In psychiatry, paranoia is a wrong perception in which a person thinks others are planning to harm them. A paranoid person may believe people are concerned with everything they are doing (for example, "Everyone is watching me", or "Talking about me"). These beliefs can also be persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself (e.g., "Everyone is out to get me"). Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety, suspicion, or fear, often to the point of delusion and irrationality.World English Dictionary (Collins English Dictionary – Complete & Unabridged 10th Edition, 2009, William Collins Sons & Co. Ltd.) 3. informal sense: intense fear or suspicion, esp when unfounded Paranoia is distinct from phobias, which also involve irrational fear, but usually no blame.
Making false accusations and carrying a general distrust of other people also frequently accompany paranoia. For example, a paranoid person might believe an incident was intentional when most people would view it as an accident or coincidence. Paranoia is a central symptom of psychosis.Green, C., Freeman, D., Kuipers, E., Bebbington, P., Fowler, D., Dunn, G., & Garety, P. (2008). Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS). Psychological Medicine, 38, 101 – 111.
Signs and symptoms A common symptom of paranoia is attribution bias. These individuals typically have a biased perception of reality, often exhibiting more hostile beliefs than average.Bentall and Taylor (2006), p. 289 A paranoid person may view someone else's accidental behavior as though it is intentional or signifies a threat.
An investigation of a non-clinical paranoid population found that characteristics such as feeling powerless and depressed, isolating oneself, and relinquishing activities, were associated with more frequent paranoia.Freeman et al. (2005) Some scientists have created different subtypes for the various symptoms of paranoia, including erotic, persecutory, litigious, and exalted.Deutsch and Fishman p. 1414-1415
Some research suggests that symptoms of paranoid personality disorder are associated with a higher number of divorces, likely due to how paranoid patterns of thinking hinder relationships. This seems to fall in line with some older sources, which allege that paranoid individuals tend to be more isolated.Deutch and Fishman (1963), p.1416
Causes Social and environmental Social circumstances appear to be highly influential on paranoid beliefs. According to a mental health survey distributed to residents of Ciudad Juárez, Chihuahua (in Mexico) and El Paso, Texas (in the United States), paranoid beliefs seem to be associated with feelings of powerlessness and victimization, enhanced by social situations. Paranoid symptoms were associated with an attitude of mistrust and an external locus of control. Citing research showing that women and those with lower socioeconomic status are more prone to locating locus of control externally, the researchers suggested that women may be especially affected by the effects of socioeconomic status on paranoia.Mirowski and Ross (1983)
Surveys have revealed that paranoia can develop from difficult parental relationships and untrustworthy environments, for instance those that were highly disciplinary, strict, and unstable, could contribute to paranoia. Some sources have also noted that indulging and pampering the child could contribute to greater paranoia, via disrupting the child's understanding of their relationship with the world.Deutsch and Fishman (1963), p. 1408 Experiences found to enhance or create paranoia included frequent disappointment, stress, and a sense of hopelessness.Deutsch and Fishman (1963), p. 1412
Discrimination has also been reported as a potential predictor of paranoid delusions. Such reports that paranoia seemed to appear more in older patients who had experienced greater discrimination throughout their lives. Immigrants are more subject to some forms of psychosis than the general population, which may be related to more frequent experiences of discrimination and humiliation.Bentall and Taylor (2006), p. 280
Psychological Many more mood-based symptoms, for example grandiosity and guilt, may underlie functional paranoia.
Colby (1981) defined paranoid cognition as "persecutory delusions and false beliefs whose propositional content clusters around ideas of being harassed, threatened, harmed, subjugated, persecuted, accused, mistreated, killed, wronged, tormented, disparaged, vilified, and so on, by malevolent others, either specific individuals or groups" (p. 518). Three components of paranoid cognition have been identified by Robins & Post: "a) suspicions without enough basis that others are exploiting, harming, or deceiving them; b) preoccupation with unjustified doubts about the loyalty, or trustworthiness, of friends or associates; c) reluctance to confide in others because of unwarranted fear that the information will be used maliciously against them" (1997, p. 3).
