Is paranoia a disorder

Paranoia - Better Health Channel

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Summary

Read the full fact sheet

Paranoia is the irrational and persistent feeling that people are ‘out to get you’.
The three main types of paranoia include paranoid personality disorder, delusional (formerly paranoid) disorder and paranoid schizophrenia.
Treatment aims to reduce paranoia and other symptoms and improve the person’s ability to function.

What is paranoia?

Paranoia is the irrational and persistent feeling that people are ‘out to get you’ or that you are the subject of persistent, intrusive attention by others. This unfounded mistrust of others can make it difficult for a person with paranoia to function socially or have close relationships. Paranoia may be a symptom of a number of conditions, including paranoid personality disorder, delusional (paranoid) disorder and schizophrenia.

The cause of paranoia is unknown but genetics are thought to play a role. Treatment depends on the condition diagnosed as its cause, and may include treatment by psychological therapy or medication.

Symptoms

Paranoid symptoms may range from mild to severe. They depend on the cause but, generally, a person who is paranoid may:

be easily offended
find it difficult to trust others
not cope with any type of criticism
assign harmful meanings to other people’s remarks
be always on the defensive
be hostile, aggressive and argumentative
not be able to compromise
find it difficult, if not impossible, to ‘forgive and forget’
assume that people are talking ill of them behind their back
be overly suspicious – for example, think that other people are lying or scheming to cheat them
not be able to confide in anyone
find relationships difficult
consider the world to be a place of constant threat
feel persecuted by the world at large
believe in unfounded ‘conspiracy theories’.

Three main types of paranoia

Paranoia is associated with three principal conditions:

Paranoid personality disorder – considered the mildest type. Most people with paranoid personality disorder function well despite their mistrust of the world. The attitudes and behaviours associated with this disorder, when they become obvious, are often discovered to have been present for much of the person’s life.
Delusional (paranoid) disorder – characterised by the dominance of one delusion (false belief) without any other sign of mental illness. The person’s behaviour depends on which delusion they have. For example, a person who has a delusion of persecution believes that other people are spying on them or plotting to harm them in some way. Stalking can be the result of delusional (paranoid) disorder – for example, the person believes they are in a relationship with a movie star they have never met. In another case, a person may imagine they have a terrible illness, despite repeated reassurance from doctors.
Paranoid schizophrenia – considered the most severe type. It is characterised by strange delusions, such as believing that one’s thoughts are being broadcast over the radio. Hallucinations, especially bizarre ones, are also common to the condition. A person with paranoid schizophrenia often finds the world confusing and functions poorly without treatment.

Causes are unclear

The causes of paranoia are unclear and depend on the condition with which it is associated. Theories include:

Genes – research is scanty and inconclusive. Some studies suggest a genetic link while others don’t. It is also unclear whether genetic predisposition to paranoia – if it exists – is inherited or not.
Brain chemistry – brain chemicals (neurotransmitters) form the basis of thoughts and feelings. Certain drugs such as cocaine, marijuana and amphetamines alter brain chemistry and can bring on paranoid thoughts, feelings and behaviours. This leads some researchers to believe that paranoia may be a biochemical disorder of the brain. The causes of this possible disorder are unknown.
Traumatic life events – for example, abuse in childhood may distort the way a person thinks and feels throughout life.
Stress reaction – some studies have found that paranoia is more common in people who have experienced severe and ongoing stress – for example, prisoners of war. How stress can trigger paranoia is unclear.
A combination of factors – it may be that a number of genetic and environmental factors working in combination cause paranoia.

Diagnosis

The condition causing the paranoia can be difficult to diagnose because an exaggerated sense of mistrust is common to a range of mental disorders and also occurs in some people with dementia. Another difficulty is that a person who has paranoia may avoid doctors, hospitals and other medical settings for fear of being harmed.

Diagnosis may include:

medical history
physical examination
assessment of symptoms
psychological tests
tests to rule out other psychiatric disorders that may be causing the symptoms.

