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{{Infobox medical condition (new)
{{Short description|Mental condition involving intense, unwarranted distrust or suspicion}}
{{Infobox medical condition
| name            = Paranoia
| name            = Paranoia
| synonyms        = Paranoid ([[adjective]])  
| synonyms        = Paranoid ([[adjective]])
| pronounce      = {{IPAc-en|ˌ|p|ær|ə|ˈ|n|ɔɪ|ə}}
| pronounce      = {{IPAc-en|ˌ|p|ær|ə|ˈ|n|ɔɪ|ə}}
| field          = [[Psychiatry]], [[clinical psychology]]
| field          = [[Psychiatry]], [[Clinical psychology]]
| symptoms        = [[Distrust]], [[False accusations]]
| symptoms        = [[Distrust]], [[Suspicion]], [[False accusations]], [[Social withdrawal]]
| complications  =  
| complications  = Impaired relationships, occupational dysfunction, social isolation
| onset          =  
| onset          = Typically early adulthood
| duration        =  
| duration        = Variable; chronic in some personality disorders
| types          =  
| types          = [[Paranoid personality disorder]], [[Delusional disorder]], [[Paranoid schizophrenia]]
| causes          =  
| causes          = Multifactorial – genetic, psychological, environmental
| risks          =  
| risks          = Family history, trauma, social isolation, substance use
| diagnosis      =  
| diagnosis      = Clinical assessment, psychiatric evaluation
| differential    =  
| differential    = [[Schizophrenia]], [[Schizoaffective disorder]], [[Borderline personality disorder]], [[Obsessive–compulsive disorder]]
| prevention      =  
| prevention      = Early intervention in high-risk individuals
| treatment      =  
| treatment      = [[Psychotherapy]], [[Cognitive behavioral therapy]], medication
| medication      =  
| medication      = [[Antipsychotics]], [[Anxiolytics]], [[Antidepressants]] (if comorbid depression)
| prognosis      =  
| prognosis      = Variable; better with early treatment and insight
| frequency      =  
| frequency      = Unknown; present in multiple psychiatric conditions
| deaths          =  
| deaths          = Indirect (e.g., suicide, accidents due to delusions)
}}
}}
Paranoia is characterized by an intense, unwarranted distrust of others, often stemming from unfounded beliefs that others intend to cause harm. Central to this condition is the attribution bias, where individuals interpret innocuous behaviors or incidents as threatening or personally targeted.<ref>{{Cite journal|last=Combs|first=DR|title=Persecutory delusion and attributional style: comparison of paranoid and nonparanoid individuals|journal=Journal of Abnormal Psychology|year=2007|volume=116|issue=3|pages=659–664|doi=10.1037/0021-843X.116.3.659}}</ref>
'''Paranoia''' is a mental state marked by pervasive and unwarranted [[distrust]] or [[suspicion]] of others, often involving the belief that others are out to deceive, harm, or exploit the individual. While occasional suspicious thoughts can be normal, especially in situations of uncertainty or fear, persistent or extreme forms of paranoia may indicate an underlying mental health condition.


Common characteristics among individuals exhibiting frequent paranoia can include feelings of powerlessness and depression, social isolation, and withdrawal from activities. Paranoid individuals may also exhibit different subtypes of symptoms, including erotic, persecutory, litigious, and exalted paranoia.<ref>{{Cite journal|last=Freeman|first=D|title=Persecutory delusions: a cognitive perspective on understanding and treatment|journal=Lancet Psychiatry|year=2016|volume=3|issue=7|pages=685–692|doi=10.1016/S2215-0366(16)00066-3}}</ref>
== Characteristics ==
Paranoia typically involves:


