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PARANOIA

by demiguin


I. Introduction

          Mental disorders not only cause great suffering but are also often associated with the stigmatization of the people stricken with them.  People who suffer from mental disorders are excluded from our society.  They are deprived from leading normal life.  They are treated differently and are not given equal opportunities as other people.  Not only are these people suffering from their illness but also from the judgemental eyes of the people who are bringing them down.

          The mere presence of mental disorder should not lead to a presumption that someone is incapable of doing anything

          Until recent decades, little could be done to ameliorate the symptoms of many mental disorders.  This is probably because of the nature of psychological topics—they are highly debatable.  There would always be disputes about each aspect of a disorder, topic, etc.  However, in recent years, there had been several strikes of success.  And now, the medical community is looking forward with optimism concerning new approaches to these mental disorders.  As a result, biomedical and behavioral research involving people with mental disorder, is now a growing field of scientific endeavor.

          There are different kinds of mental disorders.  Some are of the mild side, which could still allow a person to function normally, and some are so severe, the person affected could not even think straight and make a decision for himself.

          Paranoia is one kind mental disorder.  It is an illness, not a self inflicted disease.

          The objective of this paper is to try and explain what Paranoia is.  A person cannot confidently say that he is safe from it.  It chooses no gender.  It could happen almost anyone.

II. Definition and Kinds of Paranoia

          The word “Paranoia” is often used in our daily conversations, sometimes out of frustration, we would call other people “paranoid” just because we see them as someone who is highly or easily suspicious of the things and events happening around them.  However, simple suspiciousness is not Paranoia—not if it is based on a previous experience or expectation learned through experience from others. 

Paranoia is a term used to describe suspiciousness or mistrust based on something unreal.  It could be based on false sensory perception, delusion or possibly hallucination.  The delusions in paranoia should be persistent, unalterable, systematized and logically reasoned.   This means that Paranoia involves delusions, which are the misinterpretation of reality-- the persons affected believe that whatever they saw or heard was real.  It is neither imaginary nor a dream.

The term “paranoia” was actually first used by a German psychiatrist Karl L. Kahlbaum in 1863.  This condition often happens to people suffering from Paranoid disorders or to people of old age..

          People suffering from Paranoia are usually suspicious of the motives of others, causing them to be hypersensitive, tense and argumentative.  They are easily jealous and angry.  These emotions, in most severe cases, could lead to violent confrontation.  The people affected also believe that there is a pattern to random events happening around them and that they are somewhat related to their life and existence.

          Paranoia can sometimes be mild, allowing the individuals affected to function normally in a society.  It could also be so severe that they become incapacitated, allowing them to be excluded from society and be deprived of the rights and obligations that a normal non-paranoid person has.         

          Paranoias could be classified into three main categories: Paranoid Personality Disorder, Delusional Disorder and Paranoid Schizophrenia.

II.A Paranoid Personality Disorder

The main hallmark of this disorder is the misinterpretation of other people’s motives.  A person with Paranoid Personality Disorder consider the actions of other people as debilitating and demeaning.  To further explain what PPD is, a sample story is presented below.  Take note of the person’s attitude toward certain situations.  Consider how he reacted and what he felt during these situations. 

“Derek worked in a large office as a computer programmer. When another programmer received a promotion, Derek felt that the supervisor "had it in for him" and would never recognize his worth. He was sure that his co-workers were subtly downgrading him. Often he watched as others took coffee breaks together and imagined they spent this time talking about him. If he saw a group of people laughing, he knew they were laughing at him. He spent so much time brooding about the mistreatment he received that his work suffered and his supervisor told him he must improve or receive a poor performance rating. This action reinforced all Derek's suspicions, and he looked for and found a position in another large company. After a few weeks on his new job, he began to feel that others in the office didn't like him, excluded him from all conversations, made fun of him behind his back, and eroded his position. Derek has changed jobs six times in the last seven years. Derek has paranoid personality disorder. “ (http://www.mentalhealth.com/book/p45-para.htm)      

The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV)- diagnostic standard for mental health professionals in the US, lists similar symptoms for PPD.

Paranoid Personality Disorder involves distrust in others, as indicated by the following:         

·        suspicious without sufficient proof or basis

The person believes that other people intend to deceive, exploit and harm him without sufficient evidence and reasoning.

·        full of doubts concerning other people’s loyalty and trustworthiness

The person would always doubt a friend or loved one’s loyalty, trustworthiness, and love for him.

·        afraid to confide in other people due to unwarranted fear

He is afraid to open up and become intimate with other people because he is afraid that whatever information he discloses to other people would be used against him.  They fear several things and events that normally have no ground or basis.