Treatment

While there is no absolute cure for the conditions that cause paranoia, treatment can help the person cope with their symptoms and live a happier, more productive life. Treatment depends on the type and severity of the condition but may include:

Medications – anti-anxiety drugs or antipsychotic drugs can ease some of the symptoms. However, a person with paranoia may often refuse to take medication because they are afraid it will harm them.
Therapy – this can help the person to cope with their symptoms and may improve their ability to function. However, a person with paranoia is unlikely to talk openly and freely to a therapist, so progress can be extremely slow.
Coping skills – other treatments aim to improve the person’s ability to function socially. Options may include relaxation therapy, techniques to reduce anxiety, and behaviour modification.
Hospital admission – in severe cases, the person may need to stay in hospital until the condition causing paranoia stabilises.

Where to get help

Your GP (doctor)
Psychiatrist
Public hospital
Community health centre
Mental Health Foundation of Australia (Victoria)External LinkTel. 1300 643 287 (1300 MHF AUS)
SANE HelplineExternal LinkTel. 1800 187 263

Paranoia and delusional disordersExternal Link, Mental Health America.

This page has been produced in consultation with and approved by:

Give feedback about this page

Was this page helpful?

More information

Content disclaimer

Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 18-10-2022

Paranoia - Better Health Channel

Actions for this page

Summary

Read the full fact sheet

Paranoia is the irrational and persistent feeling that people are ‘out to get you’.
The three main types of paranoia include paranoid personality disorder, delusional (formerly paranoid) disorder and paranoid schizophrenia.
Treatment aims to reduce paranoia and other symptoms and improve the person’s ability to function.

What is paranoia?

The cause of paranoia is unknown but genetics are thought to play a role. Treatment depends on the condition diagnosed as its cause, and may include treatment by psychological therapy or medication.

Symptoms

Paranoid symptoms may range from mild to severe. They depend on the cause but, generally, a person who is paranoid may:

be easily offended
find it difficult to trust others
not cope with any type of criticism
assign harmful meanings to other people’s remarks
be always on the defensive
be hostile, aggressive and argumentative
not be able to compromise
find it difficult, if not impossible, to ‘forgive and forget’
assume that people are talking ill of them behind their back
be overly suspicious – for example, think that other people are lying or scheming to cheat them
not be able to confide in anyone
find relationships difficult
consider the world to be a place of constant threat
feel persecuted by the world at large
believe in unfounded ‘conspiracy theories’.

Three main types of paranoia

Paranoia is associated with three principal conditions:

Paranoid personality disorder – considered the mildest type. Most people with paranoid personality disorder function well despite their mistrust of the world. The attitudes and behaviours associated with this disorder, when they become obvious, are often discovered to have been present for much of the person’s life.
Delusional (paranoid) disorder – characterised by the dominance of one delusion (false belief) without any other sign of mental illness. The person’s behaviour depends on which delusion they have. For example, a person who has a delusion of persecution believes that other people are spying on them or plotting to harm them in some way. Stalking can be the result of delusional (paranoid) disorder – for example, the person believes they are in a relationship with a movie star they have never met. In another case, a person may imagine they have a terrible illness, despite repeated reassurance from doctors.

Paranoid schizophrenia – considered the most severe type. It is characterised by strange delusions, such as believing that one’s thoughts are being broadcast over the radio. Hallucinations, especially bizarre ones, are also common to the condition. A person with paranoid schizophrenia often finds the world confusing and functions poorly without treatment.

Causes are unclear

The causes of paranoia are unclear and depend on the condition with which it is associated. Theories include:

Genes – research is scanty and inconclusive. Some studies suggest a genetic link while others don’t. It is also unclear whether genetic predisposition to paranoia – if it exists – is inherited or not.
Brain chemistry – brain chemicals (neurotransmitters) form the basis of thoughts and feelings. Certain drugs such as cocaine, marijuana and amphetamines alter brain chemistry and can bring on paranoid thoughts, feelings and behaviours. This leads some researchers to believe that paranoia may be a biochemical disorder of the brain. The causes of this possible disorder are unknown.
Traumatic life events – for example, abuse in childhood may distort the way a person thinks and feels throughout life.
Stress reaction – some studies have found that paranoia is more common in people who have experienced severe and ongoing stress – for example, prisoners of war. How stress can trigger paranoia is unclear.
A combination of factors – it may be that a number of genetic and environmental factors working in combination cause paranoia.

Diagnosis

Diagnosis may include:

medical history
physical examination
assessment of symptoms
psychological tests
tests to rule out other psychiatric disorders that may be causing the symptoms.