Due to these personality traits, individuals with paranoia often struggle with interpersonal relationships, and are more likely to be single.<ref>{{Cite journal|last=Harrow|first=M|title=Perceived social adversity, paranoid thinking, and psychotic symptoms|journal=Psychological Medicine|year=2013|volume=43|issue=9|pages=1925–1937|doi=10.1017/S0033291712002763}}</ref> Furthermore, a hierarchy of paranoia has been suggested in research, with more serious threats being less common and social anxiety being the most frequently exhibited form of paranoia.<ref>{{Cite journal|last=Freeman|first=D|title=Understanding paranoia: a guide for professionals|journal=Psychosis|year=2017|volume=9|issue=1|pages=1–13|doi=10.1080/17522439.2016.1259646}}</ref>
* Persistent, irrational mistrust of others
* Interpretation of innocent remarks or events as hostile
* Belief in hidden motives or conspiracies
* Feelings of being watched, followed, or plotted against
* Reluctance to confide in others due to fear of betrayal


==Causes==
The condition can severely impair social and occupational functioning, especially when the paranoid thoughts evolve into fixed [[delusions]].


The development of paranoia is influenced by a combination of genetic, biological, environmental, and psychological factors. These include chronic stress, trauma, brain injury, substance misuse, and various mental health conditions like schizophrenia and bipolar disorder.<ref>{{Cite journal|last=Ross|first=K|title=Paranoia and the social representation of others: a large-scale game theory approach|journal=Scientific Reports|year=2016|volume=6|pages=20804|doi=10.1038/srep20804}}</ref>
== Subtypes and Presentations ==
Paranoia may manifest in various forms or themes, including:


===Genetic and Biological Causes===
* '''Persecutory paranoia''': The belief that one is being harassed, spied on, or harmed.
* '''Erotomanic paranoia''': The false belief that another person, often of higher status, is in love with the individual.
* '''Litigious paranoia''': A pattern of excessive legal complaints and belief in systematic injustice.
* '''Exalted or grandiose paranoia''': Inflated self-importance and belief in special powers or roles.


Genetic factors may play a role in the development of paranoia, though the exact nature and extent of this role is not fully understood. Certain brain abnormalities, such as dysfunction in the amygdala, a region associated with fear and aggression, have also been implicated.<ref>{{Cite journal|last=Pinkham|first=AE|title=The amygdala and social cognition in schizophrenia|journal=Schizophrenia Research|year=2014|volume=152|issue=1|pages=283–290|doi=10.1016/j.schres.2013.09.018}}</ref>
== Associated Conditions ==
Paranoia is not a diagnosis on its own but occurs in several psychiatric disorders, such as:


===Psychological Causes===
* '''[[Paranoid personality disorder]] (PPD)''': A chronic pattern of distrust and suspicion without delusions or hallucinations.
* '''[[Delusional disorder]] – persecutory type''': Fixed false beliefs about being targeted or persecuted.
* '''[[Paranoid schizophrenia]]''': Characterized by [[hallucinations]] and [[delusions]] with prominent paranoid content.


Chronic stress, trauma, and other significant negative life events can contribute to the development of paranoid thoughts. Paranoid delusions are also a symptom of several psychiatric disorders, including schizophrenia, delusional disorder, and paranoid personality disorder.<ref>{{Cite journal|last=Mittal|first=VA|title=Contributions of cognitive inflexibility to eating disorder and social anxiety symptoms|journal=Eating Behaviors|year=2015|volume=16|pages=31–34|doi=10.1016/j.eatbeh.2014.10.015}}</ref> Furthermore, certain personality traits, such as suspicion and distrust, can predispose an individual to paranoid thinking.<ref>{{Cite journal|last=Combs|first=DR|title=Persecutory delusion and attributional style: comparison of paranoid and nonparanoid individuals|journal=Journal of Abnormal Psychology|year=2007|volume=116|issue=3|pages=659–664|doi=10.1037/0021-843X.116.3.659}}</ref>
== Causes and Risk Factors ==
Paranoia is believed to arise from a combination of genetic, neurobiological, psychological, and environmental factors.


