I Think My Wife is Paranoid and Delusional

Reader’s Question

I think my wife is delusional and paranoid. She believes she is being followed by a woman (who she says is my girlfriend) as well as this woman’s friends and family. None of this is true. She also believes that these people call her a shoplifter and other derogatory things. My wife even claims that she has seen me having sex with this women in our home. This is also preposterous. She will point out a car and say that it’s this woman even though it would be impossible to tell. This has been going on for more than 20 years but has become worse in the last 1 or 2 years. I try to point out the improbability of all this, but she won’t hear any of it. Is there any thing I can do? Life is almost unbearable already and she is getting worse, but I really don’t want to walk away.

Psychologist’s Reply

Of course, an accurate assessment of your situation is not possible without direct knowledge and more information. But the information you provide is congruent with a fairly rare but well-known condition called Delusional Disorder. The most essential feature of this disorder is the presence of one or more delusions (false beliefs) that are not attributable to the action of a substance, severe mood disturbance, medical condition, or other mental disorder like schizophrenia (although the incidence of Delusional Disorder is higher if there is a family history of schizophrenia or other serious mental disorder).

There are various subtypes of Delusional Disorder, including the “Jealous Type.” In the Jealous Type Delusional Disorder the themes center around the belief that one’s partner has been or is being unfaithful. Sometimes the delusions remain confined to a particular subtype. Other times, the themes of delusions can expand to other types.

Although the false beliefs associated with Delusional Disorder necessarily affect a person’s family, occupational, and social life in a negative way, the disturbance in functioning is not as severe as is common to individuals with more serious disturbances of their thought processes. Generally speaking, the false beliefs do not cross the line into actually seeing things or hearing things that aren’t real (i.e., hallucinations), but under stress, individuals with Delusional Disorder might appear more psychotic. Further, individuals who are chronically afflicted with the disorder can develop more serious psychiatric illness over time.

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Because some medical conditions can cause brain dysfunction and produce symptoms suggestive of delusional disorder, it’s always a good idea to have the person receive a comprehensive medical evaluation. A complete psychiatric evaluation would be the next step. There are some chemical and non-chemical treatments available to help individuals who suffer from delusions. Besides that, spouses and other family members who endure the stress associated with the disorder often benefit greatly from their own supportive counseling and guidance. You indicate that you don’t want to walk away from your marriage, but you also indicate that you’ve had to deal with this problem for a long time and it’s getting worse. Help is available to you. It might take some coaxing to get your wife to agree to it, as it is common for the afflicted party not only to be in a state of denial with respect to their own odd behavior, but also to mistrust the motivations of others. So, discretion has to be used in approaching the issue. An experienced mental health professional can give you some guidance on how to set the appropriate limits and frame the issues in a manner that increases the likelihood that your wife will be amenable to the assessment and treatment needed.

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