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- Understanding Panic Disorder – December 7, 2012
The experience of being human includes incidences where we feel that the world is against us. There is even a popular song that children learn in the playground that goes like this: "Nobody likes me, everybody hates me. I think I'll go and eat worms..
So what is that difference? Should we be afraid, as we sit down to discuss what an awful day we've had and how much a victim of everything we are feeling, that our family will bundle us up and send us to a mental institution?
The difference becomes apparent when the term and its origins are examined. The word paranoia comes from the Greek meaning beside (para) mind (nous) which in the original apparently means "self-referential". The term came to describe many observable phenomena like suspiciousness and delusional jealousy.
Towards the end of the 19th century Emil Kraepelin was the first one to use the word in a clinical sense to describe a mental illness where a delusional belief holds center stage and is not accompanied by other symptoms. Though the classification itself has gone through many incarnations, including a change to the term "delusional disorder", many features of his original categorization remain intact.
Kraepelin distinguished between "pure paranoia" and dementia praecox (later to become schizophrenia) by saying that though delusion was present it caused no deterioration in intellectual abilities. He also described a number of subtypes that now fall under the "delusional disorder" category. Some of his subtypes of paranoia were persecutory, grandiose, erotomanic and jealous.
Today the National Institute of Mental Health (NIMH) describes paranoia as " a term used by mental health specialists to describe suspiciousness (or mistrust) that is highly exaggerated or not warranted at all".
The NIMH distinguishes between three different kinds of paranoia that vary greatly in terms of their severity and prognosis. The least incapacitating condition is referred to as Paranoid Personality Disorder. Someone who suffers from this disorder will display a consistent distrust of the world at large. They perceive themselves to be at the mercy of a world that is out to get them.
Despite this they are normally able to function within society though the delusions may lead them to take actions like changing jobs and towns repeatedly due to the belief that they disliked or being victimized. In this way they may create a self-perpetuating cycle of events where they respond to an imagined situation in such a way that others begin to respond to them in exactly the way that was originally simply a function of a deluded imagination.
The paranoid personality is tense, hypersensitive and hyper-vigilant. It constantly scans the horizon for the next imagined slight. Because it views the world through a veil of suspicion it can appear cold and emotionally withdrawn. Ironically it feels that the only thing it can depend on is its own rational objectivity.
Though the paranoid personality is typically antagonistic, argumentative and uncompromising it is rarely violent. The symptoms of the disorder preclude the possibility of their seeking help so they are seldom seen at mental health clinics. Paranoid personalities are most often what we are referring to when we speak of paranoia in popular culture.
Delusional (paranoid) disorder is significantly more debilitating than the paranoid personality. This is the more or less modern version of Kraepelin's classification of paranoia where the NIMH outlines, "there is the presence of a persistent, nonbizarre delusion without symptoms of any other mental disorder".
The most common delusion is that of persecution. The sufferer will suspect others of conspiring against them. The delusion may include elaborate master plans to poison, drug or have them killed. The patient is unable to retreat to any place of safety as they are surrounded by threats.
Delusions need not be of persecution though. Other delusions include the conviction that someone, normally a prominent or famous someone, is in love with them or that of being endowed with superior powers that the world has a great need for.
These delusions, unlike the paranoia of the paranoid personality, may be much more debilitating. Sufferers may believe themselves to have bugs crawling in and out of their bodies. These delusions are difficult if not impossible to integrate into a normal lifestyle. Though delusional patients are often angry and threatening they are not necessarily violent and they do not have a history of being homicidal though spouses or lovers may be endangered.
Paranoid schizophrenia is the most debilitating of the paranoias with episodes of what the NIMH calls "extremely bizarre delusions or hallucinations". There is often prominent thought disorganization, emotional flattening and seriously diminished capacity to carry out normal tasks.
Though treatment may sometimes prove difficult as trust is a necessary aspect of any clinical relationship, some antipsychotic drugs may help patients to overcome some of the symptoms. Milder cases can experience a return to some level of normalcy through participation in various forms of therapies.
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