Paranoia

Last updated
Paranoia
Other namesParanoid (adjective)
Pronunciation
Specialty Psychiatry, clinical psychology
Symptoms Distrust, false accusations

Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. [1] Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself (i.e. "Everyone is out to get me"). Paranoia is distinct from phobias, which also involve irrational fear, but usually no blame.

Contents

Making false accusations and the general distrust of other people also frequently accompany paranoia. [2] 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. [3]

Signs and symptoms

A common symptom of paranoia is the attribution bias. These individuals typically have a biased perception of reality, often exhibiting more hostile beliefs. [4] A paranoid person may view someone else's accidental behavior as though it is with intent or threatening.

An investigation of a non-clinical paranoid population found that feeling powerless and depressed, isolating oneself, and relinquishing activities are characteristics that could be associated with those exhibiting more frequent paranoia. [5] Some scientists have created different subtypes for the various symptoms of paranoia including erotic, persecutory, litigious, and exalted. [6]

Due to the suspicious and troublesome personality traits of paranoia, it is unlikely that someone with paranoia will thrive in interpersonal relationships. Most commonly paranoid individuals tend to be of a single status. [7]

According to some research there is a hierarchy for paranoia. The least common types of paranoia at the very top of the hierarchy would be those involving more serious threats. Social anxiety is at the bottom of this hierarchy as the most frequently exhibited level of paranoia. [8]

Causes

Social and environmental

Social circumstances appear to be highly influential in paranoid beliefs. Based on data collected by means of 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. Potential causes of these effects included a sense of believing in external control, and mistrust which can be strengthened by lower socioeconomic status. Those living in a lower socioeconomic status may feel less in control of their own lives. In addition, this study explains that females have the tendency to believe in external control at a higher rate than males, potentially making females more susceptible to mistrust and the effects of socioeconomic status on paranoia. [9]

Emanuel Messinger reports that surveys have revealed that paranoia can develop from parental relationships and untrustworthy environments. These environments could include being very disciplinary, stringent, and unstable. It was even noted that, "indulging and pampering (thereby impressing the child that they are something special and warrants special privileges)," can be contributing backgrounds. [10] Experiences likely to enhance or manifest the symptoms of paranoia include increased rates of disappointment, stress, and a hopeless state of mind. [11]

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 higher levels of discrimination throughout their lives. In addition to this it has been noted that immigrants are quite susceptible to forms of psychosis. This could be due to the aforementioned effects of discriminatory events and humiliation. [12]

Psychological

Many more mood-based symptoms, grandiosity and guilt, may underlie functional paranoia. [13]

Colby (1981) defined paranoid cognition in terms of persecutory delusions and false beliefs whose propositional content clusters around ideas of being harassed, threatened, harmed, subjugated, persecuted, accused, mistreated, 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. [14]

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. [15]

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. [10]

Drug-induced paranoia, associated with cannabis, amphetamines, methamphetamine and similar stimulants 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. [16] 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. [17]

Diagnosis

In the DSM-IV-TR, paranoia is diagnosed in the form of: [18]

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 personalitynot 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". [21]

At least 50% of the diagnosed cases of schizophrenia experience delusions of reference and delusions of persecution. [22] [23] 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. [24] Cognitive behavioral therapy (CBT) improves paranoid delusions relative to control conditions according to a meta-analysis. [25] 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. [26]

History

The word paranoia comes from the Greek παράνοια (paránoia), "madness", [27] and that from παρά (pará), "beside, by" [28] and νόος (nóos), "mind". [29] The term was used to describe a mental illness in which a delusional belief is the sole or most prominent feature. In this definition, the belief does not have to be persecutory to be classified as paranoid, so any number of delusional beliefs can be classified as paranoia. [30] For example, a person who has the sole delusional belief that they are an important religious figure would be classified by Kraepelin as having 'pure paranoia'. The word “paranoia” is associated from the Greek word “para-noeo”. [31] Its meaning was "derangement", or "departure from the normal". However, the word was used strictly and other words were used such as "insanity" or "crazy", as these words were introduced by Aurelius Cornelius Celsus. The term “paranoia” first made an appearance during plays of Greek tragedians, and was also used by sufficient individuals such as Plato and Hippocrates. Nevertheless, the word “paranoia” was the equivalent of “delirium” or “high fever”. Eventually, the term made its way out of everyday language for two millennia. “Paranoia” was soon revived as it made an appearance in the writings of the nosologists. It began to take appearance in France, with the writings of Rudolph August Vogel (1772) and Francois Boissier de Sauvage (1759). [31]

According to Michael Phelan, Padraig Wright, and Julian Stern (2000), [32] paranoia and paraphrenia are debated entities that were detached from dementia praecox by Kraepelin, who explained paranoia as a continuous systematized delusion arising much later in life with no presence of either hallucinations or a deteriorating course, paraphrenia as an identical syndrome to paranoia but with hallucinations. Even at the present time, a delusion need not be suspicious or fearful to be classified as paranoid. A person might be diagnosed with paranoid schizophrenia without delusions of persecution, simply because their delusions refer mainly to themselves.

