A person obsessed with delusions of persecution: how to deal with it and how to help the patient?

Some psycho-emotional disorders lead to a person losing contact with the real world. An imaginary distortion of reality provokes the emergence of various manias and phobias that completely change people’s lives, plunging them into a world of fear and endless stress. The most common type of obsessive disorder in psychiatry is persecution mania.

Persecutory mania is one of the most common mental disorders

Meaning of the concept

Doctors call this disease another name: delusion of persecution. Manic behavior is based on the so-called crooked logic and manifests itself in the fact that a person begins to perceive the surrounding reality in a distorted form, which is why he ceases to lead a normal life. As a result of a psycho-emotional disorder (insanity), he develops manic ideas that completely control his consciousness. Moreover, any attempts to prove to the patient that what is happening is completely invented by him and exists only in his imagination are completely ineffective. The pathology manifests itself as follows:

• a person replaces reality with fictitious facts;
• there is a violation of adaptation to normal life: the patient cannot continue his usual life, do work, or communicate with other people;
• a panic state begins, which is a symptom of a serious mental disorder, and not a manifestation of a person’s imagination.

For many years, persecution syndrome has been comprehensively studied by doctors from around the world. For example, the Russian physiologist Ivan Pavlov believed that the main cause of the disease lies in the disruption of the brain, and if the disease makes itself felt, then it can no longer be cured - the person will have to live with this diagnosis all his life. Acute attacks of the disease alternate with a state of remission, when the patient briefly regains consciousness and can lead a normal lifestyle.

According to data released by American psychiatrists, 15% of the world's population is susceptible to manic thoughts. If a person susceptible to this dangerous condition does not take any action and does not begin treatment, then after some time he may develop a real persecution mania. According to WHO (World Health Organization) experts, there are more than 40 million people living in the world with this diagnosis. The disease is more often recorded in Western European countries and the United States of America.

Classification of psychoses in old age

Doctors distinguish between acute and chronic forms of the disease. Provocateurs can be any abnormalities in the body. Let's look at the most common factors that can lead to temporary or permanent aggression in an elderly person.

Vitamin deficiency

This is a condition when the body does not receive a whole group of vitamins. Many people think that they are not at risk of deficiency of biologically active substances. But their deficiency manifests itself unnoticed, and external signs are erased and non-specific.

The following symptoms are often confused with symptoms of other diseases:

• Fatigue during sports or physical work.
• Sleep disorders.
• Loss of appetite.
• Frequent mood changes.
• With a slight injury, bruises and bruises immediately appear.
• Ulcers and cracks form in the corners of the lips.
• Overweight.
• Hair falls out on the head.
• The plates on the fingernails become brittle and peel.

It was mistakenly believed that vitamin deficiency occurs only in the spring, and at other times of the year the body stores them for future use.

However, the reasons for year-round nutrient deficiencies are:

• Monotony of products from which the same dishes are prepared.
• Eating large amounts of fast food, pickles and marinades.
• Bad habits, in particular smoking.
• Long-term use of medications, such as antibiotics.
• Using birth control pills for a long time.
• Past infections.
• Incomplete digestion of food, which leads to constipation or, conversely, diarrhea.
• Improper cooking.
• Passion for fashionable diets that lead to sudden weight loss.

Chronic diseases of the bronchopulmonary system

At the moment, diseases of the bronchi and lungs in older people are leading. This is due to the natural involutional restructuring of the respiratory organs in old age. Unfortunately, such changes lead to the fact that the citizen is susceptible to respiratory infections. In addition, he develops hypoxia (chronic lack of incoming oxygen) or an increase in residual air in the lungs. And against the background of dementia, Alzheimer's disease or senile psychosis (atrophic changes in the central nervous system), the cough reflex may decrease. And the weakening of the strength of the chest muscles affects breathing.

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Heart failure causes age-related senile psychosis in the elderly

An acute form of mental fog can occur due to a lack of oxygen supply to the cerebral cortex. In this case, the neurons responsible for mental abilities die off.

Thyroid diseases

To make a diagnosis, the doctor conducts studies of the endocrine glands. Laboratory testing will help identify hormonal changes. The severity of intellectual abilities depends on how affected a particular gland is.

