Lecture 10: Paranoid and Delusional Disorders

What is paranoid personality disorder (PPD)?

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) specified symptoms, and does not occur exclusively during schizophrenia, bipolar disorder, depressive disorder with psychotic features, another psychotic disorder, or due to a medical condition.

What are the 2 criteria for paranoid personality disorder?

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) listed symptoms.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder, or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

What is delusional disorder?

The presence of one (or more) delusions with a duration of 1 month or longer, without ever meeting Criterion A for schizophrenia, with functioning not markedly impaired apart from the delusion(s), and not attributable to substances, medical conditions, or better explained by another mental disorder.

What are the 5 criteria for delusional disorder?

A. One (or more) delusions for 1 month or longer.
B. Criterion A for schizophrenia has never been met.
C. Functioning is not markedly impaired and behavior is not obviously bizarre or odd (apart from the delusion).
D. Any manic or major depressive episodes have been brief relative to the delusional periods.
E. Not attributable to substances, medical conditions, or better explained by another mental disorder.

What are the seven types of delusional disorder?

Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed, and Unspecified.

What is the erotomanic type?

The central theme of the delusion is that another person is in love with the individual.

What is the grandiose type?

The central theme is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery.

What is the jealous type?

The central theme is that the individual’s spouse or lover is unfaithful.

What is the persecutory type?

The central theme involves the belief that one is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in long-term goals.

What is the somatic type?

The central theme involves bodily functions or sensations.

What is the mixed type?

No one delusional theme predominates.

What is the unspecified type?

The dominant delusional belief cannot be clearly determined or is not described in the specific types.

What terms are often paired (and why)?

Paranoid and delusional. They are distinguishable: there are delusions other than paranoid ones, and some paranoid ideation does not qualify as delusional. Each term appears in a DSM-5 diagnostic category name (PPD and DD), and both denote clinical phenomena seen in schizophrenia and other mental disorders.

How do writers differ in which response to a threat is the paranoid one (and what does this mean)?

Some define it as a fearful, furtive, and avoidant response.

Others define it as a hostile and angry response, sometimes involving preemptive antagonism. Each narrows the definition of paranoia in a way not universally shared.

What can expectations of harm lead to?

Preemptive attacks on others, which can lead to self-fulfilling prophecies.

What may the paranoid individual engage in and why (explain)?

Even when judgments of ill will are unwarranted, the paranoid individual may engage in preemptive behaviors that eventually engender real ill will.

This behavior stems from their distorted beliefs about others' intentions, leading them to perceive threats where none exist.

What did Natsuaki find about bullying and PPD characteristics?

Natsuaki et al. (2009) studied peer relations of adolescents and found that those with PPD characteristics initiated more bullying and other uncooperative behaviors.

Querulous paranoia

when the person is preoccupied with gaining redress

– May include a toxic mix of

• Obsessive grievance

• Angry confrontation

• Self-righteous disdain for the views of all other persons

Querulous paranoia is characterized by an individual's obsessive preoccupation with seeking redress for perceived grievances. This often manifests through a toxic combination of obsessive grievance, angry confrontations, and a self-righteous disdain for others' perspectives.

What is a delusion?

A false belief that has emotional significance to the person, held in defiance of the evidence at hand.

What do delusions qualify for (and why)?

Delusions qualify as psychosis because they represent a loss of touch with reality.

Do delusional states wax and wane or stay stable?

Delusional states may wax and wane or be stable. Stable delusional beliefs may be circumscribed, coherent, and non-bizarre.

What are the examples of delusions given?

• A man believes his wife is unfaithful because she comes home late.

• An Arab immigrant believes he is being trailed by the FBI.

• A musically untrained woman believes her compositions will someday be on everyone’s playlist.

• An amateur cosmologist believes the earth will explode on February 17, 2946.

• A depressed person believes himself to be uniquely evil and loathsome.

• A person with BDD believes he is ugly and repulsive.

What are the two key aspects of delusions?

Emotional significance and falsity.

What is distress?

A variable commonly associated with delusions, reflecting the idea that any diagnosis must represent either a problem for the self or others.

What are the exceptions to distress and what do they mean?

• Grandiose delusions may not be distressing and often involve wealth, power, and/or fame.

• Patients who embrace aberrant beliefs may be proud of their open-mindedness.

• Suspicious persons may be proud that they are not being duped.

How may grandiose delusions not be distressing?

They often involve wealth, power, and/or fame and therefore may not cause distress.

How may patients who embrace aberrant beliefs feel?

They may be proud of their open-mindedness because they believe their perspective is unique and enlightened.

How may suspicious persons feel?

They may be proud that they are not being duped because they believe their skepticism protects them from deception.

What is lack of insight?

Lack of awareness that one’s belief is in error.

How does DSM-5 differentiate between persistent delusions and a nonpsychotic disorder (and explain)?

DSM-5 notes that many with social anxiety disorder have good insight that their beliefs are out of proportion.

Lack of insight is often used to differentiate persistent delusions from nonpsychotic disorders. However, in obsessive-compulsive and related disorders, lack of true insight does not always qualify the individual for a delusional disorder diagnosis.

What does the delusional theme of jealousy include?

The belief that one’s partner is unfaithful.

What are the two variants of the clinical problem of jealousy?

Suspicious jealousy and reactive jealousy.

What is suspicious jealousy?

An excessive preoccupation with the possibility of betrayal.

What is reactive jealousy?

An excessive response to real or imagined betrayal.

What is the persecutory theme?

Beliefs that someone is interfering with what one aspires for or working to bring about what one dreads, encompassing humiliation, exploitation, victimization, rejection, exclusion, betrayal, etc.

Are persecutory themes the most common?

Yes. They are likely the most common of all schizophrenia symptoms.