Paranoia and schizophrenia: Symptoms, causes, and diagnosis

A person who has a condition on the schizophrenia spectrum may experience delusions and what is commonly known as paranoia.

These delusions may give rise to fears that others are plotting against the individual. Everyone can have a paranoid thought from time to time. On a rough day, we may find ourselves saying “Oh boy, the whole world is out to get me!” But we recognize that this is not the case.

People with paranoia often have an extensive network of paranoid thoughts and ideas.

This can result in a disproportionate amount of time spent thinking up ways for the individual to protect themselves from their perceived persecutors. It can lead to problems in relationships and at work.

Fast facts on paranoia in schizophrenia

Here are some key points about paranoia in schizophrenia. More detail is in the main article.

People with schizophrenia often experience confusion and fear and they may have delusions that someone is plotting against them.

Since 2013, the subtype “paranoid schizophrenia” is not separate but a part of schizophrenia.

Medications and other treatment enable many patients to manage their condition.

Lifelong treatment is usually needed to stop symptoms from returning.

Overview: Paranoia and schizophrenia

[schizophrenia can cause fear and confusion]
Schizophrenia can cause fear, confusion, and delusions. The person may believe someone is persecuting them.

Before 2013, paranoid schizophrenia was considered a type of schizophrenia, but in 2013, the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) reclassified paranoia, or delusions, as a symptom rather than a subtype.

The subtypes were removed from the diagnosis criteria because of their “limited diagnostic stability, low reliability, and poor validity.”

They were not seen as stable conditions, and they were not helping to diagnose or treat conditions related to schizophrenia.

The DSM is published by the American Psychiatric Association (APA) to help standardize diagnoses of different types of mental illness.

[having schizophrenia and paranoia can be lonely ]
A person with schizophrenia may feel detached and isolated.

The person may notice changes in sleep patterns, emotions, motivation, communication, and ability to think clearly. This is the early, or “prodromal phase” of the illness.

An acute episode is more severe. There may be feelings of panic, anger, and depression. This can be frightening for the individual, who most likely does not expect it to happen.

Appropriate treatment and support can help people cope with schizophrenia. Medications can stabilize the condition, and many live and work as they would without the condition. However, if the person stops taking the medication, symptoms often return.

Delusions are a common feature. A delusion is something the person believes is true, even when strong evidence suggests that it is false. For example, the person may believe that someone they know is planning to harm them.

Along with delusions, there may be auditory hallucinations, or hearing things that are not there, and perceptual disturbances. Visual hallucinations sometimes occur.

This can lead to physical and emotional detachment, social withdrawal, anger, and anxiety. Many people with symptoms of paranoia will be fearful and seek to avoid others.

Some people express their fears and frustration through aggression and violence, but many become a target for violence or exploitation.

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Causes and risk factors

Schizophrenia is a neuropsychiatric disorder. The exact causes are unclear, but it probably involves a combination of genetic factors and environmental triggers.

Symptoms may result from an imbalance of dopamine and possibly serotonin, both of which are neurotransmitters.

Risk factors include:

Genetics: Having a family history of schizophrenia increases the risk of developing it.

If there is no family history, the chances of developing schizophrenia are below 1 percent. If a parent had the condition, there is a 10-percent chance of developing it.

Other factors that may contribute are:

a viral infection in the mother while she was pregnant

malnutrition before birth

stress, trauma, or childhood abuse

problems during delivery

Stressful experiences often occur before a diagnosis of schizophrenia.

Before acute symptoms appear, the person may start to experience bad-temper, anxiety, and a lack of focus. This can trigger relationship problems.

These factors are often blamed for the onset of schizophrenia, but it may be that early symptoms triggered the crisis.

It is difficult to know whether schizophrenia causes certain stresses, or if it happens as a result of them.

Parental age may be a factor, as people with schizophrenia are more often born to older parents.

Use of drugs that affect the mind and mental processes has been linked to schizophrenia.

It is not clear whether this is a cause or an effect.

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