Development mechanism

This disease is one of the most severe in psychiatry. It was first recorded in the middle of the 19th century in France. According to doctors, who classify persecution mania as real paranoia, the disease develops in older people.

In this painful state, a person is overcome by real paranoia. Any action, even the simplest, can cause fear and suspicion in the patient. It seems to him that the food his relatives offer him may be poisoned, so he refuses to eat. He stops leaving the house because his pursuers are waiting for him on the street, and the attackers are waiting for an opportunity to rob and kill him. Very often the patient feels that he is being persecuted, and he strives to get rid of surveillance. Any event, even the most insignificant, can be perceived by the patient as dangerous, causing harm to his life. The person becomes extremely suspicious and agitated, and is suspicious of the people around him, including family members. As a result of the disease, the psyche suffers greatly, which cannot withstand constant stress, anxiety and fear.

People possessed by obsessive ideas write angry letters and complaints to various official authorities in order to punish and bring to justice all kinds of violators.

In this state, a person becomes extremely distrustful and suspicious, may fall into a state of aggression, be subject to frequent bouts of irritability and anxiety, and completely lose the ability to realistically assess what is happening.

Sometimes the disease develops completely differently. A person suffering from an obsessive disorder outwardly behaves completely normally, and those around him cannot even suspect that something is wrong with him. In this case, paranoia eats away at the patient from the inside, but he manages to reconcile his fears with the surrounding reality.

Paranoia is a complication of persecution mania

Stages of development of delirium

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Delusions of persecution go through several stages in its development:

1. Delusional mood. Most often, this is an all-consuming anxiety, which is expressed in a feeling of approaching danger, the source of which cannot be determined.
2. Delusional perception. In a state of anxiety, a person begins to explain certain events as confirmation that he is in danger.
3. Delusional interpretation. Absolutely all occurring phenomena are explained as if someone is pursuing a person.
4. Crystallization of delirium. Ultimately, a person brings his delusional ideas to perfection. His thoughts form a coherent, albeit paralogical (this is a term in psychiatry in which a person builds conclusions on weak signs) system.
5. Attenuation of delirium. As treatment progresses, the patient begins to criticize delusional ideas. This suggests that the patient's mental health is somewhat restored.
6. Residual delirium. These are residual delusional ideas that go away on their own over time, as the person has learned to control them.

Causes

In most cases, people who do not know how to be critical of themselves and believe that everyone is to blame for their failures in life, but not themselves, are susceptible to paranoid thoughts. In addition, this disease more often affects the fair sex. This is due to the fact that the nervous system of women is more excitable and vulnerable than that of men. Strong experiences can lead to obsessive thoughts, which can lead to persecution mania.

Psychiatrists still cannot say exactly what factors lead to the development of the disease. Some believe that the main reason is brain dysfunction. Others are of the opinion that diseases of the central nervous system at the cellular level are to blame.

Despite the endless debate, experts still identify several main factors that influence the occurrence of the disease. There are a number of reasons for the appearance of persecution mania.

1. Genetic predisposition. If the parents had serious mental disorders, then they can be passed on to their children and become the cause of this disease.
2. Prolonged stress and constant anxiety. Stressful situations can trigger paranoid thoughts, which over time turn into obsessions. A person suffering from persistent anxiety is in a state of constant tension; any life situation seems dangerous to him and causes fear.
3. The causes of persecution mania also lie in frequent psychoses. During a nervous breakdown, there is a strong tension in the whole body, adequacy is lost - the victim is often unable to remember what he did and said. After such an emotional shock, the body takes a long time to recover, and the person who has experienced a breakdown is very worried. Being fixated on his negative feelings, he can easily go into a state of obsessive psychosis.
4. Violence experienced at any age can become a reason that affects the emergence and development of persecution mania.
5. Senile dementia, which often affects older people, also underlies the emergence of obsessive ideas and thoughts.
6. Violation of the dosage of some drugs can cause hallucinations, and these give rise to delusions of persecution.
7. Brain disorders and head injuries can provoke mental disorders and disrupt the thought process, which is why the patient ceases to adequately perceive reality and develops paranoid thoughts.

The mania in question can be an independent disease, but more often it is a manifestation of schizophrenia. It can also arise as a result of other reasons, among which alcohol addiction and poisoning with harmful toxic substances pose a particular danger to human health. Mania also develops due to irreversible damage to brain activity that occurs during various diseases: progressive sclerosis and Alzheimer's disease.

