come to dominate the lives of those suffering from the said disorder. Such
people are unable or afraid to form close relationships with others. They suspect
strangers, and even people they know, of planning to harm or exploit them when there
is no good evidence to support this belief. As a result of their constant concern about
the lack of trustworthiness of others, patients with this disorder do not have intimate
friends or close human contacts. They do not fit in and they do not make good “team
players.”
Interactions with others are characterised by wariness and not infrequently by hostility.
If they marry or become otherwise attached to someone, the relationship is often
characterised by pathological jealousy and attempts to control their partner. They often
assume their sexual partner is “cheating” on them. People suffering from this disorder
are very difficult to deal with. They never seem to let down their defenses. They are
always looking for and finding evidence that others are against them.
Their fear, and the threats they perceive in the innocent statements and actions of others,
often contributes to frequent complaining or unfriendly withdrawal or aloofness. They
can be confrontational, aggressive and disputatious. It is not unusual for them to sue
people they feel have wronged them. In addition, patients with this disorder are known
for their tendency to become violent. Individual counseling seems to work best but it
requires a great deal of patience and skill on the part of the therapist. Phelan, M.
Padraig, W. Stern, J (2000) paranoia and paraphrenia are debated entities that were
detached from dementia praecox by Kraepelin, who explained paranoia as a continuous
systematized delusion arising much later in life with no presence of either hallucinations
or a deteriorating course, paraphrenia as an identical syndrome to paranoia but with
hallucinations.

2.2.3 Symptoms of Paranoia

The main symptom is permanent delusion. It should be kept in mind that there is delusion
in schizophrenia also but in that case it is not permanent or organised. In paranoia the
symptoms of delusion appear gradually, and the patient is sentimental, suspicious, irritable,
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Schizophrenia and Other introverted, depressed, obstinate, jealous, selfish, unsocial and bitter. Hence his social
Psychotic Disorders
and family adjustment is not desirable, and while he has the highest desirable, the effort
that he is prepared to expend is correspondingly little. Here the person does not
acknowledge his own failures or faults, and by sometimes accepting certain qualities as
belonging to himself, even when imaginary, he develops paranoia.
The “Diagnostic and Statistical Manual of Mental Disorders”, fourth edition (DSM-
IV), the US manual of the mental health professional; lists the following symptoms for
paranoid personality disorder:
 Preoccupied with unsupported doubts about friends or associates.
 Suspicious; unfounded suspicions; believes others are plotting against him/her.
 Perceives attacks on his/her reputation that are not clear to others, and is quick to
counterattack.
 Maintains unfounded suspicions regarding the fidelity of a spouse or significant
other.
 Reads negative meanings into innocuous remarks.
 Reluctant to confide in others due to a fear that information may be used against
him/her.
 Self-referential thinking:Sensing that other people in the world are always talking
about the paranoid individual.
 Thought broadcasting: The sense that other people can read the paranoid
individual’s mind.
 Magical thinking: The sense that the paranoid individual can use his or her thoughts
to influence other people’s thoughts and actions.
 Thought withdrawal: The sense that people are stealing the paranoid individual’s
thoughts.
 Thought insertion: The sense that people are putting thoughts into the paranoid
individual’s mind.
 Ideas of reference: The sense that the television and/or radio are specifically
addressing the paranoid individual.

2.2.4 Kinds of Paranoia

Persecutory paranoia : This is the most prevalent type of paranoia, and in this patient
makes himself believe that all those around him are his enemies, bent on harming him or
even taking his life. In this delusion people of an aggressive temperament often turns
dangerous killers.
Religious paranoia : Here the patients suffer from a permanent delusion of a primarily
religious nature. He for example believes, that he is the messenger of God who has
been sent to the world to propagate some religion.
Reformatory paranoia : In this the patient turns to considering himself a great reformer.
He accordingly looks upon all those around him. As suffering from dangerous disease,
and believes that he is their reformer and curator.
Erotic paranoia : Here the patient often tends to believe that some members of the
family of the opposite sex, belonging to an illustrious family, want to marry him. Such
people even write love letters and there by, cause much botheration to other people.
24
Litigious paranoia : In this kind the patient takes to feeling meaningless cases against Paranoid and Delusional
Disorder
other people and feels that people are linked together to bother him. Sometimes he,
even tries to murder.
Hypochondrical paranoia : In this kind the patients believes that he is suffering from
all kind of ridiculous diseases, and also that some other people are to blame for his
suffering.
Self Assessment Qeustions
1) Define Paranoia and bring out the characteristic features of this disorder.
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2) What are the symptoms of paranoia?
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3) What are the different kinds of paranoia?
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2.3 CAUSES OF PARANOIA

