Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Suspicion, Doubt, and Paranoia

The term “paranoia” is often used in everyday conversation, often in anger, and most often incorrectly. Simple suspiciousness is not paranoia–not if it is based on past experience or expectations learned from the experience of others. Having doubts and suspicions about how one’s case is being handled is not paranoia. Paranoia is a term used by psychologists to describe suspiciousness (or mistrust) that can be so severe that the individual is incapacitated.

Paranoias can be classified into three main categories–paranoid personality disorder, delusional (paranoid) disorder, and paranoid schizophrenia.

PARANOID PERSONALITY DISORDER: I once had a cardiologist as a coworker. He kept his office and desk drawers locked. He kept no materials on his desk. He wrote notes so tiny that they were illegible to anyone more than inches from the paper upon which he was writing. He was alert to any signs that a case could go badly (law suits) or that he would be open to criticism. This personality disorder was so severe that work as a private practitioner was not possible. He was suspicious, hypersensitive, cold and aloof. He maintained a distance from everyone including his wife and children.

DELUSIONAL (PARANOID) DISORDER: This disorder is characterized by the presence of a persistent, nonbizarre delusion. Delusions are firmly held beliefs that are untrue, not shared by others in the culture, and not easily modifiable. The most common delusion in delusional disorder is that of persecution; others are acting in elaborate plots to persecute them. They believe that they are being poisoned, drugged, spied upon, or are the targets of conspiracies to ruin their reputations or even to kill them. Another theme seen frequently is that of delusional jealousy. Any sign–even a meaningless spot on clothing, or a short delay in arriving home–is summoned up as evidence that a spouse is being unfaithful. Erotic delusions are based on the belief that one is romantically loved by another. Individuals with erotic delusions often harass and stalk famous persons. Individuals with grandiose delusions often feel that they have been endowed with special powers that make them capable of accomplishing monumental tasks such as curing disease. Individuals with somatic delusions are convinced that there is something very wrong with their bodies–that they emit foul odors, have bugs crawling in or on their bodies, or are misshapen and ugly. Delusional individuals are rarely homicidal. Delusional patients are commonly angry people, and if there are victims, they are usually the people who unwittingly fit into their delusional scheme. The person in most danger from an individual with delusional disorder is a spouse or lover.

PARANOID SCHIZOPHRENIA: In contrast to those with delusions of persecution or delusional jealousy, those with paranoid schizophrenia have prominent hallucinations or impossible, bizarre thoughts often with a vocabulary of invented words that they use to describe their incoherent and fragmented concepts. They may hear their own thoughts as though they were external voices. They may believe that they are the son of God or Emperor of America. Those with paranoid schizophrenia are often intellectually disorganized and confused.

What we see in workers’ compensation is fearful and frustrated individuals who accept input from a variety of people. The input does not soothe or calm the patient but, instead, plays on the injured workers’ sense of helplessness and vulnerability. Since they often have no means of dismissing these data, they begin to accept them as accurate. They cease to trust their doctor, their nurse case manager, the adjuster and employer, even their attorney. A late arriving check, a denied test or procedure, even a non-returned telephone call adds to their misery.

The only means of handling this is to be certain that the patient has sufficient documented information to allay their fears. This may include a diagnostic summary, an explanation as to when checks are sent and what may disrupt that schedule, and the reason why a procedure, referral or prescription is not being authorized.

Even if this data does not soothe them, you have documented and reassured yourself that all reasonable attempts have been made to respond to their needs.

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