Paranoia

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Definition

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.

Description

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: The sense that the paranoid individual can use his or her thoughts to influence other people's thoughts and actions.
• Thought withdrawal: The sense that people are stealing the paranoid individual's thoughts.
• Thought insertion: The sense that people are putting thoughts into the paranoid individual's mind.
• Ideas of reference: The sense that the television and/or radio are specifically addressing the paranoid individual.

Demographics

Paranoia is a very human feeling. Nearly everyone has experienced it at some or another time, to varying degrees. Paranoia exists on a continuum, ranging from a feeling of distrust due to an occasional misinterpretation of cues that can be appropriately dealt with and reinterpreted, to an overarching pattern of actual paranoia that affects every interpersonal interaction.

Some research studies have suggested that 6% of all women and 13% of all men have some chronic level of mistrust towards the motivations of others towards them. Only about 0.5% to 0.25% of men and women can actually be diagnosed with paranoid personality disorder , however. It remains interesting to researchers that men are more prone to paranoid traits and mental disorders with paranoid features than are women.

Causes of paranoia

Researchers do not understand fully what chemical or physical changes in the brain cause paranoia. Paranoia is a prominent symptom that occurs in a variety of different mental disorders, as well as a symptom of certain physical diseases. Furthermore, use of certain drugs or chemicals may cause symptoms of paranoia in an otherwise normal individual.

Paranoia is often manifested as part of the symptom complex of schizophrenia . In fact, one of the subtypes of schizophrenia is termed "paranoid schizophrenia," which actually refers to a type of schizophrenia in which the individual is particularly preoccupied with delusions in which the world seems to be pitted against him or her. As with other forms of schizophrenia, sufferers often lack contact with reality, and display hallucinations , flat or emotionless affect , and disorganized thinking and behavior.

Paranoid personality disorder is diagnosed when an individual does not have other symptoms of schizophrenia, but a personality that is driven by chronic manifestations of paranoia. These individuals are mistrustful, suspicious, and convinced that the world is out to get them.

In order for an individual to be diagnosed with paranoid personality disorder, he or she must display at least four of the following traits:

• chronically suspicious that people are lying or cheating him or her in some way
• frequently preoccupied with whether people are loyal or trustworthy
• cannot confide in others for fear of being betrayed
• misinterprets benign comments or events as being personally threatening
• harbors long-term grudges against others who are perceived as having been threatening or insulting in some way
• sees others' actions and/or words attacking him or her in some way, and therefore goes on the counterattack
• repeatedly assumes that partner or spouse is unfaithful

Paranoia can also occur as a symptom of other neurological diseases. Individuals suffering from the aftereffects of strokes, brain injuries, various types of dementia (including Alzheimer's disease ), Huntington's disease, and Parkinson's disease may manifest paranoia as part of their symptom complex. The paranoia may decrease in intensity when the underlying disease is effectively treated, although since many of these diseases are progressive, the paranoia may worsen over time along with the progression of the disease's other symptoms.

A number of different medications and drugs can cause paranoia. These include corticosteroid medications, H-2 blockers (cimetidine, ranitidine, famotidine), some muscle relaxants (Baclofen), antiviral/anti-Parkinson drugs ( amantadine ), some amphetamines (including methylphenidate, or Ritalin), anti-HIV medications, anti-depressants (Nardil). Abused drugs that can prompt paranoia include alcohol, cocaine, marijuana, ecstasy (MDMA), amphetamines (including Ritalin), LSD, and PCP (angel dust). Withdrawal from addictive drugs may also cause symptoms of paranoia.

Treatments

It can be quite challenging to get an individual who is suffering from paranoia to accept treatment. Their paranoid condition makes them distrustful of people's motivations towards them, so that even a medical doctor appears to be a suspicious party. Medications that may be offered are usually looked at with great distrust, and efforts at psychotherapy are considered "mind control" by a profoundly paranoid individual.

The first step to be taken when someone is suffering from paranoia is that of determining whether an easily reversible situation (such as an adverse reaction to a medication) might be causing the paranoia. If so, discontinuing the drug (either immediately or by gradually weaning the dose) might end the symptoms of paranoia.

Patients who have other diseases, such as Alzheimer's disease or other forms of dementia, Huntington's disease, or Parkinson's disease may notice that their paranoid symptoms improve when their general medical condition is treated. The circumstance that can occur as their underlying disease progresses, is that the paranoia may return or worsen over time.

People who are suffering from diagnosable mental conditions such as schizophrenia or paranoid personality disorder may benefit from the use of typical antipsychotic medications, such as chlorpromazine or haloperidol , or from the newer, atypical antipsychotic medications, such as clozapine , olanzapine , or risperidone .

Cognitive-behavioral therapy (CBT) or other forms of psychotherapy may be helpful for certain people who have paranoia. CBT attempts to make a person more aware of his or her actions and motivations, and tries to help the individual learn to more accurately interpret cues around him or her, in an effort to help the individual change dysfunctional behaviors. Difficulty can enter into a therapeutic relationship with a paranoid individual, due to the level of mistrust and suspicion that is likely to interfere with their ability to participate in this form of treatment.

Support groups can be helpful for some paranoid individuals—particularly helpful in assisting family members and friends who must learn to live with, and care for paranoid individuals.

Prognosis

It is difficult to predict the prognosis of an individual who has paranoia. If there is an underlying mental illness, such as schizophrenia or paranoid personality disorder, then the paranoia is likely to be a lifelong condition. It may improve with some treatments (remission), only to become exacerbated under other more stressful conditions, or with changes in medication.

Individuals who have symptoms of paranoia as part of another medical condition may also have a waxing-and-waning-course.

When paranoia is caused by the use of a particular drug or medication, it is possible that discontinuing that substance may completely reverse the symptoms of paranoia.

Resources

BOOKS

Tasman, Allan, and others. Psychiatry. Philadelphia: W. B. Saunders, 1997.

ORGANIZATIONS

National Alliance for the Mentally Ill. Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington, VA 22201.(703) 524-7600. <http://www.nami.org> .

National Institute for Mental Health. 6001 Executive Blvd., Room 8184, MSC 9663, Bethesda, MD 20892. (301)443-4513. <http://www.nimh.nih.gov> .

Rosalyn Carson-DeWitt, M.D.