Paranoia: unmistakable signs, managing a crisis

What is the definition of paranoia?

The term paranoia covers two entities: paranoid psychosis and the paranoid personality. There paranoid psychosis is a chronic mental illness from the psychoses group. Paranoia, from the Greek “para”, alongside and “nous”, the mind, is defined as a chronic delusion, organized, structured, logical in its developmentcomprising a feeling of persecution to which the patient adheres completely, but does not alter his intellectual abilities. “The paranoid is not accessible to reasoning and is convinced of the truth of his interpretationsexplains Doctor Guillaume Fond, psychiatrist. The paranoid individual believes that there is a threat looming over him and interprets numerous signs as proof.“. This psychosis generally occurs in paranoid personalities, in middle-aged male subjects (between 40 and 60 years old). Men are twice as likely to be affected by this type of disorder.

What are the signs of a paranoid person?

► A delirium of demands: as its name indicates, it relates to a firmly anchored belief in the patient according to which he is “the herald” of an unknown cause that only he was able to understand. The desire to “bring the truth to light” or even to punish the guilty is often associated with these delusions.

► A delirium of interpretation: the patient relies on tangible arguments and his own interpretations of reality to arrive at ideas of persecution, harm and one’s own victimization. This is the conspiracy theory: everything is directed against him. This type of delusion is called “network” because it gradually extends to the entire psychic life and concerns all areas of the subject’s life. The chance is considered intentional and malicious by the patient.

What is a paranoid personality?

On the other hand, some individuals have a paranoid personality, character trait to differentiate from paranoia because there are no delusions among these people. “The DSM-IV (classification tool published by the American Psychiatric Association to define mental disorders) defines a paranoid personality as a “state of pervasive suspicious distrust of others whose intentions are interpreted maliciouslycontinues the specialist. Paranoid personalities are characterized by pathological overestimation of themselves, excessive susceptibility associated with extreme distrust of others, distorted judgment, lack of self-criticism and a certain authoritarianism“. This personality develops from the end of adolescence and can remain flexible, not affecting the person’s functioning. Some business leaders or political representatives have paranoid personalities that allowed them to achieve their positions.

What causes paranoia?

As with most psychiatric conditions, there is no single cause of paranoia. “Paranoid psychosis comes froma disruption of dopamine in the brain and is treated with antipsychotics. The precise triggering factors are unknown to date. Taking certain psychoactive substances can promote the emergence of a transient paranoid episode”adds our interlocutor.

The paranoid personality comes from both of a temperament (an innate predisposition, coming from the genetic background and the development of the brain) and from a pattern acquired during childhood (through education and early experiences). A schema is a more or less rigid vision of the world which will bias the interpretation of reality. In the case of the paranoid personality, this pattern will be a pattern of distrust such as: “any stranger is a potential enemy, you can only count on yourself or, people are hiding things from me”

What are the potential complications ?

A person suffering from a paranoid personality can live normally without these disorders turning into paranoid delusions. The main risk for people of this type is therefore to fall in a real paranoid psychosis. Once paranoia is well established, the patient’s psychosis can lead him to adopt behaviors that are dangerous for himself (suicidal ideation) and/or for others (aggression, going as far as murdering the persecutor). These risks are real and certain signs should alert you to the psychiatric danger of the subject:

• Existence of a specific persecutor.
• Delirium of long standing and evolving over time.
• Mood disorders.
• Alcoholism.

“The paranoid personality can adapt to reality but can also become rigid and cause problems in interpersonal relationships (with colleagues, spouse, etc.). This is an indication for psychotherapy, only if the person is aware of the disorder and wishes to improve it. Psychotherapy can never be carried out against the patient’s will.“, insists the psychiatrist.

There are several types of paranoid delusions. On the other hand, a paranoid personality should not be confused with a paranoid psychosis. The diagnosis must be made by a psychiatrist. The psychiatrist must in fact differentiate paranoia from numerous psychiatric conditions where delusions of the same style can be observed, notably schizophrenia and bipolar disorders. Finally, the arguments used by the patient, whatever the stage of evolution of the illness, can often seem valid and relevant, which means that the paranoid can sometimes succeed in convincing people of the “truth” of these remarks.

Treatment can begin from the moment the patient agrees to seek treatment. However, for this to happen, he must be able to recognize the existence of his disorders, which seems incompatible with the nature of this condition. Thus, the patient feels the fact of seeking treatment as an attack, if he does not see it as a plot aimed at harming him. In cases of depression or risk of homicide, particularly when there is a designated persecutor, hospitalization, forced or not, may be necessary. This can go as far as forced hospitalization in psychiatry. Antipsychotics are the reference treatment for paranoid psychosis and psychotherapy the reference treatment for paranoid personality.

What to do in the event of a paranoia attack?

An acute psychotic episode of paranoia is an indication for forced hospitalization who must go through the SAMU or even the police in the event of danger. “The patient is evaluated by a psychiatrist in psychiatric emergencies most often, who orders immediate hospitalization to protect the patient and those around him”concludes the doctor.

Thanks to Dr Guillaume Fond, psychiatrist at the Assistance Publique des Hôpitaux de Marseille and teacher-researcher at the Aix-Marseille University faculty, speaker and author of the works “Become the best version of yourself in 3 steps” (Ellipses)” I am making my Life a Great Project” (Flammarion) and “Journey to the heart of suffering: the combined perspectives of a psychiatrist and a lawyer on burn-out and professional harassment” (JC Lattès).