CLINICAL
Childhood
The problems begin about three or four years by communication
difficulties. There is a shyness with adults and other children. The child fled
the confinement or contact instability. The anguish of separation from the
mother are part of an ambivalent and sometimes hate. The father is not present
and the child tries to avoid it. There may be significant and uncontrollable
anxiety that manifests itself in night terrors various fears. Found inadequate
educational attitudes and malicious.
Later, around school age appear like symptoms that are actually phobic
fears related to archaic mechanisms. There is no intellectual impairment and
learning outcomes are not disturbed. Aggression and jealousy are strongly
present at this age and occur vis-à-vis the siblings or classmates. These
children are unhappy with their grades in school, the attitude of parents and
educators, they consider unfair to them. Insignificant facts are magnified and
blown up.
In adolescence, the stiffness begins to manifest itself. These are young
people complying with strict regulations, not admitting contradiction. Authoritarian
and tyrannical vis-à-vis their peers, they profess strong opinions and
irrefutable adopt political causes with fanaticism. The downward trend
increases. Relationships with others, especially the opposite sex are difficult
and conflicting. These young people demonstrate a moralism outrageous. They
hide behind religious beliefs, rigid principles.
The paranoid style is manifested in adulthood and it becomes quite easy
to spot, because the clinical features are marked.
Character
The subject is likely, he has a hard character, authoritarian, and
sometimes delirium.
Some traits are characteristics: pride, distrust, susceptibility, stiffness,
unrealistic and false judgment. The paranoid is proud and sometimes
contemptuous of others, because he considers himself superior. Aggression is
important indirectly expressed by a hint of contempt, or directly as about
unpleasant insults. Distrust and suspicion are systematic. The subject is
expected to diminish, or other exploit and always feared an attack from them. He
questioned the honesty and loyalty of his family, he is almost always jealous.
The paranoid feel easily despised, he fears that he disrespect and
sometimes imagine when this is not the case. Likely, it is intolerant remarks
and criticisms. Disagreement, an unfavorable judgment of others, triggering
anger and resentment. Prestige and social titles, filiations famous real or
fictional attempt to compensate for this weakness. The paranoiac is rigid and
self-criticism. Hard with himself and with others, he has unwavering opinions. The
journalistic term "groupthink", is well suited to describe his way of
thinking: it is the only one able to exist and everyone should join. At no time
the subject can take a critical distance from him. For the paranoid, the world
is obviously and immediately as he thinks.
Lines and relationships
The paranoid gives meanings to behaviors that do not, it casts doubt on
others and idealizes a false judgment characteristic. This leads to
inappropriate attitudes to the situation raise perpetual conflict. Despite a
first glance remote tension in the relationship is fast.
The activity of the individual is normal and sometimes important. It may
even have a social success as spectacular adaptation of paranoia is often
excellent. It disappears only when it is invaded by delusional concerns. In the
usual hierarchical relationships, it is hard to inferiors, respectful and
obsequious to superiors, and competing aggressively with peers. It seeks to
dominate and move up the hierarchy. The subject can seriously harm and without
remorse to those he considers his enemies or rivals (for slander, premeditated
vengeance).
Sexualized as a referent object, the other is seen as very different
days. It is sometimes perceived as being very good and ideal, sometimes
completely wrong. There is little regard for its own characteristics. There is
also a desire for omnipotence which is to control, manipulate, use, object-referent.
The relationship is burdened by jealousy.
Rationalism and delirium
Rationalism is powered by constant interpretations. It implements a
dogma argued by an avalanche of arguments and reasoning assertive entirely at
the service of the premise. The themes are ideological, political and social (social
protest, racism, death penalty) or relate to the environment (neighborhood, spouse).
Rationnalisantes these trends are sustainable. The facts are interpreted, writhe
about to give a convincing demonstration.
Rationalism sometimes turns into a frenzy as the dogma becomes constant
and unwavering. These delusions can soothe and resume spontaneously or become
chronic. They occur in middle age, around 35 to 40 years. Delirium is a
delirium sector, systematic, credible and convincing. It feeds interpretations (as
fact, such a word, take an obvious meaning for the paranoid) and intuition (immediate
sense idea that confirms delirium)
The delusional accumulates facts and evidence, and ruminates constantly
nourishes sentiments of hatred against the plunderers. He devises plans to
confuse revenge. Crossing the act related to delirium may take various forms: procedure
assault to murder, separation from spouse. The passage to the act is the
application of delusions and follows the feeling of growing hostility in the
world, especially persecutors.
