Delusions (Paranoia): Causes, Symptoms & Treatment

Delusions or paranoia are when a person perceives threats that are not real. Usually, delusions occur in the context of psychosis. The reason for this is a disturbed brain metabolism.

What are delusions?

Delusions are characterized by people assuming threats of some kind, which, however, do not exist in reality, but, so to speak, “only take place in the head“. These feelings of threat can be of various kinds: for example, a suspected conspiracy by fellow human beings, by extraterrestrials, by secret services, by the devil, etc.

What form the paranoia takes typically depends on the circumstances of the person’s life. Delusions can lead people who feel threatened to take actions they would not otherwise take. They may also become aggressive as part of an imagined self-protection and pose a threat to themselves or others. This is what makes the phenomenon so dangerous and often requires inpatient treatment.

Causes

Usually, paranoia (of whatever type) is rooted in psychosis, of which there are several types: bipolar, schizoaffective, and schizophrenic. Due to a disturbed brain metabolism, which mainly affects the neurotransmitter dopamine, the perception of the affected person is distorted or false. Causes for a psychosis with the following delusions can be a genetic disposition, drug use, alcohol abuse or a general mental overload. Psychoses often occur in particularly stressful life situations, which the affected person is not able to cope with: Exam situations, social differences with loved ones, or a new stage in life. Due to the overload, the chemical balance in the brain tips, so to speak, which results in distorted perception. The affected person thereby tries to explain the strange feelings that overtake him, and thus carpenters a delusional system.

Symptoms, complaints, and signs

Paranoia leads to hallucinations and delusions. Affected individuals distrust their environment. Often, no distinction is made between strangers and those close to them. One is of the opinion that others want to harm one. Patients sense lies and deceit everywhere. In extreme cases, there is even a constant fear of death. In addition, there is the feeling of being constantly watched. Aggression and delusions of grandeur characterize everyday life. They act in ordinary situations in a strikingly peculiar and opinionated manner. If women and men are confronted with their delusions, they dismiss them. They are not amenable to rational insight. In most cases, they even reinforce counterarguments and aggravate their disorder. In their supposed astuteness, they convince themselves that the contrary views are proof of their right path. Inwardly, patients suffer – even if they do not want to admit it outwardly. They feel despised by their environment. Low self-esteem often characterizes their condition. The psychological behavioral disorder has many different manifestations. It also accompanies a number of other disorders such as neuroses, personality disorders and schizophrenia. Sometimes it occurs after alcohol and drug addiction. Scientists have found that paranoia can accompany Alzheimer’s patients. Tumor diseases in the brain also promote delusions.

Diagnosis and progression

Conspiracy theories or delusions of persecution give medical professionals a first valid clue that psychosis is present, because these are typical signs. Frequently, those affected have already become conspicuous several times in the run-up to this and usually only go to a doctor at the urging of relatives or friends. In most cases, the patients have built up a real delusional system with the help of which they categorize reality and interpret the living environment. Through a longer, empathetic conversation, a doctor can find out whether a paranoia or a psychosis is present. If the psychosis is not treated, it can become chronic, i.e., permanent. However, with early intervention, successful treatment with medication is usually possible. As a rule of thumb, about one-third of patients recover completely, another third relapse, and another third remain trapped in the condition.

Complications

The risk for complications associated with delusions increases with the duration of the illness and failure to receive psychotherapeutic or drug treatment. Particularly relevant to the occurrence of potential complications that are not due to the permanent state of paranoia and associated personality disorders are paranoid relapses. Due to the delusions, such episodes can increasingly lead to actions on the part of the affected person that endanger him and his environment. This can lead to violent acts, for example, because the delusion leads to the belief that it is necessary to protect something or someone. Nonsensical actions in this context can also sometimes lead to economic and social problems. Legal consequences for the person concerned are also conceivable. Especially occurring delusions of grandeur fuel these complications. All these actions are also risky for the environment of the affected person, as they become part of the delusion and fears and anger are projected onto them accordingly. Over time, the behavior of the paranoid, which is increasingly characterized by delusion, ensures alienation from the environment and elimination from the ability to work. Moreover, paranoia is almost always associated with other personality disorders, which in turn have largely depressive and self-injurious elements. Accordingly, as a complication, the sufferer is also at risk of self-harm – even suicide.

When should one go to the doctor?