Treatment

Medications – anti-anxiety drugs or antipsychotic drugs can ease some of the symptoms. However, a person with paranoia may often refuse to take medication because they are afraid it will harm them.
Therapy – this can help the person to cope with their symptoms and may improve their ability to function. However, a person with paranoia is unlikely to talk openly and freely to a therapist, so progress can be extremely slow.
Coping skills – other treatments aim to improve the person’s ability to function socially. Options may include relaxation therapy, techniques to reduce anxiety, and behaviour modification.
Hospital admission – in severe cases, the person may need to stay in hospital until the condition causing paranoia stabilises.

Where to get help

Your GP (doctor)
Psychiatrist
Public hospital
Community health centre
Mental Health Foundation of Australia (Victoria)External LinkTel. 1300 643 287 (1300 MHF AUS)
SANE HelplineExternal LinkTel. 1800 187 263

Paranoia and delusional disordersExternal Link, Mental Health America.

This page has been produced in consultation with and approved by:

Give feedback about this page

Was this page helpful?

More information

Content disclaimer

Reviewed on: 18-10-2022

What is paranoia?

Paranoia is a severe psychiatric illness characterized by the development of logically constructed delusional ideas. This is one of the first diseases that began to be dealt with in modern psychiatry, along with the treatment of schizophrenia and neurosis. With paranoia, the patient does not progress negative symptoms, to some extent the integrity of the personality is preserved and there is no disturbance in perception - hallucinations.

The term "paranoia" was coined by the German psychiatrist Carl Ludwig Kahlbaum in 1863. Later, another psychiatrist, Emil Kraepelin, described paranoia as an independent disease. For a long time, paranoia was considered in classical psychiatry as an independent mental disorder, and in Soviet and Russian psychiatry it was customary to distinguish paranoid syndrome from paranoid delusions.

Symptoms of paranoia

The main signs of paranoia are delusional ideas and, as a result, negative emotions in relation to others (touchiness, hostility, pathological jealousy), as well as megalomania and the inability to perceive criticism and adequately evaluate oneself. The delusion of persecution, which all patients with paranoia suffer from, is an inadequate perception of reality, some fixed idea that constantly accompanies a person in his daily life and is not questioned. With paranoia, a person is convinced that someone is following him and wants to harm him. This disease differs from other diseases, such as paranoid schizophrenia, in that the person suffering from this disorder does not withdraw into himself and does not lose himself as a person. People suffering from paranoia are characterized by unhealthy suspicion, a tendency to see the intrigues of enemies in random events, to build complex conspiracy theories against themselves. However, in another they retain the logical thinking.

Paranoia can coexist with other illnesses such as anxiety and depression.

If such a person is sufficiently socialized, that is, other people continue to communicate with him, he can work at the same job for many years, he can have acquaintances and friends. As a rule, those who suffer from paranoia do not have close friends. However, a paranoid patient may well have a family that will stay with him until the moment when the paranoid delusions intensify and the patient becomes a danger to himself or others.

Causes of paranoia

As in the case of other mental illnesses, the causes of paranoia are a genetic predisposition and some external trigger that launched the development of the disease. At the moment, science does not know exactly which genes are responsible for the development of paranoia and what specific triggers turn on this disorder. Paranoia can coexist with other illnesses such as generalized anxiety disorder and depression. Sometimes depression is a consequence of paranoia, as it becomes difficult for a person to live with the current picture of the world, according to which he is constantly being persecuted and they want to harm him.

The paranoid patient accepts for himself a certain axiom that is not subject to proof.

In many cases, individual signs of paranoia can develop in old age with degenerative processes in the brain, for example, with atherosclerotic lesions of the cerebral vessels, Alzheimer's disease, Parkinson's disease, Huntington's disease and others. Also, the development of paranoia can cause the use of psychoactive substances - hallucinogens, amphetamines, alcohol and certain drugs.

Delusions of persecution

See also

Psychiatric notes on the margins of the film "The Apprentice" by Kirill Serebrennikov

As a rule, a crazy idea is well formed in the mind of a person. The paranoid patient accepts for himself a certain axiom that is not subject to proof. He convinces himself that someone from his environment, for example, a neighbor or brother, is opposed to him and everything that this person does is aimed at harming the patient with paranoia. Any action that will be performed by this person will be interpreted as an action against the patient. The object of delusional thoughts can be not only people from the inner circle of communication, but also those who are not connected with the family, for example, the police, the KGB, the CIA and others.