===Environmental Causes===
Common contributing elements include:


Environmental factors, including upbringing and societal influences, may contribute to the development of paranoia. For example, individuals who have been victims of bullying, discrimination, or social exclusion may be more likely to develop paranoid thoughts.<ref>{{Cite journal|last=Sharma|first=T|title=The relationship between trauma, bullying and psychotic symptoms: a study of adolescent inpatients|journal=Psychosis|year=2018|volume=10|issue=1|pages=4-10|doi=10.1080/17522439.2017.1370706}}</ref>
* Family history of [[mental illness]]
* Exposure to childhood trauma or neglect
* Chronic social isolation
* Substance use, particularly [[cannabis]], [[amphetamines]], or [[cocaine]]
* Brain abnormalities affecting the limbic system and prefrontal cortex


==Diagnosis==
== Diagnosis ==
Diagnosis is made through:


Diagnosing paranoia involves a comprehensive psychiatric evaluation and the exclusion of other mental health disorders. The evaluation will typically include a thorough history and symptom assessment, as well as an assessment of the individual's mental status. Diagnosing paranoia can be challenging due to the nature of the symptoms and individuals' potential reluctance to disclose their paranoid thoughts for fear of being judged or misunderstood.<ref>{{Cite journal|last=Green|first=CE|title=Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS)|journal=Psychological Medicine|year=2008|volume=38|issue=1|pages=101-111|doi=10.1017/S0033291707001638}}</ref>
* Comprehensive [[psychiatric evaluation]]
* Interviews and standardized assessments
* Rule-out of other mental or medical conditions
* Monitoring over time for persistence of symptoms


==Treatment==
Paranoia must be distinguished from culturally appropriate beliefs or justified concerns.


Treatment for paranoia typically involves psychotherapy, medication, or a combination of both. Cognitive behavioral therapy (CBT) can be particularly effective, as it helps individuals identify and challenge their paranoid thoughts.<ref>{{Cite journal|last=Trower|first=P|title=Cognitive–behavioural therapy for psychosis: a rationale and clinical overview|journal=Psychological Medicine|year=2005|volume=35|issue=12|pages=1695-1706|doi=10.1017/S0033291705005240}}</ref> In cases where paranoia is a symptom of another underlying condition, such as schizophrenia or bipolar disorder, medications like antipsychotics or mood stabilizers may also be utilized.<ref>{{Cite journal|last=NICE|title=Bipolar disorder: assessment and management|journal=National Institute for Health and Care Excellence: Clinical Guidelines|year=2014|pages=CG185|url=https://www.nice.org.uk/guidance/cg185}}</ref>
== Treatment ==
Treatment depends on the severity and underlying cause.


==History==
=== Psychotherapy ===
* [[Cognitive behavioral therapy]] (CBT) – challenges distorted beliefs and encourages healthier thought patterns.
* [[Supportive therapy]] – builds trust and coping strategies.
* [[Group therapy]] – cautiously used, depending on the individual's comfort and symptoms.


The term "paranoia" originates from the Greek words "para" (beside) and "nous" (mind), suggesting a mind beside itself. The concept of paranoia has evolved significantly over the centuries, with shifts in its definition reflecting broader changes in societal and medical understandings of mental health and illness.<ref>{{Cite book|last=Berrios|first=GE|title=The History of Mental Symptoms: Descriptive Psychopathology Since the Nineteenth Century|publisher=Cambridge University Press|year=1996|isbn=9780521641542}}</ref>
=== Medications ===
* [[Antipsychotic medications]] – reduce delusional thinking.
* [[Anxiolytics]] – used if anxiety is prominent.
* [[Antidepressants]] – for associated depressive symptoms.


In the 19th century, German psychiatrist Emil Kraepelin distinguished paranoia from other forms of psychosis, such as schizophrenia, by its consistent, logical delusions and lack of noticeable intellectual deterioration. However, contemporary diagnostic classifications, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), recognize paranoia as a symptom present in a range of psychiatric disorders rather than a standalone diagnosis.<ref>{{Cite book|last=American Psychiatric Association|title=Diagnostic and Statistical Manual of Mental Disorders (DSM-5)|year=2013|publisher=American Psychiatric Association|isbn=978-0890425558}}</ref>
=== Lifestyle and Social Support ===
* Encouraging social engagement
* Educating family members
* Stress reduction and relaxation techniques


==Relations to Violence==
== Prognosis ==
The outcome varies widely depending on the cause and individual insight. People with paranoid personality disorder may function relatively well but struggle with interpersonal relationships. Paranoia associated with psychotic disorders may require long-term treatment.