It also happens that the cause of obsessive states is the progression of various chronic diseases. In order to get rid of the disease and reduce its manifestations, it will be necessary to undergo appropriate treatment that will help eliminate the chronic cause.

The danger lies in the fact that many people treat people with persecution mania condescendingly, not taking the disease seriously and not considering that it poses a health hazard. However, this disease can completely destroy a person's life.

Paranoia (persecution mania)

Persuasive delusions, also called paranoia, can affect men and women. The list of reasons for the onset of pathology states:

• congenital predisposition;
• drug addiction;
• alcoholism;
• injuries leading to brain damage;
• neurological diagnoses, Parkinson's disease, Alzheimer's disease;
• other reasons.

Often doctors are unable to associate the onset of a disease with a specific starting point. Regardless of the patient’s gender, the patient may expect the presence of constant surveillance from representatives of large global communities or simply neighbors. Although there is a tendency for the majority of patients to classify their “controllers” as representatives of the authorities, alien civilizations and other large structures and departments.

The diagnosis is often made in patients in the older age group. Especially those who have suffered a stroke suffer from neurological diseases. In this situation, delusional thoughts more often spread to family members and acquaintances, from the point of view of the paranoid, claiming his property and wishing him death.

Symptoms

A mental disorder manifests itself in the fact that a sick person develops the belief that he is being persecuted (by a certain person or group of people) to cause harm. Since mania develops gradually, over time the patient may develop a new source of danger. Both acquaintances and strangers come under suspicion; even relatives can be included in this “black list”. A person suffering from persecution mania thinks that a conspiracy is brewing against him, in which everyone around him takes part. In addition, the patient can describe in detail the details of how he is being persecuted, which attempts have already been made and which are being planned.

Symptoms of persecutory mania help determine that something is wrong with a person and that he is suffering from a nervous system disorder. These include:

• persistent obsessive thoughts about persecution and threat to life;
• progressive suspicion and suspiciousness;
• endless digging and chewing on the same problem;
• groundless and painful jealousy;
• inappropriate behavior;
• aggressiveness and hatred towards others.

All these oddities in behavior are very noticeable. The pathology is accompanied by impaired mental activity and asociality. A person is afraid to communicate with people, sees everyone as an enemy and suspects a desire to harm him. Frequent symptoms of persecutory mania are insomnia and suicidal tendencies.

The patient’s aggressiveness and suspicion are evident

How to identify symptoms of the disease

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It is not difficult to identify the symptoms of persecutory delusions at first glance, but similar symptoms can also occur in mentally healthy people. The main difference between a phobia and delusion is the presence of criticism of one’s ideas. Although at the moment of exacerbation of the phobia a person may feel that he is in some kind of danger, as the emotions subside, criticism returns.

Persecution mania - fear of surveillance

Also, with a phobia, a person is afraid of the possibility of persecution, while with delusion, a person sincerely believes that he is being spied on at the moment.

Thus, to define persecutory delusions, the symptoms must be:

1. The belief that the patient is being monitored for the purpose of harming him. People you don't know well may be suspected first, then family members.
2. Lack of criticism of your ideas.
3. Relying on weak signs. Conclusions are based on those features that do not allow one to come to this conclusion with normal thinking. Example: “Criminals are mostly men. This person is a man. So he is a criminal." This logic often occurs in women with this syndrome.

Attention! Other symptoms are possible, depending on the underlying disease. To define delirium, all three symptoms must be present.

Diagnostics

Diagnosis of persecutory delusions includes a clinical conversation, observation, and pathopsychological testing. It is important to distinguish the disease from a phobia by checking the patient for criticism of his thoughts, and also to establish existing thinking disorders.

A good technique to help make this diagnosis is a pictogram. Initially, it was created to study mediated memorization, but after some time it began to be used to detect thinking disorders. The essence of the technique is simple. The subject is asked to remember a list of words that he must sketch in the form of symbols on paper. In the future, these pictures should help a person remember the right word.

Persecutory mania is a common symptom of schizophrenia.

In this case, words can only be sketched; written or numerical notes cannot be made. What is important is a person’s ability to remember a word from a drawn symbol, and the reasons why he chose this particular symbol. A person with a thought disorder often uses their delusional associations or draws pictures based on weak signs.