People who report transient visual perception of figures or shadowy figures should continue to monitor their impressions. If these irregularities increase in scope and intensity, the affected person needs medical help. If the causes are due to a situation of overwork, emotional overload or insufficient sleep, spontaneous recovery occurs in most cases. Stressors should be reduced and sleep hygiene must be optimized for lasting relief. Characteristic for delusions is the lack of insight of the affected person to the experienced and described events. Behavioral abnormalities, an aggressive demeanor and a vehement defense of the perceptions indicate irregularities. If the impressions of the person concerned cannot be understood when viewed objectively, this should be discussed openly. In severe cases, a public health officer should be called, since there is no other way of making a diagnosis due to the lack of insight into the illness. If the person concerned is convinced that he is being persecuted, that thoughts are being fed to him or that he is receiving requests for action from imaginary figures, he needs help. If there is a lack of reference to reality, if everyday obligations can no longer be fulfilled, or if hysterical behavior occurs, a doctor should be consulted. Self-destructive actions or assaults of a verbal or physical nature toward other people are considered warning signs. A visit to the doctor should be made as soon as possible.

Treatment and therapy

To treat paranoia or delusion, so-called neuroleptics are administered and must be taken regularly. These neuroleptics act as a buffer for the brain, which is flooded with stimuli (too much dopamine), and contain the psychosis if the right medication is chosen. Since not much is known about psychosis and neuroleptics, it is often necessary to first try out which drug or combination of drugs works. Accompanying talk therapy is also useful to help the patient find his way back to reality and to come to terms with what is supposed to have happened, because for the patient ess was or is very real. Often, so-called benzodiazepines, tranquilizers, are used for a not too long period of time, so that the patient can sleep and generally regain calm. However, these must be discontinued after a few months because they have a high addictive potential. Often, this requires inpatient treatment altogether until the patient has stabilized again and no longer poses a threat to himself or the environment.

Prevention

To prevent a new episode of delusions, regular intake of medication and regular consultation with a specialist are necessary. Affected individuals also need a regular daily routine and should be as socially integrated as possible.An appropriate occupation that clearly structures the day can also work wonders. Alcohol or drugs should not be consumed.

Aftercare

Similar to similar mental illnesses, delusions require professional aftercare. Different forms of delusions exist; therefore, there is no universal aftercare. In the case of paranoia, psychotherapeutic aftercare in the form of individual or group therapy has proven effective. Each patient must find out for himself which method is appropriate for him. The disease affects the sufferer far beyond the completed treatment. In many cases, patients remain scarred by the mental disorder for life. The goal of aftercare is to achieve a stable condition after psychotherapy has been successfully completed. Relapses are to be avoided. The sufferer must become aware of what situation triggers delusions in him. Many patients become incapacitated as a result of the illness. During aftercare, the affected person also receives psychological support in this case. His self-confidence must be stabilized, otherwise depression can develop in addition to the delusions. During aftercare, the patient learns to be more attentive to himself. To do this, he must find his own personal path. If he distances himself from certain acquaintances for the time being and needs time alone, this is not fundamentally questionable, but can be part of his healing process. If the patient seems satisfied with the decision and his condition improves, the therapist should allow this step and accept it as correct.

This is what you can do yourself

If a patient suffers from delusions (paranoia), this is very stressful for him as well as for his environment or family. To be able to do something about the underlying psychosis yourself, it is important to know what caused it. If the delusions have been triggered by excessive stress, the patient should take shorter breaks and allow himself long rest periods. A regular sleep/wake rhythm is also beneficial in this case. If drug or alcohol consumption is the cause of the paranoia, a strict ban on drugs or alcohol applies. In any case, a person who is prone to psychoses should pay attention to a healthy lifestyle. In this way he supports his own recovery and does not endanger it additionally. In addition to a balanced diet, a healthy lifestyle also includes sufficient exercise, preferably in the fresh air. Sport regulates the metabolism and improves mood. The medication prescribed by the doctor must be taken consistently. Arbitrary attempts to stop usually lead to renewed paranoia. In any case, psychotherapy is helpful, in which the patient’s current life situation is also explored. Here it is important to determine where illness triggers are hiding and what lies behind the paranoid thoughts. Regular meditation and breathing exercises are further ways of combating delusions. Tapping acupressure (EFT) is also recommended as a self-help measure. It helps against emerging fears, stress or panic attacks.