Introduction (Psychology and Mental Health)
Paranoia is defined as a psychiatric disorder in which a person has a group of false beliefs or delusions. The person with paranoia cannot be argued out of believing that the delusions are true. Usually when paranoia is present, a network or system of interconnecting false beliefs is present in the person’s mind. Paranoia is no longer used as a diagnosis. Today when a person has been found to show paranoia, a diagnosis of delusional disorder is made.
The use of the term “paranoia” has a long history that extends back to the ancient Greeks and Romans. The word “paranoia” derives from the Greek words meaning “beside” and “mind.” The Greeks and Romans used the term to describe a wide variety of mental disorders, and their use does not reflect the current utilization of the term.
During the 1800’s, paranoia began to be defined by experts in the field of psychiatry as a mental condition influencing how a person conceptualized the surrounding environment. In 1863, Karl Kahlbaum used the term “paranoia” to describe a state of partial insanity that affected the intellect, but not other areas of mental functioning. In the view of Kahlbaum, a person with paranoia held a group of false beliefs to be true. Emil Kraepelin expanded on this concept by characterizing paranoia as a condition with a persistent delusional system of false belief that a person held to be true despite evidence to the contrary. Eugen...
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Extent of the Problem (Psychology and Mental Health)
Paranoia or delusional disorder has been found to be a rare condition, with an annual incidence of one to three new cases per 100,000 persons each year in the United States. Usually the age of onset for the disorder is around forty, but persons have been diagnosed with the condition from adolescence to late adulthood. Females show a slight edge in the number of persons diagnosed with delusional disorder. In general, it is believed that the condition is unreported because few people with delusional disorder seek professional help.
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Diagnosis (Psychology and Mental Health)
It can be difficult to diagnose paranoia because of the imprecise nature of the symptoms. Many people believe ideas that cannot be proven empirically or that are definitely false. To assist with the diagnosis of paranoia, the psychiatric community suggests that formal identification of delusions requires consideration of the beliefs and ideas in a person’s own community. If the community would label a belief as preposterous, then paranoia can be considered as a diagnosis.
For a diagnosis of delusional disorder to be made, the false beliefs must not appear to be bizarre. This means that the delusional ideas could be possible. For example, a person believing a flying hamburger is attempting to devour him would have a bizarre delusion. Bizarre delusions are usually associated with schizophrenia, which is a severe psychiatric disorder in which a person loses reasoning capacity, has a severe disruption in mood state, shows disorganized speech, and may experience hallucinations.
Delusional disorder exists in the form of different types that indicate the content of the delusions. The persecutory type is found when a person falsely believes that someone is spying, stalking, or spreading false rumors about him or her. Sometimes the person with a persecutory type of delusional disorder can be dangerous to others, threatening or carrying out acts of violence. The jealous type is found when a person is convinced that a sexual partner...
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Possible Causes (Psychology and Mental Health)
The causes of delusional disorder are not known, but delusional disorder appears to develop slowly over a period of time. The person who develops the disorder usually has a group of personality characteristics including being standoffish, unfriendly, and emotionally cold. Usually a pattern emerges in which the person blames others for his or her failures and disappointments. This leads to a paranoid social cognition as a constant interpretation of the world.
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Treatment (Psychology and Mental Health)
There is no one treatment for persons with delusional disorder. It has been found that once the delusional system has been established, it is extremely difficult to remove or modify it. For psychotherapy to be effective, a relationship needs to be developed between the patient and the therapist. However, communication with a person who has a delusional disorder is difficult, and such a patient will usually refuse offers of medication. The group of drugs called antipsychotic medications, including haloperidol and pimozide, are often tried for treatment, but the medications are usually not taken with any regularity. Many persons with this disorder are hospitalized if they become a threat to other people, but once the person renounces the delusion, he or she will be discharged. The long-term prognosis for the successful treatment of delusional disorder has been poor.
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Sources for Further Study (Psychology and Mental Health)
Chadwick, Paul, Max J. Birchwood, and Peter Trower. Cognitive Therapy for Delusions, Voices, and Paranoia. New York: John Wiley & Sons, 1996. Written for psychologists and therapists, offers guidelines for diagnosing paranoia and delusional disorders and analyzes the usefulness of cognitive therapy for dealing with them.
Gabbard, G., S. Lazar, and D. Spiegel. “The Economic Impact of Psychotherapy: A Review.” American Journal of Psychiatry 154 (1997): 147-155. This is a study on the benefits of attempting psychological treatment with persons who have delusional disorder. Although it is a difficult process, the long-term benefits are significant.
Kantor, Martin. Understanding Paranoia: A Guide for Professionals, Families, and Sufferers. Westport, Conn.: Praeger, 2008. Insightful resource for the layperson. The author describes vividly the workings of the paranoid mind, in an attempt to help sufferers and their family members, friends, and colleagues understand paranoid behavior.