·        finds hidden demeaning, insulting and threatening meanings harmless remarks.

He would look at things differently.  He would find hidden meanings from other people’s words and actions.  He would sometimes see innocent remarks as insults or threats.

·        holds long grudges and unforgiving

He does not forgive easily.  If the individual is angered, he would most probably stay angry for a long time.

·        believes that other people are out to attack his character and reputation, easily angered and is quick in reacting with his anger

He believes that other people are going against him.  He thinks that other people are out to get him because they want to “bring him down”.  He also gets angry quite easily which sometimes lead to violent episodes.

·        believes without basis that his spouse is cheating on him

He thinks that his spouse is being dishonest eventhough he does not have any sufficient basis.

Aside from being argumentative and uncompromising, people with PPD cut themselves off other people thus causing them to be cold and aloof.  They pride themselves with their rationality and objectivity.  They are also hypersensitive because they are hyperalert of the things happening around them.

Because people with PPD are naturally suspicious, they try to avoid seeking medical help, making it hard for clinicians to treat them.

 II.B. Delusional Disorder

Delusional Disorder is more debilitating than Paranoid Personality Disorder (which is a milder subtype of Paranoia).  The main hallmark of this disorder is the prescence of non-bizaare delusions for at least a month without symptoms of other mental disorders like Alzheimers and Schizophrenia.           

To understand delusional disorder better, a story is given below.  It shows how a person with Delusional Disorder think and what are the thoughts going on his, in this case, her mind.

“Ruth is a clerk typist who is efficient and helpful. Her employers and co-workers value her contribution to the office. But Ruth spends her evenings writing letters to State and Federal officials. She feels that God has opened her mind and given her the cure for cancer. She wants some leading treatment center to use her cure on all its patients so that the world can see she is right. Many of her letters go unanswered, or she receives noncommittal replies that only make her feel that no one understands that she can save all cancer patients if only given the chance. When one of her letters is answered by an employee of the official to whom she wrote, she is sure that the official is being deliberately kept unaware of her knowledge and power. Sometimes she despairs that the world will ever know how wonderful she is, but she doesn't give up. She just keeps writing. Ruth suffers from one of the delusional disorders, grandiose delusion. “

(http://www.mentalhealth.com/book/p45-para.htm)

 Non-bizaare delusions are beliefs on something that could happen in a person’s life that is not out of the realm of possibility.  For example, a certain person thinks that his spouse is cheating on him, he thinks that a friend of his is going to die, his neighbour is actually a secret agent for the government.  These things could either be true or not, but the person suffering from this disorder believes in what his delusion tells him.

People with Delusional Disorder could still function normally.  They are not impaired and they could still do daily chores and activities.  For example, they could still go to work, go to school, go out of the house, etc.  Whatever is wrong with them could not be seen on their outside appearance.

Delusional Disorder should not be mistaken with Schizophrenia.  Schizophrenia is a severe disturbance in the brain’s functioning.  Although Schizophrenia and Delusional Disorder share some similar characteristics, they also differ in some.  One major factor is the type of delusion that is attributed to the disorder.  Schizophrenia involves bizaare delusions. These delusions are highly unlikely to happen.  In other words, the delusions are hard to believe in.  The chances of them happening are from slim to nil. 

This disorder usually happens to people between the age of 40 to 55, but it may also happen to people of younger age.  It affects 1% of the population and is not determined by a person’s gender.  It occurs equally in men and women. 

Some of the signs and symptoms of delusional disorder include:

  • the feeling of being taken advantage of by others
  • doubting the loyalty of friends and loved ones
  • finding hidden meaning into events
  • having trouble with social and marital relationship
  • feeling of being alone
  • being easily irritated

Delusional Disorders could be classified into six major themes:

II.B.1. Persecution

          Persecution in Delusional Disorder is more elaborate than that of Paranoid Personality Disorder.  In Paranoid Personality Disorder, the person affected would simply suspect others of mild jokes and pranks as in making fun of him.  In Delusional Disorder, the person actually believes that other people have sinister plans to poison, drug or kill him.  They would make heavy accusations against colleagues, friends and family that the said people are threatening them.  Peole suffering from Delusional Disorder sometimes engage in litigation in an attempt to redress imagined injustices.

II.B.2. Jealousy

          In delusional jealousy, a person believes that his spouse or partner is cheating on him, based on meaningless pieces of evidences. 

          A good example of this is when a man doubts his wife of cheating on him because she is late in coming home.  Even if the wife provides a valid explanation, the husband would still insist his theory.  Another example would be when a woman doubts his husband of cheating on her because she found a strand of hair (that didn’t belong to her or her husband) on his clothes.  There are other different reasons but they are mostly senseless like blot on shirt, smell of perfume, being well groomed, etc.