Although the media often portrays individuals with paranoia as violent, the majority are not. However, in some cases, paranoid individuals may act on their false beliefs, leading to aggressive behavior or violence. This risk is higher among those with comorbid substance use disorders or those experiencing particularly severe and threatening paranoid delusions.<ref>{{Cite journal|last=Large|first=M|title=Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies|journal=PloS One|year=2013|volume=8|issue=2|pages=e55942|doi=10.1371/journal.pone.0055942}}</ref>
Early intervention and strong therapeutic alliances improve prognosis.


==Paranoid Social Cognition==
== See also ==
 
===Situational Antecedents===
 
Certain situations can trigger or exacerbate paranoid thinking. These include stressful circumstances, perceived social exclusion, and instances of perceived injustice or discrimination.<ref>{{Cite journal|last=Elahi|first=A|title=Perceived discrimination and paranoia in individuals at ultra-high risk for psychosis|journal=Psychiatry Research|year=2017|volume=257|pages=514-520|doi=10.1016/j.psychres.2017.08.021}}</ref>
 
===Dysphoric Self-Consciousness===
 
Dysphoric self-consciousness, or a negative and distressing focus on oneself, can contribute to paranoia. This form of self-focus can heighten feelings of vulnerability and the perception of threat from others.<ref>{{Cite journal|last=Startup|first=HM|title=Understanding the self in individuals with persecutory delusions|journal=American Journal of Psychiatry|year=2007|volume=164|issue=8|pages=1223-1229|doi=10.1176/appi.ajp.2007.06091591}}</ref>
 
===Hypervigilance and Rumination===
 
Paranoid individuals often display hypervigilance, a heightened state of sensory sensitivity accompanied by exaggerated intensity of behaviors whose purpose is to detect threats. They may also ruminate excessively, dwelling repetitively on their paranoid thoughts.<ref>{{Cite journal|last=Morrison|first=AP|title=Cognitive factors in source monitoring and auditory hallucinations|journal=Cognitive Neuropsychiatry|year=1995|volume=1|issue=1|pages=73-91|doi=10.1080/135468095396396}}</ref>
 
===Judgmental Biases===
 
People with paranoia may exhibit judgmental biases, such as the "jumping to conclusions" bias, where they make firm decisions based on minimal evidence. They may also exhibit a bias towards attributing harmful intent to others in ambiguous situations.<ref>{{Cite journal|last=Garety|first=PA|title=Jumping to conclusions: A faulty appraisal|journal=Schizophrenia Research|year=2017|volume=195|pages=125-131|doi=10.1016/j.schres.2017.09.024}}</ref>
 
==See Also==
 
* [[Psychosis]]
* [[Delusion]]
* [[Delusion]]
* [[Schizophrenia]]
* [[Schizophrenia]]
* [[Paranoid personality disorder]]
* [[Personality disorders]]
* [[Cognitive behavioral therapy (CBT)]]
* [[Cognitive distortions]]
==References==
* [[Social isolation]]
 
* [[Psychosis]]
{{Reflist}}
 
==Further Reading==
 
* Freeman, D., & Garety, P. A. (2014). Advances in understanding and treating persecutory delusions: a review. Social Psychiatry and Psychiatric Epidemiology, 49(8), 1179–1189. doi:10.1007/s00127-014-0928-7.
* Tandon, R., Keshavan, M. S., & Nasrallah, H. A. (2008). Schizophrenia, "Just the Facts": What we know in 2008 Part 1: Overview. Schizophrenia Research, 100(1-3), 4–19. doi:10.1016/j.schres.2008.01.022.
* Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. doi:10.1093/schbul/13.2.261.
==External Links==
* [https://www.mayoclinic.org/diseases-conditions/paranoid-personality-disorder/symptoms-causes/syc-20352966 Mayo Clinic - Paranoid personality disorder]
* [https://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml National Institute of Mental Health - Schizophrenia]
* [https://www.mind.org.uk/information-support/types-of-mental-health-problems/paranoia/about-paranoia/ MIND - About Paranoia]
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[[Category:Psychiatric diagnosis]]
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Latest revision as of 03:28, 30 March 2025

