1. Sensitive delusions of reference
This type of delusion, by far the most frequent, has the systematized symptomatic form of paranoia. It consists of systematized delusions presenting a mode fairly similar to that of obsession with obsessive ruminations that are very often repeated. It is “non-dissociative”, i.e. the delusional mechanism is mainly interpretive: the subject with sensitive paranoia perceives the events correctly but interprets them incorrectly. Consequently, these delusions do not belong to the group of schizophrenia. For example, the words or acts of other people are interpreted as a sign of contempt or a threat. The subject with sensitive paranoia subtly constructs delusional ideas in ramified and ingenious combinations, interpreting everyday conversations, snippets from newspapers, unusual attitudes of family or friends.
According to E. KRETSCHMER, delusions of reference are organized by a psychopathological mechanism of “conscious retention of a group of strongly emotionally charged representations”, for example concerning ethical and sexual or work conflicts. This retention maintains a state of physical tension “isolated from consciousness”, which induces affective slowing like “a parasitic body”.
Sensitive paranoia is very different from the other forms of paranoia (passionate or interpretative) in terms of its rapid reaction to easily detectable adjacent events, its asthenic nature and the absence of querulousness.
The themes of the delusions are mainly recurrent and can comprise:
- ideas of persecution, contempt, humiliation or the belief of being watched
- insults to the subject’s moral or religious values
- conflicts of conscience between the subject’s moral or religious values and sexual practices
- subjects with a depressive connotation
In contrast with schizophrenia, sensitive paranoia described by E. KRETSCHMER comprises little or no auditory or visual hallucinations. However, as we have seen, patients with the “unstable delusions” described by J.M. SUTTER and J.C. SCOTTO can present this type of hallucination.