The other day I was driving home. When I neared my house I noticed a large woman in pajamas, a robe, messy hair, glasses, and house slippers. I wondered who she was. She was standing on the side of the street looking through the lens of a camcorder, presumably filming something in the sky, she looked very odd. Then I realized that it was my neighbor! Rarely do I see her. In fact, I didn’t even recognize her because she had gained so much weight.
Since day one, she has rubbed me the wrong way. First of all, she has three yappy little dogs. I like dogs, but I don’t like her, so by extension I get annoyed by her dogs. But we live in the city; therefore I don’t have the right to complain. Honestly by now I am used to the little guys. Secondly, a year and a half ago she accused my oldest son of peeking through the slats of our shared fence, which irritated her dogs and made them go crazy. My oldest son was 10 at the time and the thought would have never crossed his mind to “spy” on her in her own back yard. He has better things to do, like beat up his little sister. She shared with me that she thought my son didn’t like her. In truth, my son couldn’t care less one way or another about her. A third accusation was that my children were throwing peanuts over the fence which her dogs would then eat and subsequently get sick. Also false. In actuality the resident squirles find them in another neighbor’s yard and transfer them to her yard.
Anyway, once I got out of my car I approached her to ask her what in the world she was doing. “I’m filming the angels in the sky. There are numbers, too. I’ve only got four minutes left.” Okay. I thought I was crazy. She went on to ask me if I had seen the black helicopters.
Once I got inside my house I looked up “black helicopters” because I had no idea what she was talking about. I confirmed that she really is crazy; something that I had suspected for a couple of years. Seeing her so completely removed from reality made me realize that I am more “normal” (whatever that means) than I sometimes give myself credit.
The following is from http://www.hoptechno.com/paranoia.htm and seems to come close to discribing her.
DELUSIONAL (PARANOID) DISORDER
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.
The most common delusion in delusional disorder is that of persecution. While persons with paranoid personality might suspect their colleagues of joking at their expense, persons with delusional disorder may suspect others of participating in elaborate master plots to persecute them. They believe that they are being poisoned, drugged, spied upon, or are the targets of conspiracies to ruin their reputations or even to kill them. They sometimes engage in litigation in an attempt to redress imagined injustices.
Another theme seen frequently is that of delusional jealousy. Any sign–even a meaningless spot on clothing, or a short delay in arriving home–is summoned up as evidence that a spouse is being unfaithful.
Erotic delusions are based on the belief that one is romantically loved by another, usually someone of higher status or a well-known public figure. Individuals with erotic delusions often harass famous persons through numerous letters, telephone calls, visits, and stealthy surveillance.
Persons with grandiose delusions often feel that they have been endowed with special powers and that, if allowed to exercise these powers, they could cure diseases, banish poverty, ensure world peace,or perform other extraordinary feats.
Individuals with somatic delusions are convinced that there is something very wrong with their bodies–that they emit foul odors, have bugs crawling in or on their bodies, or are misshapen and ugly. Because of these delusions, they tend to avoid the society of other people and spend much time consulting physicians for their imagined condition.
Whether or not persons with delusional disorder are dangerous to others has not been 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.
CAUSES OF PARANOIA
Genetic Contribution
Little research has been done on the role of heredity in causing paranoia. Scientists have found that the families of paranoid patients do not have higher than normal rates of either schizophrenia or depression. However, there is some evidence that paranoid symptoms in schizophrenia may be genetically influenced. Some studies have shown that when one twin of a pair of identical twins with schizophrenia has paranoid symptoms, the other twin usually does also. And, recent research has suggested that paranoid disorders are significantly more common in relatives of persons with schizophrenia than in the general population. Whether paranoid disorder–or a predisposition to it–is inherited is not yet known.