2.3.1 Homosexual Fixation
According to Freud, the patient suffering from the disease has repressed his tendency
to homosexual love to such an extent that he develops a fixation concerning it. Freud’s
view has been found correct in many cases, but it does not explain each and every case
of the disease.

2.3.2 Feelings of Inferiority

Here the psychologists have found that the main cause of paranoia is a sense of inferiority
that may be caused by a variety of condition such as failure, disgust, sense of guilt.

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Schizophrenia and Other 2.3.3 Emotional Complex
Psychotic Disorders

Certain psychologist points out emotional complexes, and also believe that they are
seen to be present in other mental diseases as also in normal individuals.

2.3.4 Personality Type

Cameron believes a certain type to be more susceptible to this disease, a personality
that has sentimentally, jealousy, suspicion, ambition, selfishness and shyness etc. Patients
of paranoia do exhibit these peculiarities of personality but on this basis they cannot be
said to belong to definite personality.

2.3.5 Heredity
In the opinion of Fisher the main responsibility of paranoia lies fairly and squarely upon
heredity, although he does not deny the importance of repression and emotional
complexes.

The causes of paranoia are not physical because no patient exhibits any signs of physical
deformity and among the causes there are many important” ones, such as defects of
personality, sense of inferiority, repression etc.

2.3.6 Biological
Researchers are studying how abnormalities of certain areas of the brain might be involved
in the development of delusional disorders. An imbalance of certain chemicals in the
brain, called neurotransmitters, also has been linked to the formation of delusional
symptoms. Neurotransmitters are substances that help nerve cells in the brain send
messages to each other. An imbalance in these chemicals can interfere with the
transmission of messages, leading to symptoms.

2.3.7 Environmental/Psychological
Evidence suggests that delusional disorder can be triggered by stress. Alcohol and drug
abuse also might contribute to the condition. People who tend to be isolated, such as
immigrants or those with poor sight and hearing, appear to be more vulnerable to
developing delusional disorder.

2.3.8 Dysfunctional Cognitive Processing

An elaborate term for thinking is “cognitive processing.” Delusions may arise from
distorted ways people have of explaining life to themselves. The most prominent cognitive
problems involve the manner in which delusion sufferers develop conclusions both about
other people, and about causation of unusual perceptions or negative events.

Studies examining how people with delusions develop theories about reality show that
the subjects have ideas which which they tend to reach an inference based on less
information than most people use.

This “jumping to conclusions” bias can lead to delusional interpretations of ordinary

events. For example, developing flu-like symptoms coinciding with the week new
neighbours move in might lead to the conclusion, “the new neighbours are poisoning
me.”
26
The conclusion is drawn without considering alternative explanations—catching an illness Paranoid and Delusional
Disorder
from a relative with the flu, that a virus seems to be going around at work, or that the
tuna salad from lunch at the deli may have been spoiled.
Additional research shows that persons prone to delusions “read” people differently
than non-delusional individuals do. Whether they do so more accurately or particularly
poorly is a matter of controversy.
Delusional persons develop interpretations about how others view them that are distorted.
They tend to view life as a continuing series of threatening events. When these two
aspects of thought co-occur, a tendency to develop delusions about others wishing to
do them harm is likely.

2.3.9 Medical Causes

Many medical conditions can lead to paranoid thoughts. Alzheimer’s disease, chemical
deficiencies, cathinone poisoning and neurological degeneration disorders can harm the
nervous system and lead to confusion and unstable emotions. Sufferers of these conditions
sometimes forget who they can trust and also lose the ability to differentiate between
trustworthy and suspicious behaviour.

