What is paranoia?

Causes and Symptoms

Paranoia is characterized by suspiciousness, heightened self-awareness, self-reference, projection of one’s ideas onto others, expectations of persecution, and blaming of others for one’s difficulties. Conversely, though paranoia can be problematic, it can also be adaptive. In threatening or dangerous situations, paranoia might instigate proactive protective behavior, allowing an individual to negotiate a situation without harm. Thus, paranoia must be assessed in context for it to be understood fully.

Paranoia can be experienced at varying levels of intensity in both normal and highly disordered individuals. As a medical problem, paranoia may take the face of a symptom, personality problem, or chronic mental disorder. As a symptom, it may be evidenced as a fleeting problem; an individual might have paranoid feelings that dissipate in a relatively brief period of time once an acute medical or situational problem is rectified.

As a personality problem, paranoia creates significant impairment and distress as a result of inflexible, maladaptive, and persistent use of paranoid coping strategies. Paranoid individuals often have preoccupations about loyalties, overinterpret situations, maintain expectations of exploitation or deceit, rarely confide in others, bear grudges, perceive attacks that are not apparent to others, and maintain unjustified suspicions about their relationship partner’s potential for betrayal. They are prone to angry outbursts, aloof, and controlling, and they may demonstrate a tendency toward vengeful fantasies or actual revenge.

Finally, paranoia may be evidenced as a chronic mental disorder, most notably as the paranoid type of schizophrenia. In paranoid schizophrenia, there is a tendency toward delusions (faulty beliefs involving misinterpretations of events) and auditory hallucinations. Additionally, everyday behavior, speech, and emotional responsiveness are not as disturbed as in other variants of schizophrenia. Typically, individuals suffering from paranoia are seen by others as anxious, angry, and aloof. Their delusions usually reflect fears of persecution or hopes for greatness, resulting in jealousies, odd religious beliefs (such as persecution by God, thinking they are Jesus Christ), or preoccupations with their own health (such as the fear of being poisoned or of having a medical disorder of mysterious origin).

Paranoia may best be understood as being determined by a combination of biological, psychological, and environmental factors. It is likely, for example, that certain basic psychological tendencies must be present for an individual to display paranoid feelings and behavior when under stress, as opposed to other feelings such as depression. Additionally, it is likely that certain physical predispositions must be present for stressors to provoke a psychophysiological response.

Biologically, there are myriad physical and mental health conditions that may trigger acute and more chronic paranoid reactions. High levels of situational stress, drug intoxication (such as with amphetamines or marijuana), drug withdrawal, depression, head injuries, organic brain syndromes, pernicious anemia, B vitamin deficiencies, and Klinefelter syndrome may be related to acute paranoia. Similarly, certain cancers, insidious organic brain syndromes, and hyperparathyroidism have been related to recurrent or chronic episodes of paranoia.

In terms of the etiology of chronic paranoid conditions, such as paranoid schizophrenia and paranoid personality disorder, no clear causes have been identified. Some evidence points to a genetic component; the results of studies on twins and the greater prevalence of these disorders in some families support this view. More psychological theories highlight the family environment and emotional expression, childhood abuse, and stress. In general, these theories point to conditions contributing toward making a person feel insecure, tense, hungry for recognition, and hypervigilant. Additionally, the impact of social, cultural, and economic conditions contributing to the expression of paranoia is important. Paranoia cannot be interpreted out of context. Biological, psychological, and environmental factors must be considered in the development and maintenance of paranoia.

Treatment and Therapy

Three major types of therapies are available to treat paranoia: pharmacotherapies, community-based therapies, and cognitive-behavioral therapies. For acute paranoia problems and the management of more chronic, schizophrenia-related paranoia, pharmacotherapy (the use of drugs) is the treatment of choice. Drugs that serve to tranquilize the individual and reduce disorganized thinking, such as antipsychotics, phenothiazines and other neuroleptics, are commonly used. With elderly people who cannot tolerate such drugs, electroconvulsive therapy (ECT) has been used for treatment.

Community-based treatment, such as day treatment or inpatient treatment, is also useful for treating chronic paranoid conditions. Developing corrective and instructional social experiences, decreasing situational stress, and helping individuals to feel safe in a treatment environment are primary goals.

Finally, cognitive-behavioral therapies focused on identifying irrational beliefs contributing to paranoia-related problems have demonstrated some utility. Skillful therapists help to identify maladaptive thinking while unearthing concerns but not agreeing with the individual’s delusional ideas.

Perspective and Prospects

Certain life phases and social and cultural contexts influence behaviors that could be labeled as paranoid. Membership in certain minority or ethnic groups, immigrant or political refugee status, and, more generally, language and other cultural barriers may account for behavior that appears to be guarded or paranoid. As such, one can make few assumptions about paranoia without a thorough assessment.

Clinically significant paranoia is notable across cultures, with prevalence rates at any point in time ranging from 0.5 to 2.5 percent of the population. It is a problem manifested by diverse etiological courses requiring equally diverse treatments. Increased knowledge about the relationship among paranoia, depression and other mood disorders, schizophrenia, and the increased prevalence of paranoid disorders in some families will be critical. As the general population ages, a better understanding of more acute paranoid disorders related to medical problems will also be necessary. Better understanding will facilitate the development of more effective pharmacological and nonpharmacological treatments that can be tolerated by the elderly and others suffering from compromising medical problems.

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