Mental condition involving intense, unwarranted distrust or suspicion


Paranoia
Synonyms Paranoid (adjective)
Pronounce
Specialty N/A
Symptoms Distrust, Suspicion, False accusations, Social withdrawal
Complications Impaired relationships, occupational dysfunction, social isolation
Onset Typically early adulthood
Duration Variable; chronic in some personality disorders
Types Paranoid personality disorder, Delusional disorder, Paranoid schizophrenia
Causes Multifactorial – genetic, psychological, environmental
Risks Family history, trauma, social isolation, substance use
Diagnosis Clinical assessment, psychiatric evaluation
Differential diagnosis Schizophrenia, Schizoaffective disorder, Borderline personality disorder, Obsessive–compulsive disorder
Prevention Early intervention in high-risk individuals
Treatment Psychotherapy, Cognitive behavioral therapy, medication
Medication Antipsychotics, Anxiolytics, Antidepressants (if comorbid depression)
Prognosis Variable; better with early treatment and insight
Frequency Unknown; present in multiple psychiatric conditions
Deaths Indirect (e.g., suicide, accidents due to delusions)


Paranoia is a mental state marked by pervasive and unwarranted distrust or suspicion of others, often involving the belief that others are out to deceive, harm, or exploit the individual. While occasional suspicious thoughts can be normal, especially in situations of uncertainty or fear, persistent or extreme forms of paranoia may indicate an underlying mental health condition.

Characteristics[edit]

Paranoia typically involves:

  • Persistent, irrational mistrust of others
  • Interpretation of innocent remarks or events as hostile
  • Belief in hidden motives or conspiracies
  • Feelings of being watched, followed, or plotted against
  • Reluctance to confide in others due to fear of betrayal

The condition can severely impair social and occupational functioning, especially when the paranoid thoughts evolve into fixed delusions.

Subtypes and Presentations[edit]

Paranoia may manifest in various forms or themes, including:

  • Persecutory paranoia: The belief that one is being harassed, spied on, or harmed.
  • Erotomanic paranoia: The false belief that another person, often of higher status, is in love with the individual.
  • Litigious paranoia: A pattern of excessive legal complaints and belief in systematic injustice.
  • Exalted or grandiose paranoia: Inflated self-importance and belief in special powers or roles.

Associated Conditions[edit]

Paranoia is not a diagnosis on its own but occurs in several psychiatric disorders, such as:

Causes and Risk Factors[edit]

Paranoia is believed to arise from a combination of genetic, neurobiological, psychological, and environmental factors.

Common contributing elements include:

  • Family history of mental illness
  • Exposure to childhood trauma or neglect
  • Chronic social isolation
  • Substance use, particularly cannabis, amphetamines, or cocaine
  • Brain abnormalities affecting the limbic system and prefrontal cortex

Diagnosis[edit]

Diagnosis is made through:

  • Comprehensive psychiatric evaluation
  • Interviews and standardized assessments
  • Rule-out of other mental or medical conditions
  • Monitoring over time for persistence of symptoms

Paranoia must be distinguished from culturally appropriate beliefs or justified concerns.

Treatment[edit]

Treatment depends on the severity and underlying cause.

Psychotherapy[edit]

Medications[edit]

Lifestyle and Social Support[edit]

  • Encouraging social engagement
  • Educating family members
  • Stress reduction and relaxation techniques

Prognosis[edit]

The outcome varies widely depending on the cause and individual insight. People with paranoid personality disorder may function relatively well but struggle with interpersonal relationships. Paranoia associated with psychotic disorders may require long-term treatment.

Early intervention and strong therapeutic alliances improve prognosis.

See also[edit]












Assassination /
suicide theories
* Zachary Taylor (1850)
Accidents / disasters
Other cases
* Joan of Arc (1431)
Body double hoax





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