Relations to violence

It has generally been agreed upon that individuals with paranoid delusions will have the tendency to take action based on their beliefs. [33] More research is needed on the particular types of actions that are pursued based on paranoid delusions. Some researchers have made attempts to distinguish the different variations of actions brought on as a result of delusions. Wessely et al. (1993) did just this by studying individuals with delusions of which more than half had reportedly taken action or behaved as a result of these delusions. However, the overall actions were not of a violent nature in most of the informants. The authors note that other studies such as one by Taylor (1985), have shown that violent behaviors were more common in certain types of paranoid individuals, mainly those considered to be offensive such as prisoners. [34]

Other researchers have found associations between childhood abusive behaviors and the appearance of violent behaviors in psychotic individuals. This could be a result of their inability to cope with aggression as well as other people, especially when constantly attending to potential threats in their environment. [35] The attention to threat itself has been proposed as one of the major contributors of violent actions in paranoid people, although there has been much deliberation about this as well. [36] Other studies have shown that there may only be certain types of delusions that promote any violent behaviors, persecutory delusions seem to be one of these. [37]

Having resentful emotions towards others and the inability to understand what other people are feeling seem to have an association with violence in paranoid individuals. This was based on a study of paranoid schizophrenics' (one of the common mental disorders that exhibit paranoid symptoms) theories of mind capabilities in relation to empathy. The results of this study revealed specifically that although the violent patients were more successful at the higher level theory of mind tasks, they were not as able to interpret others' emotions or claims. [38]

Paranoid social cognition

Social psychological research has proposed a mild form of paranoid cognition, paranoid social cognition, that has its origins in social determinants more than intra-psychic conflict. [39] [40] [41] [42] [43] This perspective states that in milder forms, paranoid cognitions may be very common among normal individuals. For instance, it is not strange that people may exhibit in their daily life, self-centered thought such as they are being talked about, suspiciousness about others’ intentions, and assumptions of ill-will or hostility (i.e. people may feel as if everything is going against them). According to Kramer (1998), these milder forms of paranoid cognition may be considered as an adaptive response to cope with or make sense of a disturbing and threatening social environment.

Paranoid cognition captures the idea that dysphoric self-consciousness may be related with the position that people occupy within a social system. This self-consciousness conduces to a hypervigilant and ruminative mode to process social information that finally will stimulate a variety of paranoid-like forms of social misperception and misjudgment. [44] This model identifies four components that are essential to understanding paranoid social cognition: situational antecedents, dysphoric self-consciousness, hypervigilance and rumination, and judgmental biases.

Situational antecedents

Perceived social distinctiveness, perceived evaluative scrutiny and uncertainty about the social standing.

Dysphoric self-consciousness

Refers to an aversive form of heightened 'public self-consciousness' characterized by the feelings that one is under intensive evaluation or scrutiny. [41] [47] Becoming self-tormenting will increase the odds of interpreting others' behaviors in a self-referential way.

Hypervigilance and rumination

Self-consciousness was characterized as an aversive psychological state. According to this model, people experiencing self-consciousness will be highly motivated to reduce it, trying to make sense of what they are experiencing. These attempts promote hypervigilance and rumination in a circular relationship: more hypervigilance generates more rumination, whereupon more rumination generates more hypervigilance. Hypervigilance can be thought of as a way to appraise threatening social information, but in contrast to adaptive vigilance, hypervigilance will produce elevated levels of arousal, fear, anxiety, and threat perception. [48] Rumination is another possible response to threatening social information. Rumination can be related to the paranoid social cognition because it can increase negative thinking about negative events, and evoke a pessimistic explanatory style.

Judgmental and cognitive biases

Three main judgmental consequences have been identified: [40]

Meta-analyses have confirmed that individuals with paranoia tend to jump to conclusions and are incorrigible in their judgements, even for delusion-neutral scenarios. [49] [50]

Research

A study suggests that combining cognitive behavioral therapy (CBT) with SlowMo, an app that helps notice their "unhelpful fast-thinking" might be more effective for treating paranoia in people with psychosis than CBT alone. [51] [52]

See also

Related Research Articles

<span class="mw-page-title-main">Psychosis</span> Abnormal condition of the mind

Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder characterized by psychosis

Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations, delusions, and disorganized thinking. Other symptoms include social withdrawal, decreased emotional expression, and apathy. Symptoms typically develop gradually, begin during young adulthood, and in many cases never become resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. To be diagnosed with schizophrenia, symptoms and functional impairment need to be present for six months (DSM-5) or one month (ICD-11). Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders, and obsessive–compulsive disorder.