Paranoia is very well organized, like a pseudo-logical system. A person suffering from this disease is clearly focused on only one crazy idea, which is why such people often manage to maintain themselves as whole individuals for many years. For example, if a person believes that a neighbor is opposed to him, he will not communicate with this neighbor, but will continue to communicate with everyone else. At the same time, he will try to convince them that the neighbor is harming him.

Paranoid people usually do not make the decision to start treatment themselves.

When a person believes that he is constantly persecuted, he either runs away from this persecution, or defends himself by attacking the one he considers the offender. If a patient with paranoia is ready to live with a sense of persecution, and not to attack the one who, in his opinion, is persecuting him, then he is considered socialized in society, and his illness proceeds passively. At the moment when he begins to actively run away from society or attack those who are the object of his delirium, such a person must be hospitalized.

Paranoia diagnostics

For the diagnosis of this disease, the patient must undergo a clinical interview with a psychiatrist. During the appointment, the specialist reveals how long ago the symptoms of the disease began, what triggered the onset of the development of the disorder, and, most importantly, with what or with whom the delusion of persecution is specifically associated. After that, it is important to find out whether the person who is chosen as the object of delirium is not in danger, those around him or the patient himself. At the end of the clinical interview, the specialist needs to decide whether the patient needs hospitalization or in this situation he can be prescribed outpatient treatment.

See also

Why do we need a psychotherapist?

Paranoid people usually do not make the decision to start treatment themselves. They are sincere and deeply convinced that their perception corresponds to reality and their thoughts are not painful. Such a person, as a rule, will appear at a specialist’s appointment only under external pressure: family, superiors, or by a court decision. In the event that the patient is not dangerous and does not require inpatient treatment, the task of the specialists who carry out the diagnosis is to try to convince the patient to start drug treatment and psychotherapy.

Treatment of paranoia

The treatment of paranoia takes a long time - sometimes more than 10 years. The main task of psychotherapy is to convince the patient that some of his thoughts and certain beliefs are painful. The psychotherapist teaches a person to notice paranoid thoughts in time and not to get involved in them so that they do not lead to actions. This is a very long and hard job. Patients who do not require hospitalization and continue to function in society usually do not stay for long-term treatment, and attend psychotherapy for only a month or two. Paranoia is a chronic disease that lasts for many years, and, unfortunately, there is no cure for it. It takes root, its symptoms begin to appear more acutely, and eventually, when the patient enters the hospital or for psychotherapy, the disease is already in a neglected state.

Diseases and disorders

What is paranoia: symptoms and signs

Paranoia - what kind of disease it is, how it affects the life of a person and the people around him. What is the relevance of the problem? What are the main causes and signs of paranoia, what is its differential diagnosis based on? Whether its effective treatment of this disease is possible or probable? The answers to these questions are offered by the Chief Physician of the Health Harmony Medical Center, a practicing psychiatrist, psychiatrist-narcologist and psychotherapist Vladislav Sipovich.

What is paranoia and how relevant is its problem?

Paranoia in Greek literally means "next to the mind", which can be regarded as a deviation from normal thinking in the direction of exaggeration of one's own personality and the ideas produced by it, while maintaining the logic of judgments. A person actually retains the ability to reason, but all his thoughts are aimed solely at proving his significance and the recognition by society of his overvalued ideas. At the same time, self-criticism is practically absent, but a critical attitude towards people who do not share ideas about the exclusivity of the patient himself literally rolls over.

Paranoia is a rare type of chronic mental disorder that develops mainly in people who have reached adulthood. According to statistics, among patients undergoing treatment in psychiatric hospitals, the proportion of patients with paranoia is only 0.5-1%, and among all mental disorders 2-4%. Perhaps such low statistics is due to low detection, which in turn is associated both with the difficulty of differential diagnosis and with the patient's non-recognition of his disease state and the ability to integrate and function in society.