Kinderman, P., and R. Bentall. “Causal Attributions in Paranoia and Depression: Internal, Personal, and Situational Attributions for Negative Events.” Journal of Abnormal Psychology 106 (1997): 341-345. The underlying cognitive processes found in delusional disorder are reviewed. The authors discuss how the delusional person generalizes small negative events to a broader...
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Causes and Symptoms (Magill’s Medical Guide, Sixth Edition)
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....
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Treatment and Therapy (Magill’s Medical Guide, Sixth Edition)
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 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.
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
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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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Barlow, David H., ed. Clinical Handbook of Psychological Disorders. 4th ed. New York: Guilford Press, 2008. This collection defines and describes psychological disorders and uses case histories as illustrations for treatment.
Bloom, Floyd E., M. Flint Beal, and David J. Kupfer, eds. The Dana Guide to Brain Health. New York: Dana Press, 2006. An easy-to-understand health guide to the brain from neuroscience, neurology, and psychiatry perspectives. More than seventy psychiatric and neurological disorders, their diagnoses, and their treatments are covered.
Kring, Ann M., et al. Abnormal Psychology. 11th ed. Hoboken, N.J.: John Wiley & Sons, 2010. This college text addresses the causes of psychopathology and treatments commonly used to treat various disorders. The book is well organized, readable, and interesting. An extensive reference list and a glossary are included.
Munro, Alistair. Delusional Disorder: Paranoia and Related Illnesses. New York: Cambridge University Press, 1999. Discusses the various subtypes of delusional disorders, such as the somatic, jealous, erotomanic, persecutory/litigious, and grandiose subtypes. Also discusses treatments.
Robbins, Michael. Experiences of Schizophrenia: An Integration of the Personal, Scientific, and Therapeutic. New York: Guilford Press, 1993. Discusses such topics as the psychological system, the family...
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Paranoia (Encyclopedia of Medicine)
Paranoia is an unfounded or exaggerated distrust of others, sometimes reaching delusional proportions. Paranoid individuals constantly suspect the motives of those around them, and believe that certain individuals, or people in general, are "out to get them."
Paranoid perceptions and behavior may appear as features of a number of mental illnesses, including depression and dementia, but are most prominent in three types of psychological disorders: paranoid schizophrenia, delusional disorder (persecutory type), and paranoid personality disorder (PPD).
Individuals with paranoid schizophrenia and persecutory delusional disorder experience what is known as persecutory delusions: an irrational, yet unshakable, belief that someone is plotting against them. Persecutory delusions in paranoid schizophrenia are bizarre, sometimes grandiose, and often accompanied by auditory hallucinations. Delusions experienced by individuals with delusional disorder are more plausible than those experienced by paranoid schizophrenics; not bizarre, though still unjustified. Individuals with delusional disorder may seem offbeat or quirky rather than mentally ill, and, as such, may never seek treatment.
Persons with paranoid personality disorder tend to be...
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Paranoia (Encyclopedia of Mental Disorders)
Paranoia is a symptom in which an individual feels as if the world is "out to get" him or her. When people are paranoid, they feel as if others are always talking about them behind their backs. Paranoia causes intense feelings of distrust, and can sometimes lead to overt or covert hostility.
An individual suffering from paranoia feels suspicious, and has a sense that other people want to do him or her harm. As a result, the paranoid individual changes his or her actions in response to a world that is perceived as personally threatening. Objective observers may be quite clear on the fact that no one's words or actions are actually threatening the paranoid individual. The hallmark of paranoia is a feeling of intense distrust and suspiciousness that is not in response to input from anybody or anything in the paranoid individual's environment.
Other symptoms of paranoia may include
- Self-referential thinking: The sense that other people in the world (even complete strangers on the street) are always talking about the paranoid individual.
- Thought broadcasting: The sense that other people can read the paranoid individual's mind.
- Magical thinking:...
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Paranoia (Encyclopedia of Psychology)
A pervasive feeling of distrust of others.
Paranoia is an ever-present feeling of suspicion that others cannot be trusted. Such feelings are not based on fact or reality; insecurity and low self-esteem often exaggerate these emotions. Typically, paranoia is not seen in children, but in most cases it begins to develop in late adolescence and early adulthood. Most people experience feelings of paranoia, usually in response to a threatening situation or in connection with feelings of insecurity based on real circumstances. These feelings are related to the mild anxiety people experience at some points during their lives.
The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) includes diagnostic criteria for the more serious condition, paranoid personality disorder. According to the DSM-IV, individuals afflicted with this disorder assume, with little concrete evidence to support the assumption, that others plan to exploit, harm, or deceive him or her; and continually analyzes the motivations of friends, family, and others to confirm his or her doubts about their trustworthiness; expects friends and family to abandon him or her in times of trouble or stress; avoids revealing personal information because of fear that it will be used against him or her;...
