Dear Dr. Robert:

When watching Gerard I have heard some spectators refer to his “paranoia” and others to his “delusions of grandeur.” I’m confused. Can one have both at once? If not, who is right? I await the diagnosis of a trained medical professional.

–S.F., Vienna, Austria

Dude,

Do I have to explain everything to you? Consulting the Diagnostic and Statistical Manual of Mental Disorders, fourth ed. ( DSM-IV), we find the following:

Paranoid perceptions and behavior may appear as features of a number of mental illnesses, including depression and dementia, but are most prominent in three types of psychological disorders: paranoid schizophrenia, delusional disorder (persecutory type), and paranoid personality disorder (PPD). Individuals with paranoid schizophrenia and persecutory delusional disorder experience what is known as persecutory delusions: an irrational, yet unshakable, belief that someone is plotting against them. Persecutory delusions in paranoid schizophrenia are bizarre, sometimes grandiose, and often accompanied by auditory hallucinations. Delusions experienced by individuals with delusional disorder are more plausible than those experienced by paranoid schizophrenics; not bizarre, though still unjustified. Individuals with delusional disorder may seem offbeat or quirky rather than mentally ill, and, as such, may never seek treatment.

“Sometimes grandiose”: that enough for you? The manual continues:

Persons with paranoid personality disorder tend to be self-centered, self-important, defensive, and emotionally distant. Their paranoia manifests itself in constant suspicions rather than full-blown delusions. The disorder often impedes social and personal relationships and career advancement. Some individuals with PPD are described as “litigious,” as they are constantly initiating frivolous law suits. PPD is more common in men than in women, and typically begins in early adulthood. Symptoms include:

• Suspicious; unfounded suspicions; believes others are plotting against him/her
• Preoccupied with unsupported doubts about friends or associates
• Reluctant to confide in others due to a fear that information may be used against him/her
• Reads negative meanings into innocuous remarks
• Bears grudges
• Perceives attacks on his/her reputation that are not clear to others, and is quick to counterattack

Spectators at Gerard’s table may find this list familiar. Although treatment is available, the Manual cautions that it “is difficult because the person’s traits make it difficult to form a professional relationship. The health care provider should respect interpersonal distance, and avoid defensiveness or attempts at humor.” You people on the honor roll, are you listening? No attempts at humor. Didn’t your parents teach you any manners at all?