Extraordinary Health for Busy People

 

Q: I’m concerned about my aunt. She moved back to town last year after her husband died and told me that ever since she moved in, she has caught my stepfather spying through her windows and stalking her when she goes out, so she stays indoors with the blinds pulled most of the time. She has called the police multiple times, and although she has installed security cameras, he has never been seen anywhere near her place. Originally I was concerned that her allegations were true, but I was with him on a family vacation on a day that she was adamant she saw him photographing her through a window. She seems normal otherwise, but her complaints about my stepfather are unfounded and crazy. I am worried about her, and about how the holidays will go with both of them in our house.

 

A: Your aunt may be suffering from delusional disorder. Delusions are firmly held false beliefs despite being contradicted by reality, reason or confrontation with actual facts, eg., a paranoid delusion. These delusions are generally non-bizarre as opposed to those of schizophrenia. For example, although it is possible that someone could be “spying” on her (non-bizarre delusion), it would be impossible for someone to “hear her thoughts” (bizarre delusion).

In delusional disorder, reality is distorted, and an ordinary event may be misinterpreted or misperceived, but in general the alleged situations are either not true at all or highly exaggerated. Their behavior seems otherwise apparently normal.

There are six types of delusional disorders: erotomanic, grandiose, jealous, persecutory, somatic and mixed.

In the persecutory type, the patient may believe that someone is spying on them, stalking them, photographing them, is out to get them, poison them or harm them in some way. They may believe they are being harassed, cheated, maligned or that others are in a conspiracy against them. The delusions can be very real to them and can cause anxiety. They often call law enforcement, or file lawsuits against their perceived persecutors. They have a relentless determination to right their perceived wrongs, and they “may engage in repeated attempts to obtain satisfaction through appeals to the courts and other government agencies.” (DSM IV, American Psychiatric Association).

These patients have no insight that their thinking may be disordered, so do not seek the care of psychiatrists or mental health professionals for this issue. A medical doctor should rule out any medical conditions or medications that could cause delusional thinking, then refer to a psychiatrist for evaluation and to rule out schizophrenia. Treatment with antipsychotic medication plus psychotherapy maybe helpful. Tranquilizers may be useful if symptoms of anxiety or insomnia are comorbid conditions. Hospitalization may be necessary if symptoms are severe or the person becomes a threat to themselves or others.

The earlier the patient gets treatment the better, and the less disruption that may occur in her relationships with your family and in her ability to function.

It is unknown what causes delusional disorder, but stress, social isolation, early dementia, genetics or substance abuse may contribute to this disorder.

 

Marian Wymore is a practicing physician and a freelance writer. She is a regular contributor to the News. To send a health question for Extraordinary Health column, send an email to drmarian@hotmail.com.

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