OVERVIEW

What is Paranoia?

"Paranoia" primarily describes a mental disorder characterized by delusions as its main feature. These delusions are not caused by any other disorder, often persist, and typically involve plausible real-life scenarios rather than bizarre content. In modern psychiatric classification systems, this disorder has been updated to "delusional disorder" or "paranoid psychosis," with the term "paranoia" no longer in use.

Individuals with delusional disorder may face exclusion or even discrimination in daily social interactions. In reality, they greatly need understanding and support. If possible, please try to reduce prejudice against them and offer them more tolerance and care.

SYMPTOMS

What are the symptoms and characteristics of delusional disorder?

The most prominent symptom of delusional disorder is delusions and related behaviors driven by delusional thinking. It typically develops insidiously in middle or late adulthood, with a slightly higher prevalence in women than in men. The content of these delusions is often fixed, systematic, and logically coherent, commonly manifesting as:

• Suspicion of being followed or poisoned (may lead to self-defense or aggressive behaviors);
• Suspicion of a spouse or partner's infidelity (may involve stalking, surveillance, or even violent attacks on the partner);
• Firm belief in being loved by someone (may lead to stalking the perceived admirer) or conviction of having a certain illness (may result in repeated medical consultations).

In these situations, about one-third of patients may exhibit significant anxiety or depressive symptoms.

The content of the delusions may be plausible in reality, with internally logical and even rigorous connections. Patients often lack insight, firmly believing in their delusions, and in most cases, do not experience hallucinations.

What are the impacts and consequences of delusional disorder?

Apart from the delusions themselves and aspects directly related to their content, patients can often function normally in other areas. Social functions unrelated to the delusional content generally remain intact.

CAUSES

What are the causes of delusional disorder?

The etiology of delusional disorder remains unclear and poorly understood, but it can be explained and interpreted from two aspects: pre-morbid personality traits and social isolation.

• Paranoid personality traits are more likely to develop into delusional disorder. Characteristics of paranoid personality typically include: extreme sensitivity to obstacles and setbacks; suspiciousness; a tendency to misinterpret others' actions as hostile, contemptuous, or malicious; and a combative, fiercely defensive attitude toward personal rights.
• Social isolation may be another risk factor for delusional disorder. Studies suggest that a higher proportion of patients with delusional disorder experience social isolation, such as refugees/immigrants or prisoners in solitary confinement. Deafness/hearing impairment, which objectively leads to social isolation, may also be a contributing risk factor.
• Additionally, cases dominated by delusions of jealousy (suspicion of a spouse's infidelity) may be associated with alcohol abuse.

DIAGNOSIS

Where should delusional disorder be treated?

Delusional disorder falls under the category of mental disorders and should be diagnosed and treated in the psychiatric or psychological department. In most cases, patients themselves do not believe they require psychiatric assistance. In some situations, measures against the patient's personal wishes may be necessary to facilitate prompt treatment.

What are the diagnostic criteria for delusional disorder?

Taking DSM-IV as an example, the diagnosis of delusional disorder requires meeting the following criteria:

• Non-bizarre delusions persisting for at least 1 month. Examples include suspicions of being followed, poisoned, infected, loved by someone, doubts about a spouse/partner's infidelity, or beliefs of having a certain illness.
• Failing to meet the diagnostic criteria for schizophrenia. In some cases, hallucinations consistent with the delusional content may occur, such as smelling peculiar odors in food when suspecting poisoning.
• Apart from the delusions and related issues causing significant negative effects, other social functions unrelated to the delusional content remain relatively intact, with no noticeably bizarre or peculiar behavior. For instance, in cases of delusional jealousy, marital or family relationships may deteriorate severely, possibly involving stalking, surveillance, or even physical violence against a spouse. However, interactions with others, such as colleagues or friends, remain normal.
• The condition must not be attributable to substances, medications, or underlying medical conditions.

Are patients with delusional disorder at risk of violent behavior?

• On one hand, patients with delusional disorder often lack insight and do not believe they need psychiatric help. They may even perceive psychiatric treatment as harmful, leading to resistance or refusal to engage with psychiatrists. Gaining their cooperation and trust often requires sufficient time and skilled interviewing techniques.
• On the other hand, potential risks associated with delusional disorder should be taken seriously. For example, individuals with persecutory delusions may attempt to harm those they perceive as persecutors, while those with delusional jealousy may resort to violence against their spouse or the perceived "third party." Any hints or threats of harming others, as well as suicidal tendencies, should be treated with caution and seriousness.
• When assessing risks, it is essential to consult relevant informants comprehensively and gather as much information as possible about the patient's past behavioral patterns.

TREATMENT

Can Delusional Disorder Be Cured?

The treatment and management of delusional disorder often face significant resistance. The main reasons are: patients are sensitive and suspicious, lack insight, may believe psychiatric treatment is intended to harm them, or firmly insist their delusions are not pathological and require no treatment. Therefore, treatment may need to address other distressing symptoms unrelated to delusions, such as anxiety, depression, tension, sleep disturbances, etc. Establishing a good therapeutic relationship is particularly crucial.

Does Delusional Disorder Require Hospitalization?

If there is a risk of severe violent harm to others or suicide, hospitalization becomes necessary and must be handled carefully. If the patient refuses voluntary hospitalization, involuntary or compulsory hospitalization must be considered.

What Are the Treatment Methods for Delusional Disorder?

A combined approach of medication and psychotherapy may maximize treatment benefits.

• For medication, atypical antipsychotics are primarily used, such as risperidone, clozapine, olanzapine, amisulpride, etc. If depressive symptoms are prominent, SSRIs like fluoxetine, sertraline, or paroxetine may be added.
• For psychotherapy, patients often need support, validation, encouragement, and reassurance. Supportive psychotherapy and cognitive therapy may be particularly important and effective, while interpretive psychotherapy or group therapy should be avoided.

How Is Delusional Disorder Considered Cured?

A reduction in delusional thinking and impulsive behaviors indicates improvement. However, there is limited long-term outcome data for delusional disorder. Clinical observations suggest a generally poor long-term prognosis, and the risks and benefits of prolonged treatment should be discussed and negotiated with the patient.

DIET & LIFESTYLE

What should family members of individuals with delusional disorder pay attention to when interacting with the patient?

The most prominent issue in delusional disorder is delusional thinking and related behaviors, often accompanied by a lack of insight and difficulty in voluntarily cooperating with treatment. For family members, it is important to avoid arguing or debating with the patient about their delusional themes or attempting to persuade them. Such strategies may further alienate the patient, worsen the relationship, and even lead to conflicts or impulsive violent behaviors.

It is worth noting that while not endorsing the delusions or suspicions, family members should try to acknowledge the patient's other distressing experiences, such as insomnia, anxiety, depression, or physical discomfort. By showing understanding and empathy on non-delusional topics, a trusting relationship can be built, starting from these distressing experiences. Gradually guide the patient toward psychiatric treatment.

PREVENTION

How to Prevent Delusional Disorder?

• Promote education about the disease, provide psychological care for suspected or diagnosed delusional patients, and ensure family members offer timely support.
• Emphasize dietary adjustments: Patients should maintain a balanced, light diet with reasonable food combinations and adequate nutrition, focusing on fruits and vegetables. Avoid tobacco, alcohol, coffee, spicy, moldy, fried, and greasy foods.