II.B.3 Erotic Delusion

          Erotic Delusion involves the belief that an individual is romantically loved by someone famous, oftenly an important public figure.  This could lead to the obsession of the individual to the important person.  It could also cause harrasment and stalking.

          An example of this is when a man with erotic delusion leaves lots of messages on a famous celebrity’s answering machine just because he thinks that the celebrity is in love with him.  Another possible example would be when a woman tells her friends that she knows that a famous politician or even co-worker is in-love with her.

II.B.4. Grandiose Delusion

          A person with grandiose delusion believes that he is jpgted with special powers that if given a chance to put into use, could perform extraordinary feats like ensuring world peace, banishing poverty, create cure for AIDS, etc.

          A good example of this is the previously given story.

II.B.5. Somatic Delusion

          An individual with somatic delusion is convinced that there is something wrong with his body.  He believes that he is extremely ugly or that he emits foul odors, have bugs crawling all over his body, etc.  Because of these, people with somatic delusion avoid other poele’s company and spend more time consulting physicians insisting that there is something very wrong with them.

II.B.6. Mixed Type

A person with this type of delusion suffers from one or more of the delusions listed above.

 II.C. Paranoid Schizophrenia

          Paranoid Schizophrenia is a type of schizophrenia that involves the feeling that one is being persecuted or plotted against.  Affected individuals may have delusions of grandeur connected to the protection of themselves from the perceived plot.

          The story below will provide a clearer picture of what a person suffering from Paranoia Schizophrenia goes though.

          “Steven had not liked high school very much and was glad to graduate and get a job. But when he realized he needed more education to reach his goals, he applied for admission into a nearby college. He rented a house with several other young men and did well in his studies. Near the end of his second year, Steven stopped eating with the others and ate only food directly out of a can so he could be sure it wasn't poisoned. When he crossed the campus, he tried to avoid girls as he felt they shot poisoned webs at him that encompassed his body like a giant spider web. When he began to feel that his housemates had put poisoned gas in his room, he dropped out of school and returned home. He cleaned up his room at home and put a lock on the door so his parents could not enter it and contaminate it. He bought a small electric hot plate and prepared all his own food. If his mother urged him to eat a meal with the family, he accused her of wanting to poison him. His parents finally were able to convince him to see a psychiatrist who diagnosed "schizophrenia, subtype paranoia." With medication, individual and group therapy, Steven has improved enough to work in an office under the supervision of an understanding and supportive employer.”

(http://www.mentalhealth.com/book/p45-para.htm)

Paranoid Schizophrenia is the most severe case of paranoia among the other two subtypes mentioned above.  It causes an individual to lose touch with reality.  They begin to hear, see, and feel things that do not really exist.  They could also become convinced of things that are not true.  They also have delusions that are usually of the specific theme.  The hallucinations involve mostly both the visual and auditory senses.  Some examples of the this is when the affected people think that they are hearing voices or that their thoughts are being broadcasted out loud.  In addition, their performance at home and at work is deteriorating.

          In other milder paranoid disorders, people only have mild delusions like that of persecution and jealousy.  They are still able to function normally in their society.  And although they are having delusions, they react to these delusions appropriately.  Unlike in Paranoid Schizophrenia wherein they have prominent hallucination that are often bizaare in nature.  Their thinking is often disorganized and are oftenly confused.

          As of now, there is still no cure.  Symptoms usually develop gradually, although onset could be sudden.  The symptoms could be seen in acute stages but these do not prevent the diagnosis of hallucinations.  Family members and friends are usually the first ones to notice the first changes before the victim does.  The first signs appear between the age of 15 to 34.

 Here are some possible signs and symptoms:

  • Confusion
  • Inability to make decisions for themselves
  • Hallucinations
  • Delusions
  • Nervousness
  • Noticeable changes in eating, sleeping and other habits
  • Strange behaviour
  • Staying away from friends, work and school
  • Negligence of personal hygiene
  • Unexplained and often sudden bursts of anger
  • Indiffernce to the comments of other people
  • Tendency to argue
  • Belief that he is better than other people or that other people are out to get him

 III. Possible Causes

            The exact cause of Paranoia is unknown.  Some possible factors are genetics, neurogical abnormalities, changes in brain chemistry, concusion, old age and stress.  It could also be caused by a side effect of drug abuse (i.e. marijuana, amphetamines, alcohol, cocaine, PCP).  Short termed Paranoia may also happen to some individuals who undergo great amount of stress.

