Elderly Paranoia and Rational Fear: Distinguishing Between the Two

Mar 19th, 2011 | By Sharon Shaw Elrod MSW EdD | Category: Lifestyle, Health & Fitness

Grandma is convinced her offspring are stealing her money.  Uncle Fred lives in an assisted living facility and recently complained about missing some items from his room.  Dad and Mom are afraid of neighbors living in public housing down the street.  How can you distinguish between elderly paranoia and reasonable fear of something that is real in the lives of senior citizens?

Most of us are neither educated nor trained to identify the difference between paranoia and fear, let alone to understand what each one really is.  Some guidelines are helpful:

  • Paranoia is thinking that results from anxiety and fear that is exaggerated.  The clinical definition includes psychosis, that is, a mental disease process in which the individual is not in touch with reality.  People who have paranoid thoughts are usually delusional and irrational. They generally think someone or something is out to get them in one way or another (e.g., stealing my money, hurting me, talking about me).    Paranoia is an irrational state of mind and needs to be addressed by a behavioral health specialist trained in the treatment of mental and emotional health issues. Medication and psychotherapy are the two most common courses of treatment for a paranoid person.
  • Fear is an important and helpful defense mechanism.  This emotion creates internal distress and propels us to do something to alleviate the distress.  If the fear is strong enough, we employ the fight or flight response to lower the distress.  We humans need fear in our lives in order to survive.

It is really important that we not dismiss either of these thinking/feeling processes in our elderly loved ones.  Mistaking paranoia (delusional thinking) for something real could be catastrophic.  And the same is true of a fearful aging person.  And believing a senior’s irrational thoughts can bring a lot of unnecessary drama to the stage.  Both fear and paranoia are behaviors that need to be seen as signs that require questions, investigation and an appropriate course of action.  The cautionary advice here is this: Do not ignore either!

The next article in this series talks about what to do with a loved one who has paranoid thinking.  Guidelines help us figure out what our response needs to be.



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  1. [...] paranoia and fear in senior citizens, particularly older seniors.  The first article dealt with distinguishing between paranoia and fear; the second talked about paranoia and avenues for caretakers to deal with and manage it.  This [...]

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