Paranoia
Paranoia, in psychiatry, is the belief that everything is about the person who is experiencing the paranoia. Paranoid thinking concerns how the paranoid person thinks. For example, a paranoid person may believe people are concerned with everything they are doing. These beliefs can also be persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself. Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety, suspicion, or fear, often to the point of delusion and irrationality. Paranoia is distinct from phobias, which also involve irrational fear, but usually no blame.
Making false accusations and carrying a general distrust of other people also frequently accompany paranoia. 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.
Signs and symptoms
A common symptom of paranoia is attribution bias. These individuals typically have a biased perception of reality, often exhibiting more hostile beliefs than average. A paranoid person may view someone else's accidental behavior as though it is intentional or signifies a threat.An investigation of a non-clinical paranoid population found that characteristics such as feeling powerless and depressed, isolating oneself, and relinquishing activities, were associated with more frequent paranoia.
Some scientists have created different subtypes for the various symptoms of paranoia, including erotic, persecutory, litigious, and exalted.
Some research suggests that symptoms of paranoid personality disorder are associated with a higher number of divorces, likely due to how paranoid patterns of thinking hinder relationships. This seems to fall in line with some older sources, which allege that paranoid individuals tend to be of a single status.
Some researchers have arranged types of paranoia by commonality. 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.
Causes
Social and environmental
Social circumstances appear to be highly influential on paranoid beliefs. According to a mental health survey distributed to residents of Ciudad Juárez, Chihuahua and El Paso, Texas, paranoid beliefs seem to be associated with feelings of powerlessness and victimization, enhanced by social situations. Paranoid symptoms were associated with an attitude of mistrust and an external locus of control. Citing research showing that women and those with lower socioeconomic status are more prone to locating locus of control externally, the researchers suggested that women may be especially affected by the effects of socioeconomic status on paranoia.Surveys have revealed that paranoia can develop from difficult parental relationships and untrustworthy environments, for instance those that were highly disciplinary, strict, and unstable, could contribute to paranoia. Some sources have also noted that indulging and pampering the child could contribute to greater paranoia, via disrupting the child's understanding of their relationship with the world. Experiences found to enhance or create paranoia included frequent disappointment, stress, and a sense of hopelessness.
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 greater discrimination throughout their lives. Immigrants are more subject to some forms of psychosis than the general population, which may be related to more frequent experiences of discrimination and humiliation.
Psychological
Many more mood-based symptoms, for example grandiosity and guilt, may underlie functional paranoia.Colby defined paranoid cognition as "persecutory delusions and false beliefs whose propositional content clusters around ideas of being harassed, threatened, harmed, subjugated, persecuted, accused, mistreated, killed, wronged, tormented, disparaged, vilified, and so on, by malevolent others, either specific individuals or groups".
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".
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 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, 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 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.
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.
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.Drug-induced paranoia, associated with cannabis and stimulants like amphetamines or methamphetamine, 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. 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.
Diagnosis
In the DSM-IV-TR, paranoia is diagnosed in the form of: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 personality—not 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".
At least 50% of the diagnosed cases of schizophrenia experience delusions of reference and delusions of persecution. 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, and paranoid personality disorder.
Treatment
Paranoid delusions are often treated with antipsychotic medication, which exert a medium effect size. Cognitive behavioral therapy lessens paranoid delusions relative to control conditions according to a meta-analysis. A meta-analysis of 43 studies reported that metacognitive training reduces delusions at a medium to large effect size relative to control conditions.History
The word paranoia comes from the Greek παράνοια, "madness", and that from παρά, "beside, by" and νόος, "mind". 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. 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". 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 Aulus Cornelius Celsus. The term "paranoia" first made an appearance during plays of Greek tragedians, and was also used by philosophers such as Plato and Hippocrates. Nevertheless, the word "paranoia" was the equivalent of "delirium" or "high". Eventually, the term fell out of use for two millennia. "Paranoia" was revived in the 18th century, appearing in the works of nosologists such as François Boissier de Sauvage and Rudolph August Vogel.According to Michael Phelan, Padraig Wright, and Julian Stern, 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, and 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 the delusions refer mainly to the self.