2.3.10 Associated Mental Illnesses

Some mental illnesses are associated with paranoia. An inability to think clearly can
cause an individual to lose the ability to differentiate between trustworthy and not
trustworthy individuals. Schizophrenia causes an individual to have bizarre or disorganised
thoughts. Some individuals hallucinate and begin to believe that which they hallucinate
rather than their friends and family members. Psychosis involves a detachment from
reality that can lead to paranoid thoughts.

2.3.11 Substance Abuse

Many substances lead to paranoia if abused: alcohol, amphetamines, crack, crystal
meth, cocaine, ecstasy, marijuana, narcotics, opioids, opium, pain killers, oxycodone,
sleeping pills and tranquilizers. Withdrawal from many of these substances can also
trigger paranoid thoughts, so withdrawal must be handled carefully with close supervision.
Self Assessment Questions
1) What are the causes of paranoia?
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2) Discuss feelings of inferiority and emotional complex as causes of paranoia.
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Schizophrenia and Other
Psychotic Disorders 3) Delineate the hereditary factors and biological factors as causes of paranoia.
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4) What is dysfunctional cognitive processing?
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5) What are the medical causes and associated mental illnesses as causes of
paranoia?
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2.4 DELUSIONAL DISORDER

Delusions are irrational beliefs, held with a high level of conviction, that are highly resistant
to change even when the delusional person is exposed to forms of proof that contradict
the belief.
Non-bizarre delusions are considered to be plausible; that is, there is a possibility that
what the person believes to be true could actually occur a small proportion of the time.
Conversely, bizarre delusions focus on matters that would be impossible in reality. For
example, a non-bizarre delusion might be the belief that one’s activities are constantly
under observation by federal law enforcement or intelligence agencies, which actually
does occur for a small number of people.
By contrast, a man who believes he is pregnant with German Shepherd puppies holds
a belief that could never come to pass in reality. Also, for beliefs to be considered
delusional, the content or themes of the beliefs must be uncommon in the person’s
culture or religion. Generally, in delusional disorder, these mistaken beliefs are organised
into a consistent world-view that is logical other than being based on an improbable
foundation.

2.4.1 Characteristic Features

Unlike most other psychotic disorders, the person with delusional disorder typically
does not appear obviously odd, strange or peculiar during periods of active illness. Yet
the person might make unusual choices in day-to-day life because of the delusional
beliefs. Expanding on the previous example, people who believe they are under
government observation might seem typical in most ways but could refuse to have a
28
telephone or use credit cards in order to make it harder for “those Federal agents” to Paranoid and Delusional
Disorder
monitor purchases and conversations.
Most mental health professionals would concur that until the person with delusional
disorder discusses the areas of life affected by the delusions, it would be difficult to
distinguish the sufferer from members of the general public who are not psychiatrically
disturbed. Another distinction of delusional disorder compared with other psychotic
disorders is that hallucinations are either absent or occur infrequently.
The person with delusional disorder may or may not come to the attention of mental
health providers. Typically, while delusional disorder sufferers may be distressed about
the delusional “reality,” they may not have the insight to see that anything is wrong with
the way they are thinking or functioning. Regarding the earlier example, those suffering
delusion might state that the only thing wrong or upsetting in their lives is that the
government is spying, and if the surveillance would cease, so would the problems.
Similarly, the people suffering the disorder attribute any obstacles or problems in
functioning to the delusional reality, separating it from their internal control. Furthermore,
whether unable to get a good job or maintain a romantic relationship, the difficulties
would be blamed on “government interference” rather than on their own failures or
omissions.
Unless the form of the delusions causes illegal behaviour, somehow affects an ability to
work, or otherwise deal with daily activities, the delusional disorder sufferer may adapt
well enough to navigate life without coming to clinical attention. When people with
delusional disorder decide to seek mental health care, the motivation for getting treatment
is usually to decrease the negative emotions of depression, fearfulness, rage, or constant
worry caused by living under the cloud of delusional beliefs, not to change the unusual
thoughts themselves.
Delusional disorder, previously called paranoid disorder, is a type of serious mental
illness called a “psychosis” in which a person cannot tell what is real from what is
imagined. The main feature of this disorder is the presence of delusions, which are
unshakable beliefs in something untrue.
People with delusional disorder experience non-bizarre delusions, which involve
situations that could occur in real life, such as being followed, poisoned, deceived,
conspired against, or loved from a distance. These delusions usually involve the
misinterpretation of perceptions or experiences. In reality, however, the situations are
either not true at all or highly exaggerated.
People with delusional disorder often can continue to socialise and function normally,
apart from the subject of their delusion, and generally do not behave in an obviously
odd or bizarre manner. This is unlike people with other psychotic disorders, who also
might have delusions as a symptom of their disorder. In some cases, however, people
with delusional disorder might become so preoccupied with their delusions that their
lives are disrupted.
Psychiatrists make a distinction between the milder paranoid personality disorder
described above and the more debilitating delusional (paranoid) disorder. The hallmark
of this disorder is the presence of a persistent, nonbizarre delusion without symptoms
of any other mental disorder.
Delusions are firmly held beliefs that are untrue, not shared by others in the culture, and
not easily modifiable. Five delusional themes are frequently seen in delusional disorder.
In some individuals, more than one of them is present. 29
Schizophrenia and Other Whether or not persons with delusional disorder are dangerous to others has not been
Psychotic Disorders
systematically investigated, but clinical experience suggests that such persons are rarely
homicidal. Delusional patients are commonly angry people, and thus they are perceived
as threatening. In the rare instances when individuals with delusional disorder do become
violent, their victims are usually people who unwittingly fit into their delusional scheme.
The person in most danger from an individual with delusional disorder is a spouse or
lover.

