La classification de la paranoïa dans la psychiatrie américaine contemporaine : une revue de la littérature

Abstract

ObjectiveThe main objective of this paper is to undertake a literature review on the classification of the paranoia in contemporary American psychiatry. MethodThe authors review two facets (“paranoid personality disorder” and “delusional disorder”) of paranoia, still present in the DSM-IV-TR, before their controversial disappearance from the new hybrid model of personality disorders in the DSM-5. The authors present delusional disorder, a clinical entity that is both singularly complex and too polymorphic to obtain any consensus in the scientific community. They then explore some effects of the emergence of the dimensional approach to mental disorders, leading on to the thorny issue of the differential diagnosis between paranoia and schizophrenia. ResultsThe emergence of the dimensional approach in a a-theoretical model that recuses the intrapsychic dynamics that organize the functioning of personality led the authors of the DSM-5 to consider paranoid personality as solely a personality trait, and not as a structural constitution. DiscussionParadoxically, work in English-speaking countries has shown clinical differences between schizophrenia and paranoia, such as social adjustment and prognosis which are better for people with paranoia, although medication therapy and research are more problematic in this case. ConclusionTo improve the care, we think crucial to combine a dimensional approach with markers of intrapsychic functioning, including privileged defense mechanisms, avoiding the trap of the use of self-questionnaires which ultimately appeared inadequate.