Understanding Paranoid Behavior

My Mother has been diagnosed with Alzheimer’s disease.  Lately, she is very suspicious of everyone, and accuses us of stealing her things.  How do I handle this?

It is not uncommon for individuals with dementia to be suspicious and paranoid.  Your Mother may accuse you of stealing money or prized possessions.  She may be certain that food has been withheld, or that her spouse is having an affair.  For family members who struggle with daily care, such accusations are painful and difficult to understand.

We label those with Dementia as “paranoid”, as if we have never experienced paranoid feelings and can’t begin to understand such odd behavior.  However, if we put ourselves in their shoes for just a moment, we might understand the logic behind the behavior.

Have you ever found yourself standing in a crowded parking lot with no memory of where you parked your car?  As you walk up and down the aisles searching for your vehicle, do you think – even for a second – that your car has been stolen?  If so, you just had a fleeting moment of paranoia.  For most of us, the paranoia passes quickly.  Our memory kicks into gear and we realize that the car has probably not been stolen.  Eventually, we find our vehicle exactly where we left it.

For the individual with Dementia, however, life is not as easy.  Her recent memory is limited.  So, when items are missing or she does not recall her last meal, it is easy to accuse others of plotting against her.   Damaged brain cells and limited memory may cause your Mother to become stuck in her thoughts of paranoia.  Her brain is unable to rationalize the situation and conclude that she must have eaten dinner or that she has hidden her money for safekeeping.  As a result, the feelings of paranoia remain and often intensify.

The natural response for anyone who has been wrongly accused of stealing or failing to provide food is to argue and defend one’s honor.  However, for the person with Dementia, such a response will only result in less trust, increased paranoia, and a lot of unnecessary conflict.  So, how do family members effectively handle their loved-one’s bouts with paranoia?

  • Be aware that those with Dementia often feel vulnerable.  They may hide items because they don’t trust their own abilities to keep track of money and valuables. They may not trust the unfamiliar faces they see in their world.
  • If you are accused of stealing, validate your Mother’s feelings by saying, “That must be difficult for you to be without your special pin.”   “I can imagine how hard it is not to have your wallet.”  Try not to use the words “lost” or “stolen”.  Resist the urge to mention how many times the item has been lost in the past.
  • Help your Mother search for the lost item.  If the item has gone missing before, try looking in the same place where it was originally found.  Those with Dementia often use the same hiding places over and over.
  • Talk about the lost item and special memories from the past.  Pretty soon, the paranoia may subside.
  • If you are accused of withholding food, validate feelings by saying, “Let’s see if we can find something for you to eat.”  Provide a healthy snack.  Don’t discuss the recent meal that has been forgotten.  Such a discussion will only cause anger and a loss of trust in you.
  • If you are a devoted spouse who has been wrongly charged with cheating, the accusation can be especially painful.  Remember that your Mother is likely aware of her shortcomings and may feel vulnerable and insecure.  she is afraid of losing you.  Ongoing reassurance and understanding, rather than an argument, may help to reduce her feelings of paranoia.

Nancy Dezan
Care Manager