2.4.2 Types of Delusional Disorder

Paranoia is an unfounded or exaggerated distrust of others, sometimes reaching delusional
proportions. Paranoid individuals constantly suspect the motives of those around them,
and believe that certain individuals, or people in general, are “out to get them.”
Paranoid perceptions and behaviour may appear as features of a number of mental
illnesses, including depression and dementia, but are most prominent in three types of
psychological disorders: paranoid schizophrenia, delusional disorder (persecutory type),
and paranoid personality disorder (PPD).
Individuals with paranoid schizophrenia and persecutory delusional disorder experience
what is known as persecutory delusions: an irrational, yet unshakable, belief that someone
is plotting against them. Persecutory delusions in paranoid schizophrenia are bizarre,
sometimes grandiose, and often accompanied by auditory hallucinations. Individuals
with delusional disorder may seem offbeat or quirky rather than mentally ill, and, as
such, may never seek treatment.
Persons with paranoid personality disorder (PPD) tend to be self-centered, self-
important, defensive, and emotionally distant. Their paranoia manifests itself in constant
suspicions rather than full-blown delusions. The disorder often impedes social and
personal relationships and career advancement. Some individuals with PPD are described
as “litigious,” as they are constantly initiating frivolous law suits. PPD is more common
in men than in women, and typically begins in early adulthood.
The exact cause of paranoia is unknown. Potential causal factors may be genetics,
neurological abnormalities, changes in brain chemistry, and stress. Paranoia is also a
possible side effect of drug use and abuse (for example, alcohol, marijuana,
amphetamines, cocaine, PCP). Acute, or short term, paranoia may occur in some
individuals overwhelmed by stress.
The diagnosis of patients with paranoid symptoms includes a thorough physical
examination and patient history to rule out possible organic causes (such asdementia)
or environmental causes (such as extreme stress). If a psychological cause is suspected,
a psychologist will conduct an interview with the patient and may administer one of
several tests to evaluate mental status.
Paranoia that is symptomatic of paranoid schizophrenia, delusional disorder,or paranoid
personality disorder should be treated by a psychologist and/or psychiatrist.
Antipsychotic medication such as thioridazine (Mellaril),haloperidol (Haldol),
chlorpromazine (Thorazine), clozapine (Clozaril), or risperidone (Risperdal) may be
prescribed, and cognitive therapy or psychotherapy may be employed to help the patient
cope with their paranoia and/or persecutory delusions. It is uncertain whether
antipsychotic medication benefit individuals with paranoid personality disorder and may
even pose long-term risks.
If an underlying condition, such as depression or drug abuse, is found to be triggering
the paranoia, an appropriate course of medication and/or psychosocial therapy is
30 employed to treat the primary disorder.
Because of the inherent mistrust felt by paranoid individuals, they often must be coerced Paranoid and Delusional
Disorder
into entering treatment. As unwilling participants, their recovery may be hampered by
efforts to sabotage treatment (for example, not taking medication or not being forthcoming
with a therapist). They may also exhibit a lack of insight into their condition or the belief
that the therapist is plotting against them. Although their lifestyles may be restricted,
some patients with PPD or persecutory delusional disorder continue to function in society
without treatment.
Distrust is the hallmark of delusional disorder. Someone who suffers from this disorder
is very defensive, sometimes to the point of being aggressive, and may constantly question
the motives of others. Even if people appear harmless on the surface, the patient believes
that they are simply trying to lull the patient into a sense of complacency, and the patient
will remain on guard as a result. Other symptoms of delusional disorder can include a
sense of social isolation caused in part by the patient’s defensive and suspicious
behaviour, and a lack of humor.