Paranoid cognition has been conceptualized by clinical psychology almost exclusively in terms of psychodynamic constructs and dispositional variables. From this point of view, paranoid cognition is a manifestation of an intra-psychic conflict or disturbance. For instance, Colby (1981) suggested that the biases of blaming others for one's problems serve to alleviate the distress produced by the feeling of being humiliated, and helps to repudiate the belief that the self is to blame for such incompetence. This intra-psychic perspective emphasizes that the cause of paranoid cognitions is inside the head of the people (social perceiver), and dismisses the possibility that paranoid cognition may be related to the social context in which such cognitions are embedded. This point is extremely relevant because when origins of distrust and suspicion (two components of paranoid cognition) are studied many researchers have accentuated the importance of social interaction, particularly when social interaction has gone awry. Even more, a model of trust development pointed out that trust increases or decreases as a function of the cumulative history of interaction between two or more persons.Deutsch, 1958
Another relevant difference can be discerned among "pathological and non-pathological forms of trust and distrust". According to Deutsch, the main difference is that non-pathological forms are flexible and responsive to changing circumstances. Pathological forms reflect exaggerated perceptual biases and judgmental predispositions that can arise and perpetuate them, are reflexively caused errors similar to a self-fulfilling prophecy.
It has been suggested that a "hierarchy" of paranoia exists, extending from mild social evaluative concerns, through ideas of social reference, to persecutory beliefs concerning mild, moderate, and severe threats.Freeman, D., Garety, P., Bebbington, P., Smith, B., Rollinson, R., Fowler, D., Kuipers, E., Ray, K., & Dunn, G. (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry 186, 427 – 435.
Physical A paranoid reaction may be caused from a decline in brain circulation as a result of high blood pressure or hardening of the arterial walls.
Drug-induced paranoia, associated with cannabis and stimulants like amphetamines or methamphetamine, has much in common with schizophrenic paranoia; the relationship has been under investigation since 2012. Drug-induced paranoia has a better prognosis than schizophrenic paranoia once the drug has been removed. For further information, see stimulant psychosis and substance-induced psychosis.
Based on data obtained by the Dutch NEMESIS project in 2005, there was an association between impaired hearing and the onset of symptoms of psychosis, which was based on a five-year follow up. Some older studies have actually declared that a state of paranoia can be produced in patients that were under a hypnotic state of deafness. This idea however generated much skepticism during its time.Bentall and Taylor (2006), p.281
Diagnosis In the DSM-IV-TR, paranoia is diagnosed in the form of:American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Paranoid personality disorderAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders p.690 () Paranoid schizophrenia (a subtype of schizophrenia) () The persecutory type of delusional disorderAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders p.325 ()
According to clinical psychologist P. J. McKenna, "As a noun, paranoia denotes a disorder which has been argued in and out of existence, and whose clinical features, course, boundaries, and virtually every other aspect of which is controversial. Employed as an adjective, paranoid has become attached to a diverse set of presentations, from paranoid schizophrenia, through paranoid depression, to paranoid personality—not to mention a motley collection of paranoid 'psychoses', 'reactions', and 'states'—and this is to restrict discussion to functional disorders. Even when abbreviated down to the prefix para-, the term crops up causing trouble as the contentious but stubbornly persistent concept of paraphrenia".McKenna (1997), p.238
At least 50% of the diagnosed cases of schizophrenia experience delusions of reference and delusions of persecution.Sartorius, N., Jablensky, A., Korten, A., Ernberg, G., Anker, M., Cooper, JE., & Day, R. (1986). Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychological Medicine, 16, 909 – 928.Cutting, J. (1997). Principles of Psychopathology : Two Worlds–Two Minds–Two Hemispheres. Oxford University Press: Oxford. Paranoia perceptions and behavior may be part of many mental illnesses, such as depression and dementia, but they are more prevalent in three mental disorders: paranoid schizophrenia, delusional disorder (persecutory type), and paranoid personality disorder.
Treatment Paranoid delusions are often treated with antipsychotic medication, which exert a medium effect size. Cognitive behavioral therapy (CBT) lessens paranoid delusions relative to control conditions according to a meta-analysis. A meta-analysis of 43 studies reported that metacognitive training (MCT) reduces (paranoid) delusions at a medium to large effect size relative to control conditions.
History The word paranoia comes from the Greek παράνοια (paránoia), "madness",παράνοια ,