Delusional Disorder (Paranoia) pp. 496-501
Delusional disorder is more commonly recognized by its name of long time use, paranoia. The definition used in the book for this disorder is impaired contact with reality but without the bizarreness, fragmentation, and severe personality disorganization characteristic of schizophrenia. We look at the two different categories related to paranoia, delusional disorder, and shared psychotic disorder. As stated above, delusional disorder is defined as paranoia, and shared psychotic disorder is when two or more people usually of the same family develop persistent, interlocking delusional ideas.
Delusional disorder is difficult for clinicians to diagnose because of term is not exact in it’s meaning and leaves a lot of room for interpretation. The term paranoia is felt to be too readily used in cases where it is simply a disagreement on an issue, not a delusional thought or perception. The book uses the example of Hitler and the Nazi movement against Jews, a lot of people do not believe that it ever happened, but facts show otherwise and the thought is held sincerely by many people, regardless of the evidence. In everyday thought, people may experience paranoia, but to be psychotic and diagnosed as such, it must specified in categories meriting the term “delusional”. These categories are as follows: Persecutory type, Jealous type, Erotomanic type, Somatic type, Grandiose type, and Mixed. The person falling into the category labeled persecutory have delusions that they themselves or someone they are close to is being stalked, being spied on, or the subject of false rumors regarding immoral behavior or illegal action. The jealous type is pretty self explanatory, one believes that their significant other is unfaithful. Those with the type erotomanic feel that someone of higher social status, such as a movie star, loves them and wants a sexual relationship with them. Somatic type includes people that believe they are plagued with a disease that is absurd or unreal. Grandiose type patients have the delusion that they have more power, talent and ability than is actually true, or they have a relationship with someone who does, such as a political leader or movie star. The last of these types is the mixed type, a mixture of the above types or the absence of a predominant type. The diagnosis of delusional disorder is considered rare among clinical institutions and hospitals, but is not an accurate example of how often it actually occurs. Many people with delusional disorder can function normally in society and carry on with their lives unless they become seriously inflicted with delusional behavior. The decision that someone may be in need of psychological treatment for this disorder is a difficult one to decide because of the gray area separating those that have a few thoughts along the delusional line and those that have a serious problem with it.
People suffering with delusional disorder often find themselves being the object of persecution in their disorder and this thought may progress into bigger thoughts down the road. As stated before, the person suffering from this may appear normal in conversation and the workplace and their ideas may be constructed in such a structured way the person listening to them may be convinced that the delusion is a real event. An example of this type of charismatic leadership of the delusional person is capable of is the religious cults that develop with followers that are so convinced, they consider mass suicide a good idea when presented by their delusional leader. Factors found that contribute to delusional disorder are a cognitive disorganization similar to those with schizophrenia but on a smaller scale, an absence of a history of normal playtime with other children, and a scrutinization of every event that occurs in their life that is not in their favor. This last one is called “paranoid social cognition.” The idea of this factor is that a person feels that they are being singled out and all others are against them in whatever they do. It is, in a sense, a defense mechanism against realizing that they have the problem and pushing that problem onto the way others treat them. The person who lives in this paranoid world is said to have built up a “pseudo-community” in which people have a job to cause harm to them or interfere with their well-intended actions.
The treatment for someone diagnosed with delusional disorder is still in the process of being established in a way that is truly helpful. The world the delusional person has created for themselves is so well constructed that it is hard to break it down and perform therapy. When approached about their problems, they usually think the person is against them and trying to harm them by saying things about them. The refusal to admit that they have a problem as stated above is the factor that blocks the ability of the therapist to conduct treatment and even offer medication. They view it as a way of someone trying to persecute them and say things about them that are unjust or harmful. In hospitalization, the delusional person will often seem to come out of their delusional world long enough to leave the care of the clinicians and doctors, but is usually only role-playing in realizing that they will be trapped if they do not act “normally”. The therapy and treatment for the person suffering with delusional disorder is still being studied to have the effectiveness that is desired.