A paranoid person is a person who is convinced of the value of his ideas and the prejudice of others. Attempts to prove the irrationality and unreality of the thoughts put forward by the paranoid cause only anger, distrust, hostility and even aggressiveness not only towards outsiders, but also to close people themselves, as well as to specialists trying to help. Establishing contact with such a patient is extremely difficult and requires, at the initial stage, a partial recognition of the supervalue and uniqueness of even the most delusional ideas. Paranoia is a disease that has such features as:
• Gradual development without aggravation of the pathological dynamics of symptoms and without an increase in personality changes. In practice, this means the absence of apathy, a decrease in vitality, abulia (loss of will and motivation). The nervous and energy potential of the patient remains consistently high, aimed at achieving the goal, and internal dissatisfaction finds a way out in conflict with the outside world and the fight against imaginary injustice.
• Logical validity and consistency of false ideas, which is almost impossible to refute. All objections have seemingly logical antitheses.
• The topic of ideas is usually monodirectional, i.e. concerns a certain sphere of knowledge and activity of society. A classic example is graphomania, when a person, having once achieved the publication of his poems or story, begins to consider himself an outstanding and unsurpassed poet or writer. The constant refusals of publishers to publish his "masterpieces" are perceived as the intrigues of envious people, unprofessionalism and bias of editors, publishers, and so on. It is almost impossible to prove the inconsistency of the claims of the paranoid, tk. he takes criticism as a personal insult and reacts with extreme hostility. Switching to another topic is uncharacteristic, the patient stubbornly achieves his goal and attacks various publishing houses ad infinitum. All these torments last for years and decades, causing extreme anger and hostility to the whole world.
• Absence of hallucinations, i.e. distortions in the perception of reality. By the way, experts do not have a unanimous opinion on this matter, many sources recognize the existence of various types of illusions in paranoid people, but usually these symptoms are observed in combined mental disorders, for example, delusions similar to paranoia in schizophrenics. These phenomena have nothing to do with classical "pure" paranoia.
• Consistent and generally predictable behavior based on the formal connection of many real elements with the paranoid's false ideas.

A person with paranoia is characterized by extreme suspicion, blaming imaginary enemies for his failures, and a tendency to construct conspiracy theories against him in his imagination.
The urgency of the problem is that one paranoid person can complicate the lives of many people, including not only those closest to him, but also those to whom he addresses with his "projections". The circle of interests of the paranoid includes officials, specialized specialists, writers, directors, producers, public figures, judicial authorities, etc. The received refusals to satisfy requests and logical explanations do not stop the paranoid, but only increase his perseverance. Sometimes he turns into a manic persecutor and can even stoop to physical violence against those who refused him protection.

What is the differential diagnosis of paranoia based on?

If earlier in classical psychiatry paranoia was considered as an independent disease for a long time, then according to the modern international classification of diseases of the 10th revision (ICD-10), it is not distinguished into a separate heading, but is referred to as a subheading of delusional disorder.
Paranoia should be differentiated from similar paranoid (paranoid) personality changes. The latter often accompanies many mental disorders, in particular, schizophrenia, paraphrenia, social phobias, anxiety disorders, post-traumatic stress and borderline conditions, and alcoholic psychoses.

The difference between paranoia and paranoid personality disorders (hereinafter BPD):
• Paranoia is characterized by following one idea, for example, if a paranoid person is convinced that a neighbor is harming him, then he will not communicate with him, maintaining communication with another environment. A hostile and aggressive attitude towards certain people develops when they do not recognize the overvalued ideas of the patient and when they make critical statements about him. With paranoid disorder, distrust of everyone and everything comes to the fore, colleagues, the CIA, the FSB and the whole world can be objects of distorted ideas. At the same time, the presence of an initial overvalued idea is absolutely not necessary.
• Paranoia is always distinguished by a consistently built and logically connected system of ideas, which is based on the acceptance of some idea as an axiom that does not require proof. Otherwise, thinking retains its rationality and allows paranoids to exist and function normally in society. They usually do not make friends, but they may have family relationships. In BPD, delusions are unsystematized and inconsistent.
• In paranoia, there are no hallucinations or illusions. Paranoid disorder is characterized by a distorted perception of reality.
• Paranoid disorders are much more common than paranoia. For example, in the United States, about 2-4% of the population suffer from more or less pronounced mental disorders of the paranoid type. This is due to the fact that the very concept of BPD is broader and includes paranoia itself, endogenous (paranoid schizophrenia) and exogenous (provoked by stress, an unusual situation, etc.) paranoid psychoses.
• In BPD, there is a progressive change in personality, which can lead to a complete disorganization of thinking, which is not typical for classical paranoia with the preservation of structured, consistent and logical thought processes.
• Cause of paranoia unknown. There are only hypotheses about a genetic predisposition, but the gene responsible for its development has not been found. An external trigger that starts the psychopathological process can be any event that is extremely difficult to identify. A number of factors predispose to the development of a paranoid disorder. These include schizophrenia and delusional disorders in close relatives, problems of upbringing in a family with violence, totalitarianism and increased parental care, as well as restriction of communication due to physical defects or illness. In fact, paranoid disorder is formed as a hypertrophied self-preservation instinct, which leads to isolation, pathological suspicion and distrust of close and distant environment, constant readiness to defend oneself from hostile, harmful persons and events. In addition, hallucinogens, amphetamines, alcohol, and other chemicals can cause a temporary paranoia-like disorder.

