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Dr. Rossi
Dr. Rossi, Psychotherapist
Category: Mental Health
Satisfied Customers: 4627
Experience:  PsyD, LPC, CHt
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We're concerned about our son. He's 25 and we feel he's

Customer Question

We're concerned about our son. He's 25 and we feel he's showing signs of paranoid, dillusional thoughts. He thinks everyone is out to ruin his reputation or set him up to fail.
He senses everyone is jealous of him and want him to fail. He has outbursts of anger
where he can rip a door off the wall or heave something across the room, when doing this consistently "demanding the truth". Usually how things start is he comes in from work (he's self employed) and he starts shouting out inuendos about blacks, greeks, italians, church goers, old people are out to get him. He complains people treat him like he's an idiot and has accused us (his parents) of selling his soul. We try to reason with him, but that's when he gets angered. It's been esculating to the point that he finally hit me (his mother). Concerned for his and our safety and other people. Can you give us some recommendations on what to do or how to reason with him.
We know he will not seek help willingly.
J & N
Submitted: 8 years ago.
Category: Mental Health
Expert:  Dr. Rossi replied 8 years ago.

Thank you for clarifying.

There are limited options to involuntarily commit someone to a mental health/hospital. 1/ the individual must pose imminent danger to self or another or 2/ family members can try to get a judge to sign a lay affidavit (by sharing their concern about this person's mental/medical status.)

The judge once he signs the lay affidavit, the sheriff dept can pick him up and bring to a crisis center where he can be kept for up to 72 h. Of course, this is just for crisis stabilization purposes (he could chose to leave after 72h and also can chose to decline medication while there) You may want to contact someone for clarification of the process (versus from state to state)

You may try a family intervention (but if he is in a paranoid state) this may yield littler results.

Psychosis (paranoia) can be triggered in those with severe depression or those who may have a diagnosis of schizophrenia. It is managed by mood stabilizers and anti psychotic meds.

Customer: replied 8 years ago.
We're in Toronto, Canada.
From what we've told you, do you think our son is a Paranoid schizophrenia?
or perhaps something else like bi-polar?
Expert:  Dr. Rossi replied 8 years ago.

It sounds like schizophrenia (symptoms start to manifest in the early 20's) The chances are higher if there is history of it in the family.

Other possibilities are if he is severely depressed or abusing drugs.

The symptoms listed does not sound like bipolar where a person shifts from depression to mania (and bipolar disorder would have manifested earlier in his life)

Customer: replied 8 years ago.
He is depressed and he's started smoking marijuana about 2 months ago.
I don't know how often. We do know during his high school days he show
bouts of anger and he was smoking then. But he stopped using for about 3 years
and just starting smoking it again. So not sure if its the dope that's doing it to him.
Customer: replied 8 years ago.
What kind of info.
Expert:  Dr. Rossi replied 8 years ago.

The marijuana is not a hallucinogenic, so most likely this is psychologically based.

IS there anyone that he trusts? That person can persuade him to see a psychiatrist as medication is very effective in managing delusions.

Customer: replied 8 years ago.
Right now he trusts no one. I can only maybe think of one person,
but the problem with that is, by this person talking to our son, then
our son know we've been talking about him to other people.
And he hates the fact that we might talk to people about him. He
doesn't like people knowing his business.
Expert:  Dr. Rossi replied 8 years ago.

The options then would be limited (unless he poses a threat or is violent) involuntary commitment would be hard.

As far as "reasoning "with him, you would not be able to reason when he is in the paranoid stage. If there are ever days that he is less paranoid would be the time to talk to him. You would want to share your concern and let him share if he will, how you as a family can help him feel better. Trying to get him to trust you would be a priority. You would not be trying to persuade him that his thoughts are delusional. Rather, you would be providing some support by asking him what this sort of thinking is causing him to feel (anxiety, frustration, depression, etc) Then, educate him on the treatment options (of course, you may not want to do all of this in the same day) Each day one step at a time.

Once you gain the trust, then you could challenge his thinking process as to where he can see that his thoughts and behavior are alienating others from him. You can point out that if he is distressed, there are things to make him feel better as long as he is willing to try them.

The Complete Family Guide to Schizophrenia: Helping Your Loved One Get the Most Out of Life by Kim T. Mueser PhD and Susan Gingerich MSW (Paperback - May 26 2006)

Customer: replied 8 years ago.
If this goes untreated and we can't persuade him to get help or gain his trust,
and he continues on this path, in your expertise, what do you think
the worst case scenario? Either hurts himself or others?
Sometimes when he starts he tells me he's just venting, but I personally
feel it's more then just venting now.
Expert:  Dr. Rossi replied 8 years ago.
It would depend on the severity of the delusion. Some individuals can act out when delusional or while hallucinating. Usually hurting others is more common in delusional disorders and hurting oneself in depressive ones.
Dr. Rossi and other Mental Health Specialists are ready to help you
Customer: replied 8 years ago.
I thought of some more questions. When he's at his worst, he's eyes almost
bug out of his head and threaten to hit us. We've even actually had a door ripped
right off its hinges. Can you recommend something to say to him to calm him down at the time other then running for your life? Is there any calming techniques you can suggest when he's ranting "I want the truth". Facial expressions from us seem to trigger him as well, so we try not to show any emotion.
Expert:  Dr. Rossi replied 8 years ago.

The approach would depend on what evokes a calming response in him.

It may be best not to engage him when angry (perhaps say, let's talk when you're calmer, or we can talk about this when you're feeling in a good space, etc) It would be important not to escalate your voice/keeping it calm. if you have to remove yourself from the setting though, you would have to do what is safe and better for you (sometimes you can not reason with someone who is having a fit. It may escalate them)