Biochemistry
The discovery that psychosis (a state in which the individual is out of touch with reality) is treatable with antipsychotic drugs has led scientists to look for the origins of severe mental disorders in abnormal brain chemistry. The search has become very complex, as more and more of the chemical substances that carry messages from one nerve cell to another–the neurotransmitters–have been discovered. So far, no clear-cut answers have been found. As with the genetic studies, biochemical studies have not examined paranoia except as a subtype of schizophrenia. There is, however, limited evidence that paranoid schizophrenia is biochemically distinct from nonparanoid forms of the disorder.
Abuse of drugs such as amphetamines, cocaine, marijuana, PCP, LSD, or other stimulants or “psychedelic” compounds may lead to symptoms of paranoid thinking or behavior. Patients with major mental disorders like paranoid schizophrenia may have their symptoms become worse under the influence of these drugs. Scientists are studying the biochemical actions of such drugs to determine how they produce their behavioral effects. This may help us to learn more about the neurochemistry of paranoid disorders, which is poorly understood at this time.
Stress
Some scientists believe paranoia may be a reaction to high levels of life stress. Lending support to this opinion is the evidence that paranoia is more prevalent among immigrants, prisoners of war, and others undergoing severe stress. Sometimes, when thrust into a new and highly stressful situation, people suffer an acute form–called “acute paranoia”–in which delusions develop over a short period of time and last only a few months.
Some studies indicate that paranoia has become more prevalent in the twentieth century. The connection between stress and paranoia does not, of course, rule out other contributing factors. A genetic defect, a brain abnormality, an information-processing disability–or all three–could predispose a person to paranoia; stress may merely act as a trigger.
TREATMENT OF PARANOIA
Paranoid people’s mistrustfulness makes treatment of the condition difficult. Rarely will they talk casually in an interview. They are suspicious of the kind of open-ended questions many therapists rely on to learn about the patient’s history (for example, “Tell me about your relationships with your co-workers.”). They may try to avoid hospitalization and drugs, fearing a loss of control or other real or imagined dangers.
Drug Treatment
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. Paranoid patients receiving medication must be closely monitored. Their fearfulness and persecutory delusions often lead them to refuse or sabotage treatment–for example, by holding the drug in their cheek until they are alone and then spitting it out.
Psychotherapy
Reports on individual cases suggest that the regular opportunity to express suspicions and self-doubts afforded by psychotherapy can help the paranoid patient function in the community. Although paranoid ideas do seem to persist, they may be less disruptive. Other types of psychotherapy that have reportedly led to improved social functioning without appreciably diminishing paranoid delusions are art therapy, family therapy, and group therapy.
OUTLOOK FOR PARANOID PATIENTS
In spite of the treatment difficulties, patients with a paranoid disorder may function quite well. Even though their paranoid views are apparently unshakable, various treatments appear effective in improving social functioning, so that they do not often require lengthy hospitalization. The symptoms are less bizarre than those associated with paranoid schizophrenia. Also, the paranoid disorders seem to cause less disorganization of the personality and disruptions in social and family life. Unlike schizophrenia, which can become progressively worse, paranoid disorder seems to reach a certain level of severity and stay there.
FOR FURTHER INFORMATION
This booklet was produced by the National Institute of Mental Health (NIMH), the U.S. Government agency that supports and conducts research to improve the diagnosis, treatment, and prevention of mental illness. NIMH-supported studies alleviate suffering and bring hope to people who have a mental disorder, to those who are at risk of developing one, and to their families, friends and coworkers. Thus mental health research benefits millions of Americans and reduces the burden that mental disorders impose on society as a whole. NIMH is part of the National Institutes of Health, a component of the U.S. Department of Health and Human Services.
All material appearing in this volume is in the public domain and may be reproduced or copied without permission from the Institute. Citation of the source is appreciated.
Acknowledgments
This brochure was revised by Margaret Strock, staff member in the Office of Scientific Information, National Institute of Mental Health (NIMH). An earlier version was done under contract for NIMH by Wray Herbert. Expert assistance was provided by David Shore, M.D., David Pickar, M.D., and Darryl G. Kirch, M.D., NIMH staff members. Their help in assuring the accuracy of this pamphlet is gratefully acknowledged.