2.4.3 Delusion of Grandeur

In this patient believes himself to be, a great individual, and according to Bleuler, this
delusion of grandeur accompanies a persecutory delusion. A delusion is (common in
paranoia) that you are much greater and more powerful and influential than you really
are.
One of the toughest psychiatric anomalies both to diagnose and treat is delusion disorder
like delusion of grandeur, delusional paranoid, even delusional jealousy. The reason
why diagnosis can be tough is the person is often working quite typically in the world.
The delusions in this disorder are non bizarre, meaning that they can essentially be
plausible even if they are not true. Those suffering from this disorder often will not
believe they have a problem, so it is difficult to get them into treatment.
While paranoia is the most typical manifestation, there are more types of delusion disorder
including delusion of grandeur, delusional paranoid, even delusional jealousy as well as
for example, believing one is the secret love interest of a famous person, being convinced
one has striking abilities or is very significant, worrying about physical problems or
disfigurements that do not exist, or believing that one’s romantic partner is unfaithful.
Psychological fitness treatment is sometimes refused because of these convictions, which
are immune to any sort of disproof. The patient is certain they are correct.
Therapists who are ready to be used slightly different treatments, instead adopt the
more usual drugs or characteristic psychotherapy approaches. They may gain the
patient’s trust enough to begin exploring any doubts the person expresses about their
own ideology. The two of them can work in partnership, gradually discovering real
world explanations for those ideology. If the therapist treads conscientiously and uses
tactfully, then the patient and therapist together can work through the delusion disorder
like delusion of grandeur, delusional paranoid, even delusional jealousy and effect a
cure.

2.4.4 Motivated or Defensive Delusions

Some predisposed persons might suffer the onset of an ongoing delusional disorder
when coping with life and maintaining high self esteem becomes a significant challenge.
In order to preserve a positive view of oneself, a person views others as the cause of
personal difficulties that may occur. This can then become an ingrained pattern of thought.

31
Schizophrenia and Other
Psychotic Disorders 2.5 DELUSIONS AND OTHER DISORDERS
Even though the main characteristic of delusional disorder is a noticeable system of
delusional beliefs, delusions may occur in the course of a large number of other psychiatric
disorders.
Delusions are often observed in persons with other psychotic disorders such as
schizophrenia and schizoaffective disorder. In addition to occurring in the psychotic
disorders, delusions also may be evident as part of a response to physical, medical
conditions (such as brain injury or brain tumors), or reactions to ingestion of a drug.
Delusions also occur in the dementias, which are syndromes wherein psychiatric
symptoms and memory loss result from deterioration of brain tissue. Because delusions
can be shown as part of many illnesses, the diagnosis of delusional disorder is partially
conducted by process of elimination.
If the delusions are not accompanied by persistent, recurring hallucinations, then
schizophrenia and schizoaffective disorder are not appropriate diagnoses. If the delusions
are not accompanied by memory loss, then dementia is ruled out.
If there is no physical illness or injury or other active biological cause (such as drug
ingestion or drug withdrawal), then the delusions cannot be attributed to a general
medical problem or drug-related causes. If delusions are the most obvious and pervasive
symptom, without hallucinations, medical causation, drug influences or memory loss,
then delusional disorder is the most appropriate categorisation.
Because delusions occur in many different disorders, some clinician researchers have
argued that there is little usefulness in focusing on what diagnosis the person has been
given.
Those who ascribe to this view believe it is more important to focus on the symptom of
delusional thinking, and find ways to have an effect on delusions, whether they occur in
delusional disorder or schizophrenia or schizoaffective disorder.
The majority of psychotherapy techniques used in delusional disorder come from
symptom-focused (as opposed to diagnosis-focused) researcher-practitioners.
Self Assessment Questions
1) What is Delusional Disorder? Define and bring out its characteristic features.
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2) What are delusions of grandeur?
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 Paranoid and Delusional
3) Describe delusions of persecution and erotomania. Disorder

