Background: 
Visual disability and neuropathy, along with chronic neuropathic pain in poorly controlled diabetes amplify sensitivity to rejection, making it possible to construct non-bizarre delirium, favoring the development of an Organic Personality Disorder that overlaps an organic delusional disorder.
Presentation of a 74-year-old patient at first admission to psychiatry for bizarre expansive behavioral manifestations, due to the paranoid clinical picture, comorbid with chronic pain due to diabetic polyneuropathy and retinopathy of the same etiology.
The vulnerable structure (early strength myopia) and the transgenerational stigma make, with the advancing of visual impairment and with the accentuation of neuropathic pain, the patient disorganizes his thinking and behavior, becoming delusional. In the alternative, there is major depression, doubled by suicide risk.
Methods: Clinical Interview, Hetero-anamnesis, Cerebral CT and Computerized EEG (which confirm organicity), psychological testing, psychiatric monitoring, assays of diagnostic assumptions, psychodynamic interpretations.
Results: The diagnosis of organic delusional disorder with differential diagnoses of Organic Personality Disorder and Parafrenia is explained and supported. From psychodynamic point of view, the patient's functioning is marked by immature denial defense mechanisms and psychotic projection, along with black humor. The patient presents suspiciousness, delirious interpretativity, emotional ambivalence, tangential thinking and circumstantiality, a delusional idea of relationship, persecution and prejudice that alters his or her attitudes and reporting to the world and life.
Conclusions: Defensive mechanisms that have once been beneficial and have facilitated acceptance of the vision deficiency condition (from the Hyperstezia Register and other senses area) have now escalated to sensory delirium phenomenology of relationship.

WAYS TO COMPENSATE FOR MORAL PAIN IN VISUAL IMPAIRMENT