Paranoia

Paranoia
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Synonyms	Paranoid (adjective)
Pronounce
Field	Psychiatry, clinical psychology
Symptoms	Distrust, False accusations
Complications
Onset
Duration
Types
Causes
Risks
Diagnosis
Differential diagnosis
Prevention
Treatment
Medication
Prognosis
Frequency
Deaths

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>Combs, DR,

 Persecutory delusion and attributional style: comparison of paranoid and nonparanoid individuals, 
 Journal of Abnormal Psychology, 
 2007,
 Vol. 116(Issue: 3),
 pp. 659–664,
 DOI: 10.1037/0021-843X.116.3.659,</ref>

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>Freeman, D,

 Persecutory delusions: a cognitive perspective on understanding and treatment, 
 Lancet Psychiatry, 
 2016,
 Vol. 3(Issue: 7),
 pp. 685–692,
 DOI: 10.1016/S2215-0366(16)00066-3,</ref>

Due to these personality traits, individuals with paranoia often struggle with interpersonal relationships, and are more likely to be single.<ref>Harrow, M,

 Perceived social adversity, paranoid thinking, and psychotic symptoms, 
 Psychological Medicine, 
 2013,
 Vol. 43(Issue: 9),
 pp. 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>Freeman, D, 
 Understanding paranoia: a guide for professionals, 
 Psychosis, 
 2017,
 Vol. 9(Issue: 1),
 pp. 1–13,
 DOI: 10.1080/17522439.2016.1259646,</ref>

Causes

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>Ross, K,

 Paranoia and the social representation of others: a large-scale game theory approach, 
 Scientific Reports, 
 2016,
 Vol. 6,
 pp. 20804,
 DOI: 10.1038/srep20804,</ref>

Genetic and Biological Causes

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>Pinkham, AE,

 The amygdala and social cognition in schizophrenia, 
 Schizophrenia Research, 
 2014,
 Vol. 152(Issue: 1),
 pp. 283–290,
 DOI: 10.1016/j.schres.2013.09.018,</ref>

Psychological Causes

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>Mittal, VA,

 Contributions of cognitive inflexibility to eating disorder and social anxiety symptoms, 
 Eating Behaviors, 
 2015,
 Vol. 16,
 pp. 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>Combs, DR, 
 Persecutory delusion and attributional style: comparison of paranoid and nonparanoid individuals, 
 Journal of Abnormal Psychology, 
 2007,
 Vol. 116(Issue: 3),
 pp. 659–664,
 DOI: 10.1037/0021-843X.116.3.659,</ref>

Environmental Causes

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>Sharma, T,

 The relationship between trauma, bullying and psychotic symptoms: a study of adolescent inpatients, 
 Psychosis, 
 2018,
 Vol. 10(Issue: 1),
 pp. 4-10,
 DOI: 10.1080/17522439.2017.1370706,</ref>

Diagnosis

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>Green, CE,

 Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS), 
 Psychological Medicine, 
 2008,
 Vol. 38(Issue: 1),
 pp. 101-111,
 DOI: 10.1017/S0033291707001638,</ref>

Treatment

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>Trower, P,

 Cognitive–behavioural therapy for psychosis: a rationale and clinical overview, 
 Psychological Medicine, 
 2005,
 Vol. 35(Issue: 12),
 pp. 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>NICE, 
 Bipolar disorder: assessment and management, 
 National Institute for Health and Care Excellence: Clinical Guidelines, 
 2014,
 
 pp. CG185,
 
 
 
 
 Full text,</ref>

History

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>GE,

 The History of Mental Symptoms: Descriptive Psychopathology Since the Nineteenth Century, 
  
 Cambridge University Press, 
 1996, 
  
  
 ISBN 9780521641542,</ref>

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>,

 Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 
  
 American Psychiatric Association, 
 2013, 
  
  
 ISBN 978-0890425558,</ref>

Relations to Violence

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>Large, M,

 Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies, 
 PloS One, 
 2013,
 Vol. 8(Issue: 2),
 pp. e55942,
 DOI: 10.1371/journal.pone.0055942,</ref>

Paranoid Social Cognition

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>Elahi, A,

 Perceived discrimination and paranoia in individuals at ultra-high risk for psychosis, 
 Psychiatry Research, 
 2017,
 Vol. 257,
 pp. 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>Startup, HM,

 Understanding the self in individuals with persecutory delusions, 
 American Journal of Psychiatry, 
 2007,
 Vol. 164(Issue: 8),
 pp. 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>Morrison, AP,

 Cognitive factors in source monitoring and auditory hallucinations, 
 Cognitive Neuropsychiatry, 
 1995,
 Vol. 1(Issue: 1),
 pp. 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>Garety, PA,

 Jumping to conclusions: A faulty appraisal, 
 Schizophrenia Research, 
 2017,
 Vol. 195,
 pp. 125-131,
 DOI: 10.1016/j.schres.2017.09.024,</ref>

See Also

• Psychosis
• Delusion
• Schizophrenia
• Paranoid personality disorder
• Cognitive behavioral therapy (CBT)

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

• Mayo Clinic - Paranoid personality disorder
• National Institute of Mental Health - Schizophrenia
• MIND - About Paranoia

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