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4) What are motivated defensive delusions?
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5) Discuss delusions as part of other psychiatric disorders.
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2.6 TREATMENT APPROACHES TO PARANOIA

AND DELUSIONAL DISORDER
A cure of paranoia is very difficult and it is essential that treatment should be started
immediately the disease comes to be known. Once it grows on a person there is no
curing to it. The chief method of curing it is the following:

2.6.1 Treatment and Cure

A cure of paranoia is very difficult and it is essential that treatment should be started
immediately the disease comes to be known. Once it grows on a person there is no
curing to it. The chief method of curing it is the administering Injection of Insulin. Some
patients also responds to this treatment but this cannot be said of all.

2.6.2 Psychoanalytic Method

Compared to other mental diseases, this disease does not respond immediately to
psychoanalytic treatment because, being suspicious, the patient does not cooperate
with the doctor. Even then, with due precaution, certain results can be achieved by
employing this method.

2.6.3 Cognitive Behavioural Therapy (CBT)

CBT or other forms of psychotherapy may be helpful for certain people who have
paranoia. CBT attempts to make a person more aware of his or her actions and
motivations, and tries to help the individual learn to more accurately interpret cues
around him or her, in an effort to help the individual change dysfunctional behaviours.
Difficulty can enter into a therapeutic relationship with a paranoid individual, due to the
level of mistrust and suspicion that is likely to interfere with their ability to participate in
this form of treatment. 33
Schizophrenia and Other Support groups can be helpful for some paranoid individuals—particularly helpful in
Psychotic Disorders
assisting family members and friends who must learn to live with, and care for paranoid
individuals.

2.6.4 Drug Therapy

Treatment with appropriate antipsychotic drugs may help the paranoid patient overcome
some symptoms. Although the patient’s functioning may be improved, the paranoid
symptoms often remain intact. Some studies indicate that symptoms improve following
drug treatment, but the same results sometimes occur among patients who receive a
placebo, a “sugar pill” without active ingredients. This finding suggests that in some
cases the paranoia diminishes for psychological reasons rather than because of the
drug’s action.
Delusional disorder treatment often involves atypical (also called novel or newer-
generation ) antipsychotic medications, which can be effective in some patients.
Risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa) are all
examples of atypical or novel antipsychotic medications.
If agitation occurs, a number of different antipsychotics can be used to conclude the
outbreak of acute agitation. Agitation, a state of frantic activity experienced concurrently
with anger or exaggerated fearfulness, increases the risk that the client will endanger
self or others.
To decrease anxiety and slow behaviour in emergency situations where agitation is a
factor, an injection of haloperidol (Haldol) is often given usually in combination with
other medications (often lorazepam , also known as Ativan).
Agitation in delusional disorder is a typical response to severe or harsh confrontation
when dealing with the existence of the delusions. It can also be a result of blocking the
individual from performing inappropriate actions the client views as urgent in light of the
delusional reality.
A novel antipsychotic is generally given orally on a daily basis for ongoing treatment
meant for long-term effect on the symptoms.
Response to antipsychotics in delusional disorder seems to follow the “rule of thirds,” in
which about one-third of patients respond somewhat positively, one-third show little
change, and one-third worsen or are unable to comply.
Cognitive therapy has shown promise as an emerging treatment for delusions. The
cognitive therapist tries to capitalise on any doubt the individual has about the delusions;
then attempts to develop a joint effort with the sufferer to generate alternative
explanations, assisting the client in checking the evidence. This examination proceeds in
favour of the various explanations.
Much of the work is done by use of empathy, asking hypothetical questions in a form of
therapeutic Socratic dialogue—a process that follows a basic question and answer
format, figuring out what is known and unknown before reaching a logical conclusion.