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Paranoia (International Dictionary of Psychoanalysis)
Paranoia has individual and institutional, social and cultural forms and determinants. There is probably at least a germ of paranoia in everyone which may be activated in regressive states with increased vulnerability. Clinically, paranoia may be found in mild transient forms, paranoid states of varying degree and duration, fixed paranoid traits and paranoid character, and borderline schizophrenia. The range of paranoid conditions doubtless depends upon constitutional, characterological, and experiential variables.
Unlike other types of psychosis, a paranoid psychosis is usually well-defined, and more or less circumscribed in a delusional part of the personality. The disturbance may remain encapsulated or systematized without generalized tendencies toward deterioration of the overall personality.
The paranoid personality is characterized by a number of common traits: basic distrust; suspiciousness; readiness to feel slighted, injured or persecuted; a tendency to collect grievances and grudges; and vindictiveness. The paranoid personality either anticipates or fears being exploited and abused; is irrationally suspicious of hidden dangers or threats; and expects or believes in the infidelity of a spouse, the disloyalty of friends, and notions of hostile conspiracy. Betrayals are anticipated or assumed, so that for the paranoid friend may immediately become foe, and seeming affection may be replaced by an implacable animosity. Self-esteem issues are also apparentonnected with both the extraordinary sensitivity to narcissistic injury and humiliation, and concomitant grandiosity which may extend to megalomania.
The psychoanalytic understanding of paranoia was initiated by Freud (1911c) who, prior to the Schreber case, had already linked the defense mechanism of projection to the paranoia personality. Via projection, the paranoid defends against unacceptable impulses, especially hate and aggression, which are also related to paranoid defiance. The importance of regression to narcissism, with attendant hypersensitivity to narcissistic mortification and grandiosity associated with infantile omnipotence, was highlighted in the Schreber case. Grandiosity could also be a compensatory reaction to unconscious feelings of inadequacy and inferiority. However, Freud shifted the dynamic understanding of paranoia at the same time to a core oedipal conflict. The paranoid defense constellation warded off unconscious homosexual wishes. In the paranoid male the unconscious proposition: "I, a man, love him, a man," is contradicted in the following ways: (1) delusions of jealousy: "It is not I who love the man; it is she," (2) delusions of persecution: "I do not love him, I hate him. Because of this he hates and persecutes me," (3) erotomania: "I do not love him. I love her, and she loves me," (4) megalomanic disavowal: "I do not love anyone else, but only myself."
It should be noted that Freud's formulations in the Schreber case were based upon the utilization of the libido theory and an attempt to understand paranoia in terms of psychosexual disturbance, which reversed his earlier formulation of repressed hostility. Subsequent contributions have confirmed the importance of malignant narcissism and the defense of projection, but also of hatred, aggression, and splitting of the ego and of self and object representations.
This defensive splitting off (Klein, Melanie, 1932) is also recognizable in group processes, as in the tendency to idealize one's own group and to distrust and project evil and hostility to those outside the group, especially against defenseless minorities unable to counterattack. Paranoid processes may be discerned in various sects and ideologies, where there is devaluation and persecution of those who are seen as opposed to the sect or group's narcissistically-invested belief system. In such dynamics, those who diverge may be scapegoated, and those who deviate or depart may be persecuted as heretics. Individuals with paranoid proclivities are far more readily attracted and susceptible to paranoid demagogues and groups. Paranoid leaders may foment and foster group paranoid reactions among vulnerable individuals. On the other hand, paranoid tendencies may contribute to individuals being vigilant guardians of civil liberty, ever-ready to detect a base of power and threats of exploitation. Feelings of being watched and scrutinized, so commonly seen with paranoid superego regression and externalization, may also have adaptive functions.
Contemporary understanding of the paranoid personality sometimes relates to circumstances in which a traumatic reality is embedded in fantasy, and historical truth in delusion (Freud, 1937d; Blum, 1994). There is often a history of childhood paranoia, so that pronounced narcissistic and paranoid features are already present in childhood. Feelings of mistrust, suspicion, and susceptibility to feelings of insult and injury may have been lifelong. The nightmares of paranoid patients may leave a hangover effect, so that the paranoid nightmare and terror of attack invades reality.
Traumatic experience with the terror of helplessness and inevitable narcissistic mortification may also be associated with severe and enduring vulnerability to narcissistic hurt and humiliation. Some cases involve selective identifications with paranoid parents. Paranoid dispositions may be anchored in familial styles of paranoid suspicion and scapegoating, or blaming and vengeful familial attitudes.