At the same time, the patient is not told the real purpose of the study. We can say that it is tested how it is easier for a person to remember: with the help of images or by ear.

When analyzing an image, you need to pay attention to:

1. Abstract term or concrete.
2. How significant is this image for the person being studied?
3. What does the picture mean?
4. How often do healthy people choose this particular symbol.
5. How adequate is the image?

To interpret the results, you should pay attention to the following criteria:

1. Is a person able to find a generalized image that is indirectly associated with the named word?
2. How adequate are the associations?
3. How easily and efficiently a person can name a word from a picture.

Treatment methods

An unstable mental state can harm not only the patient himself, but also those around him. A person who has been diagnosed with persecutory mania necessarily needs treatment in a hospital under the supervision of a psychiatrist.

Many doctors express the opinion that it is impossible to cure this disease forever. Today there is no universal medicine that would help restore a shattered psyche, remove fear and suspiciousness. Please note that treatment of persecutory mania with medications is carried out only after examination and consultation with a specialist.

1. Patients are prescribed psychotropic medications that help relieve anxiety, worry, fear, normalize sleep and do not suppress the psyche. Neuroleptics help overcome delirium, antidepressants improve mood and stabilize the condition. Among the latest generation of medications are Triftazine, Tizercin and Etaperazine.
2. Doctors also resort to the use of electroconvulsive therapy, i.e., electric current is used to treat the disease. This method is used only if others have not produced any results, and only with the consent of the patient’s relatives, since after such therapy a person may lose his memory.
3. If mania is a consequence of schizophrenia, then insulin therapy can be prescribed, which, according to some experts, prevents the disease from progressing. The patient is specially put into an artificial coma, and then returned to consciousness using a glucose injection. Since this method of treatment is very dangerous for the patient’s health, it is used extremely rarely.
4. Psychological methods are also widely used in the treatment of persecutory mania, since they help a person to better adapt after returning to normal life. During individual consultations, the psychotherapist helps the patient remove fear and mistrust, and suggests how to interact with people so that it does not cause stress.

After a person suffering from paranoid thoughts is discharged home, he may need the help of a social worker who should provide patronage support for him. During this period, a lot depends on family and friends. Without their understanding, support and a friendly environment in the home, the period of remission can end very quickly.

Use of psychological methods

The use of psychological methods can completely help get rid of phobias and anxiety disorders accompanied by fear of persecution, and significantly reduce the severity of symptoms in the case of delirium. The main psychological method for treating persecutory delusions is cognitive behavioral therapy. Delusion of persecution is a destructive mental state in which a person is pathologically convinced that he is being watched and they want to harm him.

Rules of behavior with the patient

Psychotherapists give several basic recommendations on how to behave correctly if you live in the same house with a person who has persecution mania.

1. It is necessary to develop a clear position and understand that your relative is not to blame for being sick, he does not even realize it. Such patients are no different from any other people who have problems with the heart, hearing or vision - the disease is not their fault, so there is no need to get irritated about it. It is also necessary to understand that your relationship determines how your relationship with the patient will develop, and the conditions under which the process of treatment and recovery will take place.
2. You must always be prepared for the patient’s mistrust and hostility, and for this it is important to maintain composure, not raise your voice, and be friendly.
3. It is important to understand that this disease is incurable, so living all the time in the expectation that the situation will change and suffering from the lack of change is wrong. Although it is not easy, you need to accept the situation with the disease as it is, and then you will definitely be able to help your loved one.

The disease is incurable, so you shouldn’t expect changes for the better

Diagnostic methods

Persecutory mania, the symptoms and signs of which must be known in order to contact a specialist in a timely manner, is diagnosed by a psychotherapist or psychiatrist (if drug treatment is necessary).

When the first symptoms appear, you must consult a doctor for a correct diagnosis and comprehensive treatment. The examination is often carried out together with a loved one of the patient, who will be able to adequately tell the doctor about the observed symptoms in cases where the patient has lost a sense of reality and is unable to critically assess his disorder.