2.6.5 Combining Pharmacotherapy with Cognitive Therapy

The integration of both the treatment may being out the possible underlying biological
problems and the symptoms can be reduced with psychotherapy.

2.6.6 Psychotherapy
This is the primary treatment for delusional disorder, including psychosocial treatment
which can help with the behavioural and psychological problems associated with
34
delusional disorder. Through therapy, patients also can learn to control their symptoms,
identify early warning signs of relapse, and develop a relapse prevention plan. Paranoid and Delusional
Disorder
Psychosocial therapies include the following:
Individual psychotherapy: Can help the person recognise and correct the underlying
thinking that has become distorted.
Cognitive behavioural therapy (CBT): Can help the person learn to recognise and
change thought patterns and behaviours that lead to troublesome feelings.
Family therapy: Can help families deal more effectively with a loved one who has
delusional disorder, enabling them to contribute to a better outcome for the person.

2.6.7 Prognosis of Paranoia and Delusional Disorder

Predicting the prognosis of an individual suffering from Paranoia is quite difficult. Paranoia
generally becomes a whole life or lifelong condition if there exists any underlying mental
disorder, such as schizophrenia or paranoid personality disorder. It certainly and
sometimes get better with some treatments or remission or with slight changes in
medication. People who have symptoms of paranoia as part of another medical condition
may also have a waxing and waning mental course.
Sometimes it is the case that paranoia is caused by the use of a particular drug or
medication. In this case, it is possible that discontinuing that substance may completely
reverse the symptoms of paranoia.
Paranoia can also occur as a symptom of other neurological diseases. Individuals suffering
from the aftereffects of strokes, brain injuries, various types of dementia (including
Alzheimer’s disease ), Huntington’s disease, and Parkinson’s disease may manifest
paranoia as part of their symptom complex. The paranoia may decrease in intensity
when the underlying disease is effectively treated, although since many of these diseases
are progressive, the paranoia may worsen over time along with the progression of the
disease’s other symptoms.

2.7 LET US SUM UP

We defined paranoia as a medical illness, which happens to affect the brain, and causes
changes in thinking and feeling. Those with the condition are hypersensitive, are easily
slighted, and habitually relate to the world by vigilant scanning of the environment for
clues or suggestions to validate their prejudicial ideas or biases.
Paranoid individuals are eager observers. They think they are in danger and look for
signs and threats of that danger, disregarding any facts. They tend to be guarded and
suspicious and have quite constricted emotional lives. Their incapacity for meaningful
emotional involvement and the general pattern of isolated withdrawal often lend a quality
of schizoid isolation to their life experience.
Even at the present time, a delusion need not be suspicious or fearful to be classified as
paranoid. A person might be diagnosed as a paranoid schizophrenic without delusions
of persecution, simply because their delusions refer mainly to themselves.
Their fear, and the threats they perceive in the innocent statements and actions of others,
often contributes to frequent complaining or unfriendly withdrawal or aloofness. They
can be confrontational, aggressive and disputatious. It is not unusual for them to sue
people they feel have wronged them. The main symptom of paranoia is permanent
delusion. It should be kept in mind that there is delusion in schizophrenia also but in that
case it is not permanent or organised. In paranoia the symptoms of delusion appear
gradually, and the patient is sentimental, suspicious, irritable, introverted, depressed, 35
Schizophrenia and Other obstinate, jealous, selfish, unsocial and bitter. Hence his social and family adjustment is
Psychotic Disorders
not desirable, and while he has the highest desirable, the effort that he is prepared to
expend is correspondingly little.
The “Diagnostic and Statistical Manual of Mental Disorders”, fourth edition (DSM-
IV), has listed the symptoms of paranoid personality disorder:
Then we deal with different kinds of paranoia such as the persecutory, religious,
reformatory, erotic, litigious etc. Then the causes of paranoia were delineated.
Delusions are often observed in persons with other psychotic disorders such as
schizophrenia and schizoaffective disorder. In addition to occurring in the psychotic
disorders, delusions also may be evident as part of a response to physical, medical
conditions (such as brain injury or brain tumors), or reactions to ingestion of a drug.
Delusions also occur in the dementias, which are syndromes wherein psychiatric
symptoms and memory loss result from deterioration of brain tissue. Because delusions
can be shown as part of many illnesses, the diagnosis of delusional disorder is partially
conducted by process of elimination.
The majority of psychotherapy techniques used in delusional disorder come from
symptom-focused (as opposed to diagnosis-focused) researcher-practitioners. A cure
of paranoia is very difficult and it is essential that treatment should be started immediately
the disease comes to be known. Once it grows on a person there is no curing to it. The
chief method of curing it is the following:
Compared to other mental diseases, this disease does not respond immediately to
psychoanalytic treatment because, being suspicious, the patient does not cooperate
with the doctor. Even then, with due precaution, certain results can be achieved by
employing this method.
CBT or other forms of psychotherapy may be helpful for certain people who have
paranoia. CBT attempts to make a person more aware of his or her actions and
motivations, and tries to help the individual learn to more accurately interpret cues
around him or her, in an effort to help the individual change dysfunctional behaviours.
Difficulty can enter into a therapeutic relationship with a paranoid individual, due to the
level of mistrust and suspicion that is likely to interfere with their ability to participate in
this form of treatment.
Delusional disorder treatment often involves atypical (also called novel or newer-
generation ) antipsychotic medications, which can be effective in some patients.
Risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa) are all
examples of atypical or novel antipsychotic medications.
Predicting the prognosis of an individual suffering from Paranoia is quite difficult. Paranoia
generally becomes a whole life or lifelong condition if there exists any underlying mental
disorder, such as schizophrenia or paranoid personality disorder. It certainly and
sometimes get better with some treatments or remission or with slight changes in
medication. People who have symptoms of paranoia as part of another medical condition
may also have a waxing and waning mental course.