¤ Delusions of claim relate to neighbors,
family, entrepreneurs, doctors, employers. This delusion can take the form of
pessimism. After an accident, the paranoid claiming compensation, disability
pension or annuity. Harasses social security experts responsible for the
accident, lawyers, doctors. In the delirium of persecution the patient is
convinced that a conspiracy was directed against him. Any word or act outside
is interpreted according to the delirium that can lead to violent acts.
¤ Delusions of jealousy for the spouse
or an acquaintance. Every look, word, or delay, is interpreted as evidence of
infidelity. This is often the spouse who is desperate request. Erotomaniac delirium
usually reaches a woman who feels loved by a third party (often a high social
rank). The starting point can be a look, a word, etc. ... Then the delirium and
organizes the patient builds a story in which she is courted.
¤ Other delusions have organized the
theme of politics, religion, justice. Political extremism in recruiting willing
paranoid.
For details on these delusions, see § "systematized delusions"
in the article on psychotic decompensation in.
The evolution
Middle age brings little change for the paranoid. Traits are accentuated,
become stiff and freeze. The trend is the same delusional. In old age, the
decline of intellectual faculties gives free rein to delirium at the same time
it makes it less convincing and less developed.
Theorizing
The central problem
Difficulties arose around the time of individuation. The object is split
into two objects archaic omnipotent, good and bad and there is a prevalence of
bad object. The relation to the other as object-referent is dominated by fear
and hatred. The relation to the other is not stabilized by law and therefore
persecutory fantasy is always ready to emerge and the projection is greatly
facilitated.
Defensive reorganization occurs during the second structure. Defense
mechanisms like control, retention, désafectisation, ritualization, powerful, erected
a bulwark against anxiety archaic. Remote control and are used to counteract
the lack of separation from the other. Because of overinvestment anal stage, the
homosexual tendency is strong, but it is still suppressed.
Arrived at adulthood, is so fragile, aggressive impulses are important
defense mechanisms of projection type predominate, there is a deficiency in the
function réalitaire. The ego is weak, the superego and the ideal keep an
archaic form. The libidinal fixations are not in the foreground, but the anal
and homosexuality strongly tinged character.
Place of the subject in Scheduling human is not ignored, but it is
uncertain which gives rise to a claim research and intense search for a site
compensatory social (valuing prestigious positions) or even a genealogical
research delirious descent.
Father and archaic superego
The paternal function and relationship to the law is distorted. There is
a lack of integration in the sense of well-tempered assimilation rules. In its
place there is an overvaluation of the paternal imago, poorly differentiated
and omnipotent. The ideal and the superego are archaic related to this imago
and invested by the deadly instincts. They are the custodians of an arbitrary
order powerfully idealized producing totalitarian demands. This set forms a
rigid binding instance archaic fed a parental imago very powerful and
terrifying. It causes the "groupthink", which it is not possible to
derogate for instance invades psychic functioning and I can not play any
regulatory role. On the other hand waive subject to sanctions terrible and
cause enormous stress.
Narcissistic disorder
Primary narcissism and relationship to the world organize themselves
pathological. The existence, the sense of being, as is the independence from
the mother, but in a defensive manner, as hateful aspects dominate the
libidinal aspects. Relation to the world is organized in a hostile fashion. The
child, not having a good protective idealized object, is organized defensively
against other always suspected of being hostile. Empowerment is based on a
decline and stabilization hate narcissistic remains uncertain. Primary
narcissism is a defensive expensive furnishings.
Concerns and wacky themes can all be related to a narcissistic injury. -
Harm: The subject feels that he is injured in an existential sense. It will
seek to show harm in looking for all occasions, whether practical or moral. Jealousy
is also in this vein: the subject thinks that her husband is cheating, but it
is especially wrong. - The size unknown: The paranoid safe value and
superiority think it is despised. In all cases is, he feels that his being and
value are basically attacked ... which is just about psychopathology. He will
try all his life bearing on the mode of delusional projection the original
narcissistic wound.
