Paranoia and Delusions

Paranoia diagnostic criteria

A pervasive distrust and suspiciousness of others

believes they will be harmed

unjustified doubts

reluctant to confide in others for fear of having info used against them

reads hidden meanings into benign remarks

bears grudges

Delusional disorder diagnostic criteria

belief for at least one month in a delusion

criteria for schizophrenia has not been met (no hallucinations)

besides for delusions, behavior is not markedly odd

Types of delusions in delusional disorder

Erotomanic -belief that someone else is in love with them

Somatic - related to the body

Jealous - believes partner is cheating on them

• suspicious - excessive preocupation with possibility of betrayal

• reactive - excessive response to real or imagined betrayal

Mixed

unspecified

grandioise - belief that they are an undiscovered genius

persecutory - belief that people are out to get them

• most common for schizophrenia

Paranoia

To suspect (expect) harm

open to any information confirming suspicions

what kind of attribution bias do paranoid people have

hostile

biases of paranoia

exaggerated assessment of risk of impending betrayal

skewed judgement regarding what constitutes betrayal

the view that betrayal is especially bad (would rather die)

Overreaction to perceived betrayal

What can paranoid responses look like?

Angry / hostile

Fearful / avoidant

Paranoia and social anxiety

both involve delusions of reference and negative expectations

paranoid people expect harm by others and attribute it to others

socially anxious people expect judgement by others and blame themselves

Self-fulfilling prophecy of paranoia

Paranoid people can expect harm which leads to preemptive attacks on others

people with PPD initiate more bullying

Querelous paranoia

Has an obsession with percieved revenge

Delusions

False beliefs with an emotional significance, held even in presense of contrary evidence

delusions qualify as

psychosis

delusions may

wax and wane or remain stable

stable delusional beliefs may appear coherent and nonpsychotic

DD versus schizophrenia

DD seen as a milder form of schizophrenia

many still marry and are self supporting

has a later age of onset 30s to 40s

Emotional significance of delusions

most delusions related to place in universe

specific goals / life circumstances

Falsity of delusions

tough to be certain about falsity - could believe they are being cheated on or being followed by aliens technically both can be false even tho one is more likely

bizareness

historically indicitave of schizophrenia

sometimes more obvious but interrater reliability is low

distress

grandioise delusions may actually be pleasant

suspicious persons may be proud of not being “duped”

conviction

imperviousness to feedback / certainty

can be self-sustaining

insight

lack of insight is lack of awareness that ones belief is in error

involvement

behavioral involvement is the presense of delusion related actions or pressure to act upon beliefs

sometimes they are involved but also have insight - acknowledge the belief isnt true but still act on it

preocupation

extent to which delusion takes up life

if someone qualifies for ocd can they qualify for DD?

no, even when insight is absent

characteristics of delusions

bizareness

involvement

conviction

preoccupation

insight

distress