Furthermore, the paranoid often not only detects the latent envy and hostility of others, but tends to activate and evoke hostile reactions as well. The paranoid's expectation of social slights and hurts becomes a self-fulfilling prophecy as their own suspiciousness and hostility arouses similar mistrusts and hostility in others. Freud (1922b) observed the tendency of the paranoid personality to recognize but exaggerate the imagined infidelity present in both partners. Since blame and guilt are projected, the paranoid remains indignant about innocent victimization and may become litigious. Narcissistic rage over feelings of injury and compensatory aggrandizement serve to undo and reverse traumatic helplessness and avenge prior narcissistic hurts and humiliations (Kohut, 1972). The paranoid's own urge toward betrayal becomes a means of vengeance, vindication, and mastery. A preemptive strike may be related to the paranoid's expectation of attack, betrayal, and the rationalization of a defensive counterattack. Any narcissistic frustration, disappointment, or traumatic disturbance may regressively activate a paranoid persecutory system. All levels of personality development may contribute to the paranoid persecutory system.
Current explanations of paranoia involve recognition of diffuse developmental disturbance without a single point of developmental fixation or deficit, appreciating the possibility of complex overdetermination. In paranoia, murderous hostility is now considered far more important than repressed homosexual love. There is a stress on preoedipal roots, leading to failure of oedipal resolution, and to the patient's vulnerability to malignant narcissistic regression (Kernberg, 1975).
Freud's proposition of the delusional reconstruction of the lost object world is still accepted by many analysts, while others have proposed different views concerning impaired reality testing and paranoid object relations. Reality testing, cognition, and affect regulation may be constitutionally fragile and further impaired by projection, traumatic injury, and ego regression. The paranoid personality may have many areas of intact ego, but it has been proposed (Blum, 1981; 1994) that the persecutor is a narcissistic object or a part object (Klein, 1932), incompletely differentiated from the self representation. In addition to the splitting of representations, there is a regressive failure of object constancy with incomplete separation-individuation (Mahler, Margaret, 1971), and a desperate effort to reestablish object constancy within a constant persecutory relationship. The persecutory narcissistic object is sought, followed, or is imagined to be following the paranoid patient. The split-off dangerous object is the lesser evil when compared to objectless disorganization and fragmentation. Extreme ambivalence prevails, with the dominance of hate over love and with predominant projection of destructive rage, hatred, and self-hatred. Fear of being attacked by an invading or engulfing object is readily fused and confused because of unstable self-object differentiation, intrapsychic representation, and ego integration. Masochistic wishes to be attacked are less unpalatable to the paranoiac than the potentially malignant narcissism.
In national and social paranoia, concern with ego boundaries and narcissistic injury is reflected in concerns about national boundaries and enemy betrayal. The nation's integrity, and its boundaries, must then be defended because of fear of destructive invasion and engulfment.
The paranoid personality, depending upon the degree and fixity of the underlying disturbance, may be variably amenable to psychoanalytic treatment. Mistrust and lack of confidence in the analyst or therapist, fear of humiliation and abuse, coupled with an entrenched and entitled narcissism make the paranoid patient a major therapeutic challenge. For those patients amenable to psychoanalysis, consistent interpretation of paranoid transference manifestations, management of paranoid regression, and awareness of the patient's ego fragility and extreme ambivalence are of critical importance.
HAROLD P. BLUM
See also: Narcissism; Paranoid position; Paranoid-schizoid position.
Blum, Harold P. (1994). Paranoid betrayal and jealousy: the loss and restitution of object constancy. In J. Oldham, S. Bone (Eds.), Paranoia: New psychoanalytical perspectives. Madison: International Universities Press, p. 97-114.
Freud, Sigmund. (1911c ). Psycho-analytic notes on an autobiographical account of a case of paranoia (dementia paranoides). SE, 12: 1-82.
. (1922b ). Neurotic mechanisms in jealousy, paranoia and homosexuality. SE, 18: 221-232.
. (1937d). Constructions in analysis. SE, 23: 255-269.
Kernberg, Otto. (1975). Borderline conditions and pathological narcissism. New York: Jason Aronson.
Kohut, Heinz. (1972). Thoughts on narcissism and narcissistic rage. The search for the self. (Vol. 2.) New York: International Universities Press, p. 615-65.
Auchincloss, Elizabeth L., and Weiss, Richard W. (1992). Paranoid character and the intolerance of indifference. Journal of the American Psychoanalytic Association, 40, 1013-1038.
Blum, Harold P. (1980). Paranoia and beating fantasy: psychoanalytic theory of paranoia. Journal of the American Psychoanalytic Association, 28, 331-362.
Kernberg, Otto F. (1992). Psychopathic, paranoid, and depressive transferences. International Journal of Psychoanalysis, 73, 13-28.
Meissner, William. (1986). Psychotherapy and the paranoid process. Northvale, NJ: Jason Aronson.
Oldham, John M., and Bone, Stanley. (Eds.). (1994). Paranoia: New psychoanalytic perspectives. Madison, CT: International Universities Press.