Dominates the projection
Delirium is a decline in function réalitaire, but also the importance of
projective mechanisms for adaptation to reality is far from being compromised. It
is sometimes put at the service of delirium. The initial intuition is made by
any concerns of the paranoid. The projective mechanism psychotic tendency
specific topic is assigned to another project in general aggressive: he does
not like me, he wants to hurt me. The contribution of delirium secondary
benefits: Finally there is evidence of injury. The contradiction between
certain damage but nonexistent subsides and more aggressive impulses are
finally expressing themselves. Delusional themes refer to the narcissistic
injury compensation and its megalomaniac.
Psychotic projection is a defensive mechanism archaic. She is steadfast
and very specifically for an active tendency of the subject and immediately
placed him outside in what is the reality for him. The psychotic plans which
belongs to him and he can not recognize. Moreover, the mechanism generates
absolute conviction. In jealousy is the homosexual tendency and projected that,
in the persecution is the sadistic streak. We see that the function is not
abolished réalitaire is how I use it to change: it is more the offsetting
change in the fantasy, it is put to its service. Moreover, the judgment of attribution
fail: the outcome of this trend can be recognized and attributed to himself, so
it is assigned to what is outside oneself (to others or reality in general).
CLINICAL FORMS APPENDICES
Sensitive form
Paranoia itself generates intermediate sensitive to the shape distanced
we'll see then. The term comes from Kretschmer who described three types of
paranoia: the paranoid combat, paranoid and paranoid sensory desire. Kretschmer
invented this clinical form after connecting the character "sensitive"
to paranoia. Sensitive form is characterized by a milder character, a female
and sometimes delirium network. This is an opportunity to pay tribute to the
author who first connected the character and all of the subject's life at
critical moments (crazy). It is the precursor of the idea of decompensation.
Sensitives are sensitive to the reactions of others, easily hurt, fleeing
the contact. Fear leads to the establishment of a distance from others, perceived
as hostile, which provides a protective search. The subject is on the alert, fearing
not to be respected, to be attacked. Without feeling persecuted frankly, these
topics have the impression that cares about them in a way that is excessive in
their eyes and not caring. Generally dominates inhibition timidity relationship
difficulties. The person has a sense of fragility and weakness. She fears not
know how to answer, do not know how to fight. She sees herself as superior
while having a sense of inferiority one self-deprecation. There is a mixture of
pride and humility. Something painful enough to trigger delirium (a look
unpleasant, a haughty attitude, a little prejudice).
On a theoretical level we can say that aggression is weaker and tends to
turn against itself. Characterological defenses are less pronounced. Failure to
meet the requirements of the ideal body archaic superego mixed and impose them
on others results in a return of aggression against self and depressive
tendency. On the other hand, these requirements exhausted by their binding. Sensitive
paranoia can be considered as a transition with psychotic distanced form.
Paranoid type reactions
Sometimes you see these symptoms and traits appear transiently in other
psychotic personalities or boundaries. This is called paranoid reaction. In
cases of paranoid reactions, there are often circumstances triggering real (prejudice,
rudeness, etc.).. They lead the certainty of having been prejudiced or misled. It
follows will repair and revenge. The desire for revenge triggers different
behaviors of claim whose commitment procedures to the authorities for redress. This
way of reacting is favored by chronic poisoning cannabis poisoning and acute
amphetamine or cocaine.
WHAT TO DO
The applicants are not paranoid care on the psychic plane. There are not
psychotherapy and if by chance it was the case, it would not be because of the
indiction projective mechanisms that would hinder it. The psychiatrist usually
meets paranoid during treatments somatic delusions or severe requiring
hospitalization or circumstances after expertise crimes.
It must be very cautious and do not give rise to interpretations, which
is sometimes impossible. The words to the paranoid must be very explicit and
free of jokes or double meaning. It is useful to protect themselves using all
possible legal and institutional guarantees: scrupulous procedures, safety
rules. It may be helpful to be accompanied by another caregiver.
In forms delusional dangerous it is sometimes useful to use the police
and the judiciary. It is a rare occasion that paranoids are psychiatric
inpatients either HDT or by HO. Neuroleptic treatment can temporarily alleviate
aggressive and reduce delirium. The paranoid is generally believed that hospitalization
is abusive. In it, he tries to alert the public and the authorities, and after
he tries to initiate a procedure vengeance.
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