What is Decompensation (Psychology)?

Introduction

In medicine, decompensation is the functional deterioration of a structure or system that had been previously working with the help of allostatic compensation.

Background

Decompensation may occur due to fatigue, stress, illness, or old age. When a system is “compensated,” it is able to function despite stressors or defects. Decompensation describes an inability to compensate for these deficiencies. It is a general term commonly used in medicine to describe a variety of situations.

Physiology

For example, cardiac decompensation may refer to the failure of the heart to maintain adequate blood circulation, after long-standing (previously compensated) vascular disease (see heart failure). Short-term treatment of cardiac decompensation can be achieved through administration of dobutamine, resulting in an increase in heart contractility via an inotropic effect.

Kidney failure can also occur following a slow degradation of kidney function due to an underlying untreated illness; the symptoms of the latter can then become much more severe due to the lack of efficient compensation by the kidney.

Psychology

In psychology, the term refers to an individual’s loss of healthy defence mechanisms in response to stress, resulting in personality disturbance or psychological imbalance. Some who suffer from narcissistic personality disorder or borderline personality disorder may decompensate into persecutory delusions to defend against a troubling reality.

What is Persecutory Delusion?

Introduction

Persecutory delusions are a set of delusional conditions in which the affected persons believe they are being persecuted, despite a lack of evidence.

Background

Specifically, they have been defined as containing two central elements:

  • The individual thinks that harm is occurring, or is going to occur.
  • The individual thinks that the perceived persecutor has the intention to cause harm.

According to the DSM-IV-TR, persecutory delusions are the most common form of delusions in paranoid schizophrenia, where the person believes “he or she is being tormented, followed, tricked, spied on, or ridiculed”, or that their food is being poisoned. They are also often seen in schizoaffective disorder and, as recognised by DSM-IV-TR, constitute the cardinal feature of the persecutory subtype of delusional disorder, by far the most common.

Delusions of persecution may also appear in manic and mixed episodes of bipolar disorder, polysubstance abuse, and severe depressive episodes with psychotic features, particularly when associated with bipolar illness.

Prevalence

A 2020 study by Sheridan and colleagues gave figures for lifetime prevalence of perceived stalking by groups, a common form of persecutory delusion, at 0.66% for adult women and 0.17% for adult men.

When the focus is to remedy some injustice by legal action, persecutory delusions are sometimes termed “querulous paranoia”.

In cases where reporters of stalking behaviour have been judged to be making false reports, a majority of them were judged to be delusional.

Treatment

Medications for schizophrenia are often used, especially when positive symptoms are present. Both first-generation antipsychotics and second-generation antipsychotics may be useful. Cognitive behavioural therapy (CBT) has also been used.