Paranoid Delusions

paranoidPsychotic symptoms, such as delusions, hallucinations, paranoia, and thought disorder, are attributed to abnormalities in brain structure and function.[1] The classic chemical imbalance is thought to be a consequence of incorrectly wired neural circuits and faulty receptor activity.1 This is seen as an essential component in the distortions of thinking, feeling, and behavior that vary enough from the norm to merit the designation “psychotic.”1

The following story is about a women who behavior would be considered paranoid and delusional by any standard:1

Ninety-five year-old Karen lives alone in a ranch-style house, located in a rural suburb.1 She prefers spending time alone, and encourages occasional, short visits from her family.1 She has no friends, nor does she want any.1 She keeps up with the outside world by watching the news on cable television.1 Her sense of the world is largely intact. In 1986, Karen’s husband died suddenly of heart failure.1 She has never shown any signs of mourning, instead seeming rejuvenated by her husband’s death.1 She has made it clear that she is not afraid to die, and takes very good care of herself.1

Karen’s health is mostly good, especially for her age.1 She takes 81mg of aspirin every other day and receives monthly injections of vitamin B12 and folic acid.1 She has had occasional chest pains since her mid-80s, which her doctor attributed to angina.1 She was then found to have atrial fibrillation.1

Karen has a son and a daughter, both in their 60s.1 The daughter and her grown children live nearby, and her son lives in a distant city.1 Karen’s daughter does her grocery shopping and drives her to doctors’ appointments.1

Cognitively, Karen is intact—except for one thing.1 She claims that her grandchildren come in the middle of the night or when she is away to steal her possessions.1 Karen believes her daughter knows and approves of this. The “stolen” items include sheets, towels, pots and pans, milk, and orange juice.1 Karen also believes her sterling silver and antiques have been sold and replaced by cheaper items so that her grandchildren can pocket the difference.1 She also believes her phone is being tapped by her grandchildren, who listen in on her phone calls to see when she is going to sell her house so they can receive their inheritance.1

Karen has been making these accusations for a number of years.1 She has become extremely hostile toward her family, as she feels their success and happiness threaten her.1 Karen clearly meets the criteria for delusional disorder, persecutory type.1 Although she often has direct outbursts of anger towards her family members, she has never shown any indication of depression or low mood.1 She has also never been manic or hypomanic.1 Mental disorders do not run in her blood relatives.1

Some clinicians believe that we are free to create and re-create ourselves and to construct our own world, as circumstances allow.1 Therefore, it seems reasonable to ask whether a willed distortion and deformation of a person’s world could itself be significant enough to produce psychotic thinking, feeling, and behavior.1 Those who create a paranoid psychosis can be seen as making the kind of uncalled-for connections and inevitable enemies that those who live in the validated world choose not to make.1

John Perry, M.D. understands paranoia as a weakening of the ego’s rational controls, where the energy escapes from the ego and goes into the subconscious, becoming the person’s whole world.1 As Karen’s accusations are nightmarish, they are not controlled by reason but by the primitive processes set loose by what appears to be hatred of her family.1 The more her family does for her, the more she accuses them.1 Her delusional beliefs absorb their disbelief of her taunts and neutralize it.1

Karen’s paranoia has always peaked at times when things were going well for her family.1 If it was good for them, it was bad for her.1 After a get-together of family at her home, Karen ended up in the emergency room with chest pain, shortness of breath, light-headedness, and tachycardia, which came on suddenly at the height of the celebration.1 Her body responded to the anxiety of a perceived threat from her happy family, with somatic symptoms of a panic attack.1 After that, Karen did not have any more get-togethers or panic attacks.1 She cracks psychically under stress of family and social pressures, breaking from reality to protect herself.1

Unfortunately, there are no published reports to substantiate treatments for patients with persecutory delusions.1 Karen would be placed on antipsychotic medicine that may not work.1 Also, due to her delusions, she would not seek help.1

[1] Muller, R. (2006, December 1). Willing Paranoid Delusions. Psychiatric Times. Retrieved November 25, 2013, from http://www.psychiatrictimes.com/paranoid-personality-disorder/willing-paranoid-delusions/page/0/1

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