Emergence of the disorders

Sensitive delusions occur gradually in a subject with sensitive personality following exclusion or lack of consideration by friends or family. This exclusion or lack of consideration can sometimes appear derisory, but it seriously hurts the self-esteem of these highly sensitive subjects, who eventually reach the conclusion of a feeling of worthlessness and humiliation by their family and friends.

The humiliations experienced can, for example, concern the work environment or may be related to inner conflicts, conflicts of conscience concerning sexuality (bad conscience, homosexuality, infidelity, masturbation, etc.). In every case, they lead to self-depreciation, and the subject, in order to protect himself from the strong mental pressure, by an inversion characteristic of subjects with a sensitive personality, then attributes the criticisms or pejorative allusions to other people.

This humiliation is going to affect all of the sensitive subject’s being and the subject then continuously conducts an elaborative testing of his/her own status in relation to other people in the form of ruminations. These ruminations constitute an attempt to compensate a devalorized self-image (humiliation). They are the expression of the central and literally vertiginous question for subjects with sensitive personality, i.e. “being good enough”. Ruminations are all the more persistent in that subjects with sensitive personality are characterized by a painful withholding of affects. They can hide behind sulking, incomprehensible passivity, and all sorts of unjustified resistance.

Following resolution of the first delusional episode, when the subject is able to critically analyse the previous delusions, it is important for somebody to choose the right moment to cautiously ask the patient, with considerable empathy, to reveal, with a maximum of details, the origin and nature of the event that triggered this episode.

On the one hand, being able to calmly talk about the experience helps to considerably decrease the mental pressure experienced by the subject and reduce the event to its true level of seriousness.

On the other hand, detailed knowledge of the conditions in which the delusions emerged is very important for the psychiatrist, who can then establish a differential diagnosis with respect to other disorders.