A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other misleading effects of perception, as individuals with those beliefs are able to change or readjust their beliefs upon reviewing the evidence. However:

<span class="mw-page-title-main">Erotomania</span> Subtype of a delusional disorder

Erotomania, also known as de Clérambault's Syndrome, named after French psychiatrist Gaëtan Gatian de Clérambault, is listed in the DSM-5 as a subtype of a delusional disorder. It is a relatively uncommon paranoid condition that is characterized by an individual's delusions of another person being infatuated with them. This disorder is most often seen in female patients who are shy, dependent and sexually inexperienced. The object of the delusion is typically a male who is unattainable due to high social or financial status, marriage or uninterest. The object of obsession may also be imaginary, deceased or someone the patient has never met. Delusions of reference are common, as the erotomanic individual often perceives that they are being sent messages from the secret admirer through innocuous events such as seeing license plates from specific states, but has no proof. Commonly, the onset of erotomania is sudden, and the course is chronic.

Ideas of reference and delusions of reference describe the phenomenon of an individual experiencing innocuous events or mere coincidences and believing they have strong personal significance. It is "the notion that everything one perceives in the world relates to one's own destiny", usually in a negative and hostile manner.

<span class="mw-page-title-main">Delusional disorder</span> Mental illness featuring beliefs with inadequate grounding

Delusional disorder is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily generally seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.

Richard Bentall is a Professor of Clinical Psychology at the University of Sheffield in the UK.

<span class="mw-page-title-main">Thought disorder</span> Disorder of thought form, content or stream

A thought disorder (TD) is any disturbance in cognition that adversely affects language and thought content, and thereby communication. A variety of thought disorders were said to be characteristic of people with schizophrenia. A content-thought disorder is typically characterized by the experience of multiple delusional fragments. The term thought disorder is often used to refer to a formal thought disorder.

Paranoid personality disorder (PPD) is a mental illness characterized by paranoid delusions, and a pervasive, long-standing suspiciousness and generalized mistrust of others. People with this personality disorder may be hypersensitive, easily insulted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions that may validate their fears or biases. They are eager observers and they often think they are in danger and look for signs and threats of that danger, potentially not appreciating other interpretations or evidence.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

The Hearing Voices Movement (HVM) is the name used by organizations and individuals advocating the "hearing voices approach", an alternative way of understanding the experience of those people who "hear voices". In the medical professional literature, ‘voices’ are most often referred to as auditory verbal hallucinations. The movement uses the term ‘hearing voices’, which it feels is a more accurate and 'user-friendly' term.

Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations and without deterioration of intellect or personality.

<span class="mw-page-title-main">Grandiose delusions</span> Subtype of delusion

Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, are a subtype of delusion that occur in patients with a wide range of psychiatric diseases, including two-thirds of patients in a manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, frequently in narcissistic personality disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. Around 10% of healthy people experience grandiose thoughts at some point in their lives but do not meet full criteria for a diagnosis of GD.

A persecutory delusion or persecution complex is a common type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an individual or a group of people. Persecution delusions are very diverse in terms of content and vary from the possible, albeit improbable, to the completely bizarre. The delusion can be found in a multitude of disorders, being more usual in psychotic disorders, such as schizophrenia, schizoaffective disorder and delusional disorder.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

A religious delusion is defined as a delusion, or fixed belief not amenable to change in light of conflicting evidence, involving religious themes or subject matter. Religious faith, meanwhile, is defined as a belief in God or a religious doctrine in the absence of evidence. Psychologists, scientists, and philosophers have debated the distinction between the two, which is subjective and cultural.

The relationship between religion and schizophrenia is of particular interest to psychiatrists because of the similarities between religious experiences and psychotic episodes; religious experiences often involve auditory and/or visual phenomena, and those with schizophrenia commonly report hallucinations and delusions that may resemble the events found within a religious experience. In general, religion has been found to have "both a protective and a risk increasing effect" for schizophrenia.

<i>Doctoring the Mind</i>

Doctoring the Mind: Why psychiatric treatments fail is a 2009 book by Richard Bentall, his thesis is critical of contemporary Western psychiatry. Bentall, a professor of clinical psychology, argues that recent scientific research shows that the medical approach to mental illness is fatally flawed. According to Bentall, it seems there is no "evidence that psychiatry has made a positive impact on human welfare" and "patients are doing no better today than they did a hundred years ago".

<span class="mw-page-title-main">Elizabeth Kuipers</span>

Elizabeth Alice Kuipers is a professor of psychology at the Institute of Psychiatry, King's College London, and was head of the Psychology Department from 2006- 2012. Kuipers is a consultant clinical psychologist and until 2012, had an honorary appointment at the South London and Maudsley NHS Foundation Trust, working as part of the psychosis community mental health team in Southwark. She is a founding director of the PICuP clinic and was the chair of the NICE Schizophrenia Guideline update 2007-9 and the Psychosis and Schizophrenia update 2011-2014

Metacognitive training, (MCT), is an approach for treating the symptoms of psychosis in schizophrenia, especially delusions, which has been adapted for other disorders such as depression, obsessive-compulsive disorder and borderline over the years. It was developed by Steffen Moritz and Todd Woodward. The intervention is based on the theoretical principles of cognitive behavioral therapy, but focuses in particular on problematic thinking styles that are associated with the development and maintenance of positive symptoms, e.g. overconfidence in errors and jumping to conclusions. Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+).

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Further reading