Only an experienced specialist can differentiate paranoia from paranoid disorder. Moreover, there is no complete clarity on this issue in psychiatry. The importance of the problem is that the choice of an effective method of its treatment depends on the nature of a mental disorder.

What are the types of paranoia?

The classification of certain types of paranoia is based mainly on the prevailing fixed idea. Depending on this, the most common forms of paranoia are distinguished:
• Involutional paranoia that develops at a mature age of 45-60 years, in women often coinciding with menopause. It is characterized by systematized delusions of persecution, jealousy, less often grandeur. The onset is usually acute, the course is long, the treatment is stationary.
• Paranoia of greatness, or megalomaniac with ideas of reforming society, science and art, as well as inventions and "great" discoveries.
• The paranoia of jealousy is based on the dogma of adultery or adultery. Moreover, treason does not need fixation and proof, but is accepted as an axiom. No arguments of the second half are able to shake the confidence of the pathological jealous that he is right. Initially, the patient accuses the partner of coquetry, the desire to attract the attention of the opposite sex, cheeky behavior, shameless snuggling during the dance, and even a bashful reaction to compliments. This goes on for several years, after which suspicions develop into a firm belief in treason.
• A religious form that develops against a background of religious beliefs.
• Erotic paranoia, in which the main content of delusional ideas is erotic fantasies. It develops mainly in women between 40 and 50 years of age.
• Persecutory form - paranoia with systematized delusions of persecution.
• Senile paranoia of old age, often coinciding with senile dementia, Alzheimer's, Parkinson's and other degenerative diseases of the brain.
• Alcoholic paranoia, which is a chronic psychosis caused by alcoholic encephalopathy. Most often occurs in men and is manifested by delusions of jealousy and / or persecution.
There are other types of paranoia, such as those with complainer delusions or hypnotic charms, but these are much less common.

What are the main signs of paranoia and its clinical picture?

The main symptoms of paranoia include such mental manifestations as:
• The presence of overvalued ideas that become fixed ideas and haunt the patient throughout his life. At the same time, paranoids are as persistent as possible, they spend all their strength and finances on proving the importance of their invention, discovery or method of reforming society. The literature describes a case when a man from Vladivostok "discovered" a new way of fishing, taking into account the location of the stars. He arrived in Moscow, knocked on the thresholds of various authorities, which gradually began to ignore him, went down and even spent the night at railway stations. At the same time, the fate of the family abandoned in Vladivostok - parents, wife and children, did not bother him at all.
• Overestimation of the role of one's own personality, leading to delusions of grandeur or persecution. In the first case, the patient considers himself capable of doing good to all mankind, and in the second, that all the forces of the world are directed against him. For example, the neighbor's dog barks because the neighbors tease her to spite him, the March cats yell specifically to prevent him from sleeping, the children in the yard make noise in order to annoy him, etc.
• Pathological suspicion, in which a person sees in everything the machinations of enemies and ill-wishers. He connects even the most insignificant events into a conspiracy theory built by him against himself. All this is accompanied by suspiciousness, vindictiveness, vindictiveness, inadequate assessment of criticism and a complete lack of a critical attitude towards one's own actions. The patient does not perceive someone else's opinion, it is useless to prove the fallacy and inconsistency of his ideas. The paranoid is convinced that everyone around wants to harm him, take away his property, downplay his merits, exploit him and try to manipulate him in their own interests. As a result, a hostile attitude towards everyone around is formed, which, with an attack of acute paranoia, can turn into aggressive actions and make the patient dangerous even for the closest people.
• Extreme susceptibility to stressful situations. The state of affect lasts for a long time and at any memory of it “comes to life with renewed vigor. Even if the paranoid does not show his emotions, then only with an eye on future revenge, because. he does not forgive insults.
One's own failures, mistakes made are experienced very sharply because of wounded pride. Paranoids are extremely ambitious, distinguished by arrogance and a tendency to overestimate their abilities and achievements.