2.8 UNIT END QUESTIONS

1) Define paranoia and delineate its characteristic features.
2) What are the symptoms of paranoi and what are its causes?
3) What are delusional disorders?
36 4) Describe in detail the delusional disorder of grandeur and persecution
5) What are motivated delusions? Paranoid and Delusional
Disorder
6) What are the various treatment methods available for paranoia and delusional
disorders? How effective they are?

2.9 SUGGESTED READINGS

Farrell, John (2006). Paranoia and Modernity: Cervantes to Rousseau. Cornell
University Press.
Freeman, D. & Garety, P. A. (2004). Paranoia: The Psychology of Persecutory
Delusions. Hove: Psychology Press.
Igmade (Stephan Trüby et al., eds.), 5 Codes: Architecture, Paranoia and Risk in
Times of Terror, Birkhäuser 2006.
Kantor, Martin (2004). Understanding Paranoia: A Guide for Professionals,
Families, and Sufferers. Westport: Praeger Press.
Mezzich JE, Honda Y, Kastrup MC, eds. Psychiatric Diagnosis: A World
Perspective. New York, NY: Springer Verlag; 1994.
Sims, A. (2002). Symptoms in the mind: An Introduction to Descriptive
Psychopathology (3rd edition). Edinburgh
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eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2004:
chap 134.
Satterfield JM, Feldman MD. Paranoid personality disorder. In: Ferri FF, ed. Ferri’s
Clinical Advisor 2008: Instant Diagnosis and Treatment. 1st ed. Philadelphia, Pa: Mosby
Elsevier; 2008.
Sims, A. (1995) Symptoms in the mind: An introduction to descriptive psychopathology.
Edinburgh: Elsevier Science Ltd.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental
Disorders, (4th ed., text revision). Washington, DC: American Psychiatric Association.
Valdimarsdottir U, Hultman CM, Harlow B, Cnattingius S, Sparen P. Psychotic illness
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Karagianis JL, Dawe IC, Thakur A, et al. Rapid tranquilization with olanzapine in acute
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Karno M, Jenkins JH. Cultural considerations in the diagnosis of schizophrenia and
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Lin KM. Cultural influences on the diagnosis of psychotic and organic disorders. In:
Mezzich JE, Kleinman A, Horacio F, Parron DL, eds. Culture and Psychiatric
Diagnosis: A DSM-IV Perspective. Washington  DC: American  Psychiatric
Press; 1996.
Mezzich JE, Lin KM. Acute and transient psychotic disorders and culture-bound
syndromes. In: Sadock BJ, Sadock VA, eds. Kaplan and Sadock’s Comprehensive
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