The following types of diagnostics can be used during the examination:

• Observation. First of all, during a consultation with a specialist, the doctor evaluates the patient’s behavior. Most often, among the observed features one can notice stiffness, uncertainty, suspicion and isolation of the patient. In severe stages of the disease, the patient refuses to trust the doctor, listens to extraneous sounds, and asks to close the doors and windows in the offices.
• Conversation with a psychotherapist. With direct contact between the patient and the doctor, data is revealed about the patient’s mental state in the past, the presence of concomitant diseases, and possible drug or alcohol addiction. The specialist also considers the option of real persecution, analyzes situations (if any) in the patient’s life related to debts, revenge and crimes that could become a real basis for persecution. During the conversation, the patient is most often very distrustful and suspects the doctor of colluding with his enemies.

• Testing. Psychological tests help study the patient's cognitive functions and personality states. Such tests include the Minnesota Multidimensional Personality Questionnaire, which examines individual characteristics and mental states of an individual. Also included in the diagnostic method is the Cattell multifactorial questionnaire, which consists of 187 questions and identifies personality traits, inclinations and interests. In addition to the questionnaires, there are interpretation tests, drawing tests, tests of thinking and memory. A thematic apperception test is useful in diagnosis, which identifies internal conflicts, drives, interests and motives of the patient. The patient is offered black and white drawings, most of which depict people in everyday situations. Based on the images, the subject comes up with a story for each picture, tells what the characters in the picture think and feel, what they want, what led to the situation depicted in the picture, and how it will end. The patient's responses are recorded verbatim and analyzed by a specialist.

Bottom line

Persecution mania is a serious psychological disorder. Sometimes, suffering from obsessive ideas and thoughts, a person can maintain a normal lifestyle, achieving significant success both in the personal and professional sphere.

If this painful state develops into psychosis, and then into real mania, the person changes beyond recognition, becoming aggressive, nervous, suspicious and suspicious. In this state, he can become dangerous to the people around him.

People with persecutory mania require medication and mandatory medical assistance. Although the disease cannot be completely cured, achieving stabilization of the patient’s condition is a feasible task. During remission, a person will be able to return to normal life, will do what he is used to and enjoy it.

Symptoms

As already mentioned, a person suffering from persecutory delusions can live with his problem alone for years. He perfectly understands the falsity of his thoughts and carefully controls his own behavior. None of those around him have any idea about the borderline mental state of such an individual, since everything seems to be fine with him in his personal life and work.

But this happens extremely rarely. Typically, persecution mania manifests itself with the following symptoms:

• suspicion;
• excessive jealousy;
• thoughts about a threat to life;
• suspiciousness;
• strangeness of actions;
• aggressiveness;
• anxiety and panic attacks;
• insomnia;
• mental disorder;
• litigiousness;
• isolation;
• distrust;
• suicide attempts.

The patient is characterized by a constant feeling of persecution and threat. The obsessive state and anxiety are increasing. A delusional mood turns into a mania of persecution, and this is defined as follows: a person can accurately name when and how they began to be persecuted, describe the nuances of the “attempt” and what results it gave.

All this develops gradually, the source of the threat may change: first it comes from a loved one, then it expands to neighbors and other people, and then it acquires “universal proportions.” That is, literally everyone around them is part of the conspiracy.

A person changes personally: he becomes suspicious, aggressive, always tense, commits actions unusual for him and cannot explain for what purposes.

The disease develops in stages:

Stage I. Anxiety appears, the patient withdraws into himself.

Stage II . A person cannot communicate with relatives, go to work, and becomes an antisocial person.

Stage III . The condition becomes severe: boundless fear, depression, attacks of insanity. The patient tries to harm someone or attempt suicide.

The mental state of a patient with persecutory mania in severe cases is very dangerous both for him and for those around him, which requires the intervention of specialists and even hospitalization.

How to behave to others?

First of all, it is necessary to help a sick person understand his problem and convince him to see a psychotherapist. It is very important to find a specialist who will find an approach to such a patient. The success of treatment and the emotional state of the patient largely depend on the level of trust in psychotherapists and psychiatrists.

You should also monitor the intake and dosage of medications prescribed by your doctor.

It is necessary to be patient and try to provide a favorable psycho-emotional atmosphere. There is no need to show excessive anxiety and negative reactions; all these actions encourage retaliatory attacks of aggression.

Relatives of a patient diagnosed with persecution mania should put themselves in the patient’s shoes, so if a person believes that some secret organization wants to kill him, then there is no need to convince him of the opposite.