What are the main ways to treat paranoia and how should others behave during an attack of paranoia?

Paranoia is a psychiatric illness that is very difficult to treat. This is explained by the fact that because of his supernatural suspicion, the patient does not trust anyone or anything, extending his suspicions to the doctor and the drugs prescribed by him. He perceives psychotherapy as another attempt to manipulate his mind. In addition, the paranoid categorically denies the morbidity of his condition, and relatives who prove the need for treatment are transferred by the paranoid into the category of "enemies".

The need for treatment becomes especially acute if a person ceases to be socialized, which is manifested by a willingness to isolate himself from the “persecuting” society or even attack an object that is harmful, in his opinion. Such a transition from the passive course of the disease to the active phase is an indication for inpatient treatment.

In the event of an attack of paranoia, it is necessary to call an ambulance, and unnoticed by the patient. Before the arrival of a specialized team, in no case argue with the patient, accept his position and even play along a little. Do not try to prove something or appeal to common sense. This is useless and even dangerous, since the delusions of the paranoid cannot be corrected. If the arrived specialists cannot stop the attack and relieve the psycho-emotional stress on the spot, the patient is hospitalized.
In the chronic course of paranoia, outpatient complex treatment is indicated, the main element of which is drug therapy with the use of anti-delusional antipsychotics. Their action is aimed at normalizing the exchange of neurotransmitters and blocking the excitation of the nerve centers responsible for the symptoms of paranoia. The appointment of other pharmacological drugs is symptomatic and is aimed at eliminating the symptoms of paranoia that prevail in a particular patient. For example, antidepressants are used to relieve depressive moods, tranquilizers - to eliminate fear and anxiety, sleeping pills - to normalize sleep.

An additional and important direction in the complex treatment of paranoia is psychotherapy. It is aimed primarily at restoring socialization and eliminating elements of irrational behavior in patients with paranoia.

At the first stage of treatment, the main thing is to establish contact and trusting relationships with the patient. This is extremely difficult to achieve, but possible. If the patient himself decided to be treated and correctly assesses his condition, this is already half the success in getting rid of paranoia. Unfortunately, this development is rare. Most of these patients remain outside the attention of psychiatrists and psychotherapists (what is the difference between a psychiatrist and a psychotherapist) for a long time, sometimes for decades. If, during an exacerbation, situations occur that are dangerous to the life of the patient himself (auto-aggression) and / or his environment, then only then treatment begins, usually in stationary conditions.

The choice of drugs, as well as psychotherapeutic methods of correction, depends on many factors - on the general physical condition of the body, mental characteristics, gender, age and the main symptoms.

In drug treatment, it should be borne in mind that abrupt discontinuation of drugs can lead to the so-called withdrawal syndrome, when, after stopping treatment, the symptoms of the disease return again and sometimes with more force than before treatment.

Only drug therapy, not supported by psychotherapy, is not able to fully return the patient to a normal life in society. It is possible to achieve stable and long-term remission only with the use of both methods of therapy - medication and psychotherapy. The most effective in the treatment of paranoia are Gestalt therapy, cognitive behavioral therapy (CBT) and psychodynamic psychotherapy. Unfortunately, paranoia is a disease that is treated for a long and difficult time, sometimes for 10 years. If the treatment is carried out on an outpatient basis, then it is important to take drugs according to the scheme developed by the doctor, the regularity of psychotherapy sessions, following the recommendations of the psychotherapist, using the acquired communication skills, and after achieving remission, periodic consultations with the specialist observing the patient.

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