Genetic Contribution

Little research has been done and it is still unclear if paranoia can be inherited.  Scientists found out that families of paranoid patients do not have abnormal rates of either schizophrenia or depression.  However, there is some evidence that symptoms in schizophrenia could be genetically influenced.  Recent research also shows that paranoid disorders are more common to relatives of people with schizophrenia.  It is also said that if a twin has paranoia, the other pair is most likely to have paranoid disorder too.

Biochemistry

          Paranoia has not yet been directly examined except as a subtype of schizophrenia.  The causes of schizophrenia are still being debated.  It is also said that the abuse of drugs such as amphetmines, cocaine, marijuana, PCP, LSD, and other stimulants could lead to symptoms of paranoid thinking or behaviour.  The situation of people with severe mental disorder could get worse by taking these drugs.

Stress

          Some scientists would like to believe that paranoia is caused by high level stress.  In support to this, people undergoing large amount of stress (i.e. prisoners of war, businessmen, immigrants, etc.) are more prone to paranoia.  Considering this information, other factors could not be ruled out.  Genetic defect, brain abnormality, an information-processing disability or all these could predispose a person to paranoia and that stress merely acted as a trigger.

IV. Possible Treatment

The treatment for people suffering from Paranoid Personality Disorder and Delusional Disorder are similar.  However, because of the complexity and the amount of damage it inflicts, treatment in Paranoid Schizophrenia is different.

IV.A. Paranoid Personality Disorder and Delusional Disorder

Because of a patient’s mistrustfulness and suspiciousness, it is hard to treat a person with Paranoid Disorder.  Rarely will they talk casually in an interview.  They are suspicious of the kind of questions a therapist may ask.  They would also try to avoid taking drugs and hospitalization because they are afraid that they may lose control in other dangers. 

IV.A.1. Drug Treatment

          A patient’s condition may be improved by treating him with appropriate antipsychotic drugs like thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), or risperidone (Risperidal).  However, the paranoid symptoms still remain intact.  Some studies show that the symptoms improve right after the drug treatment, but the same results could be seen on patients who received a placebo.  A placebo is a “sugar pill” without active ingredients.  A patient’s medication should be closely monitored because their suspiciousness could cause them to refuse treatment. (i.e. hiding the medicine in their cheek and spit it out when nobody is looking.)

IV.A.2.Psychotherapy

          Some reports state that the oppurtunity to express one’s feelings (i.e. suspicion, self-doubts) afforded by psychotherapy, can help the patient to function in a community.  Although paranoid ideas still exist, they seem to be less disruptive.  They could function normally but the delusions are still there.

IV.B. Paranoid Schizophrenia

An acute attack may recquire full time hospitalization in a locked inpatient unit.  When the symptoms subside, the person may be transferred to a partial care program in which they could return home after each day’s therapy.  Although inpatients are allowed to wear their own clothes, they would still be searched for sharp objects.  Patients who present danger outside the hospital may be involuntarily hospitalized.  While spending time there, patients may encounter the one or more of the following:

IV.B.1 Group Therapy

It is ran by a medical staff wherein patients share their ideas.  It is more like a support group session.

IV.B.2. Individual Therapy    

          Patients talk to the therapist alone.  They discuss their ways of dealing with their disease.

IV.B.3. Family Meetings

          In these sessions, medical staff will prepare you and your family for your return home.

IV.B.4. Time Out

          If you seem dangerous, medical staff may separate you from other patients and put you in a “safety room”

IV.B.5. Restraints

          Those who pose danger to other people and himself will be tied up with leather bands.

IV.B.6. Electroconvulsive Therapy

          This is also known as ECT or Shock Therapy.  It applies mild electric current.  The memory is temporarily disrupted but it usually comes back in 2 weeks.  This is done to patients who become very depressed.  This helps in speed recovery.

IV.C. Risks

          If a patient fails to get medication, he may not function in the real world.  And when he falls into hallucination and delusion, he may endager himself and the people around him.

V. Conclusion

          Paranoia is now known as a disorder, not just a word we call out to people we consider crazy.  It is not a colloquial term we use that is inline with “geeks” and “nerds”.  It is an illness that nobody wanted or chose to have.  People who have these disorders should not be laughed at.  They are already undergoing tremendous amount of pain and confusion. They do not need us teasing them because they are already deprived of the chance to live normally.  Most narrow-minded people shove them away from their lives and consider them as weirdos.

Eventhough this is the case for some people, it is good to know that man and science are working together to determine the root and possibly the ultimate cure for these illnesses.  A day would come when medical science will finally find the root and treatment for these disorders.

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“Treatment- resistant schizophrenia tackled”, Manila Bulletin, Vol.290 # 17, F 11 ‘97

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