Course of the disorders

Patients with sensitive paranoia must be regularly followed by a psychiatrist. The information provided below cannot replace a medical opinion, but is based on all of the experiences reported by patients with sensitive paranoia. Although there are many different types of sensitive paranoia, they nevertheless share many points in common. This exchange of experience is very beneficial for all.

1. A difficult diagnosis

The diagnosis of sensitive paranoia is generally difficult to confirm. Some patients sometimes wait many years before the right diagnosis is established. Kretschmer wrote [1]: “In any event, to detect these cases, it is generally necessary to examine them in detail, which takes a lot of time. It is also necessary establish a psychotherapeutic affective contact with these patients. The usual processes of description used in superficial psychiatry will never be able to reveal sensitive delusions of reference. It is therefore easy to believe certain authors when they say that they have never encountered this syndrome.”

This diagnostic difficulty is increased by the fact that cases of sensitive paranoia are fairly rare and their features are therefore not well known.

The polymorphic appearance of sensitive paranoia also complicates the diagnosis: the disorders may present in the 4 forms described by Kretschmer, but also in the related forms described on the home page.

The resemblance with other disorders makes the differential diagnosis particularly difficult.

It is especially difficult to distinguish the acute dissociative delusions of sensitive paranoia from those of schizophrenia. On this subject, Kretschmer wrote [2]: “Serious prognostic difficulties are observed in cases in which “schizophrenic reaction” mechanisms are observed at the culminating point of sensitive disorder, before subsequently resolving without a trace.” This similarity between these two diseases is dangerous, as these two disorders must be treated by different drugs, as we will see below.

Finally, the difficulty of establishing the diagnosis is further increased by the tendency of sensitive subjects to deny their disorders, as indicated below.

2. Tendency to denial of the disorders

Subjects with sensitive paranoia generally have an ambivalent and changing opinion on their disorders.

In the less severe cases of paranoid neurosis, the subjects may acknowledge that they have ideas of persecution, but without accepting medical attention or drug treatment. However, they sometimes also accept to take treatment.

In more severe cases of delusions of reference or acute delusional disorders, subjects with sensitive paranoia are persuaded that everything is fine and that it is other people who want to harm them. In this case, they do not accept their disease. For example, they may lie to the doctor for months by pretending that they are taking the prescribed medication. They may also deceive the nurse who wants to check that they have taken the medication by hiding it under their tongue and subsequently spitting it out. They sometimes think that the doctors are “false doctors”, who really want to harm them.

Family and friends have an important role to play. They must ensure, as reliably as possible, that the patient with sensitive paranoia takes his/her medication. When this is not the case, they must inform the doctor and request hospitalisation if necessary. Subjects with sensitive paranoia can go for several months without taking their medication and without experiencing any delusions and are therefore able to convince themselves that they are not mentally ill, and that they are perfectly well without medication. However, the delusions will very probably relapse. Relapses must be prevented by continuously taking medication, because, as indicated by Kretschmer, the body progressively becomes accustomed to relapses (see paranoid neurosis).

Denial of the disease prevents satisfactory adherence to drug treatment and therefore constitutes an almost insurmountable obstacle to stabilization. It is often difficult to convince a subject with sensitive paranoia about the reality of his/her disease. Acceptance of the disease obviously means accepting a severely devalorized self-image, which damages the subject’s very high self-esteem. The very marked distrust of these subjects also leads them to believe that medication will change their personality, which is only one step away from believing that healthcare personnel and their family and friends who encourage them to take their medication actually want to harm them. For these more or less conscious reasons, these subjects do not want to acknowledge their disease.

However, there is a special time at which subjects with sensitive paranoia are more receptive: following an acute delusional episode. At this time, subjects with sensitive paranoia clearly remember their delusions and gloomy thoughts that made them suffer for days on end. They are very aware that medications, instead of annihilating them, restored a certain equilibrium and enjoyment of life. The psychiatrist and family and friends must take advantage of this special time to very tactfully show the patient that medications were able to restore their true personality. The patient must be convinced without making him angry, these subjects are highly susceptible. After several months, there is a high risk that the subject will have forgotten all of this advice and will stop treatment without telling anyone.

1.Paranoïa et sensibilité, 3ème édition ,1963, PUF, page 12
2.Ibid. page 6