A 2012 American psychological thriller, Black Swan is a dramatic confrontation of a self with a self. Starring Natalie Portman, Vincent Cassel, and Mila Kunis, the movie revolves around the production of a prestigious New York City Company. In constant competition with the Swan Queen and her controlling mother, Nina (Natalie Portman) suffers from increasing paranoia, and startling delusions, all packed with erotic hallucinations and violent streaks. 

Keeping the movie Black Swan in the backdrop, today we are discussing whether paranoid delusion, self mutilation and visual hallucinations are all a part of a psychotic disorder? Can a combination of all these really push a person to go over the edge? With expert inputs from Pulkit Sharma, Clinical Psychologist & Psychoanalytical Therapist at VIMHANS, New Delhi, let's take a closer look at self mutilation, visual hallucinations and paranoid delusions to understand this Black Swan phenomenon better. 

Understanding Self Mutilation. Self-mutilation refers to inflicting explicit and deliberate damage to one's own body. It includes cutting and scratching one's own body with sharp objects and burning. It may sound bizarre but people do it to cope with extremely unpleasant emotions. These emotions include anxiety, sadness, rage, loneliness and emptiness. After indulging in self-mutilation these people report a temporary relief from unpleasant feelings. 

Self-mutilation is of two types- situational and chronic. Situational self-mutilation is extremely common and many normal average people do it once or twice in their lifetime when they are experiencing severe distress. Chronic and continuous self-mutilation is seen in people suffering from personality disorders, psychiatric disorders or victims of abuse and neglect. Self-mutilation is effectively treated with psychotherapy. In psychotherapy, the person is able to understand the sources of his/her distress and develop skills to deal with it. Dialectical behavior therapy (DBT), Cognitive behavior therapy (CBT) and Psychoanalytic therapy bring a marked reduction in self-mutilation.

Understanding Paranoid Delusions. A paranoid delusion is a rigid and false idea that one is being harmed or plotted against by a person, group of people or supernatural power. Even though there is no evidence to support the same, the person holds on to this idea strongly. Paranoid delusion has a strong impact on the person's being- he/ she withdraws, remains anxious, becomes violent and extremely cautious. Hallucinations and delusions can be symptoms of a number of different mental illnesses, such as Schizophrenia, Bipolar Disorder, Severe Depression, Acute Transient Psychotic Disorder and Psychosis. Hallucination is perception without a stimulus. The person hears, sees, feels or tastes things which do not exist. Common types of hallucinations are visual hallucinations and auditory hallucinations. Usually the person experiencing them feels very scared. While people may experience transient delusions in their lifetime, delusional disorders per se are not very common. 3/ 1000 people suffer from a delusional disorder in a general population sample.

Understanding Visual Hallucinations. Visual hallucinations involve seeing things out of your visual field or seeing things which do not exist.

Causes of visual hallucinations can be disturbance in structure and function of the brain, neurotransmitter imbalance, problems in the unconscious mind and spiritual experiences. Visual hallucinations are seen in neurological, psychological and psychiatric disorders. These include delirium, dementia, schizophrenia and schizoaffective disorder. At times visual hallucinations accompany some spiritual experiences and these need to be dealt with very differently. Visual hallucinations are treated by a combination of psychiatric medicine and psychotherapy.

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