Paranoia



Paranoia (par-a-NOY-a) refers to either an unreasonable fear of harm by others (delusions * of persecution) or an unrealistic sense of self-importance (delusions of grandeur). While paranoia is often associated with a severe mental illness such as schizophrenia, people without such illnesses can have paranoid feelings, think that people are talking about them, or have difficulties trusting others.

KEYWORDS

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Delusions

Mental Illness

Paranoid personality disorder

Schizophrenia

John's Experience

One day John came across a group of his friends huddled together on the soccer field. As he approached, they were all talking and laughing and enjoying themselves. However, when he reached where they were standing, the group suddenly became quiet. John could not help feeling that his friends had been talking about him and that was why they had all stopped talking when he approached. He found himself thinking about this throughout the rest of the day. He even began to believe that his friends had been plotting against him.

The next morning, John saw the same group of guys huddled around his locker. This time when he approached, they shouted "surprise" and presented him with a new CD for his birthday. With embarrassment he realized that they had probably been discussing his birthday surprise the day before on the soccer field. He wondered what had caused him to doubt himself and his friends like that? Was it paranoia or a simple misunderstanding?

* delusions (de-LOO-zhuns) are false beliefs that remain even in the face of proof that they are not true.

What Is Paranoia?

Paranoia is not a particular disorder so much as a way of experiencing (or incorrectly experiencing) reality. For example, John experienced paranoia when he wrongly believed that his friends were out to get him. A person whose phone was once tapped and was thereafter cautious about saying confidential things over the telephone might be considered reasonably concerned rather than paranoid. In contrast, a person who unrealistically feared that his or her phone was tapped even though it never had been before, and who persisted in the belief even when presented with compelling evidence that it was not true, would be considered paranoid. The key issue is not the behavior itself so much as its basis in reality.

Common characteristics of people who tend to be paranoid include:

  • poor self-image
  • social isolation
  • an expectation that others are trying to take advantage of them
  • an inability to relax
  • an inability to work with others
  • a deep mistrust of others
  • an inability to let go of insults or to forgive others
  • a poor sense of humor

Like many personality traits, paranoia is something that can occur in different degrees of severity. In its milder forms, paranoia may be something that a person feels only occasionally or only in certain situations. John, for example, experienced paranoia one day, but he did not usually feel this way. In its more severe forms, however, paranoia can seriously limit an individual's life. People with significant levels of paranoia may consistently misinterpret reality and experience delusions. Delusions are classified as bizarre or nonbizarre. A person who believes that others are out to get him and are somehow monitoring his actions through the television set is experiencing a bizarre paranoid delusion; this type of delusion is called bizarre because it is completely unbelievable. An example of a nonbizarre paranoid delusion is a person's belief that he or she is under surveillance by the police; while the belief might be false, it is not out of the realm of possibility. Because everyone's experience of reality seems real to them, it is hard to tell individuals with paranoid delusions that they are not in danger. For a person with paranoia, minor hassles or mild insults may be seen as dangerous threats.

Even people with severe paranoia may function normally much of the time if, for instance, they have a paranoid delusion that affects only a part of their life. For example, they might become obsessed with the idea that a particular chain of restaurants is conspiring to poison unsuspecting customers like themselves. They might stop eating in those restaurants and even go so far as to call the health authorities to investigate while they still function normally in other parts of their lives.

* temporal lobe epilepsy (EP-i-lep-see), also called complex partial epilepsy, Is a form of epilepsy that affects the part of the brain that Is located underneath the sides of the head, near the ears. Epilepsy Is a condition of the nervous system characterized by recurrent seizures that temporarily affect a person's awareness, movements, or sensations. Seizures occur when powerful, rapid bursts of electrical energy interrupt the normal electrical patterns of the brain. Epilepsy is generally treated with medication that helps prevent these "electrical storms" from beginning.

What Causes Paranoia?

The cause or causes of paranoia are not precisely known. Many healthy people experience paranoid feelings at some point in their lives, just as John did. Certain situations may make it more likely for someone to experience paranoid feelings. For example, there is evidence to suggest that immigrants are more prone to suspiciousness and paranoia as a result of the language and other cultural barriers they face. People in the majority culture may misunderstand the immigrants' suspiciousness and react with hostility, which creates even more mistrust.

Paranoia can accompany a number of illnesses. It is associated with certain neurological conditions such as temporal lobe epilepsy * and some forms of dementia * associated with aging, such as Alzheimer disease * . It can be caused by the repeated use of drugs such as cocaine or amphetamines. Paranoia is also known to be associated with mental disorders such as schizophrenia (skit-so-FREE-nee-a) and paranoid personality disorder.

Paranoid schizophrenia

Schizophrenia is a serious mental disorder that causes people to experience hallucinations * , delusions, and other confusing thoughts and behaviors that distort their view of reality. Doctors have come to understand that schizophrenia likely is the result of brain differences or chemical imbalances within the brain. However, schizophrenia is a complex and disabling disorder, and there is still much to learn to fully understand it. Schizophrenia is also a disorder that can assume many different forms. These forms (catatonic, disorganized, paranoid, undifferentiated, and residual) are known as subtypes.

* dementia (duh-MEN-shuh) is a decline in mental ability that usually progresses slowly, causing problems with thinking, memory, and judgment. It is most often seen in older individuals and is caused by deterioration in parts of the brain.

* Alzheimer (ALTZ-hy-mer) disease is a condition that leads to a gradually worsening loss of mental abilities, including memory, judgment, and abstract thinking, as well as to changes in personality.

* hallucinations (huh-loo-sin-AY-shuns) are sensory perceptions that a person believes are real but that are not actually caused by an outside event. People who experience hallucinations may, for example, hear threatening voices (auditory (AW-dit-or-ee) hallucinations) that are not really there or see things (visual hallucinations) that others cannot see.

Paranoid schizophrenia is characterized by the presence of one or more prominent delusions or auditory hallucinations in a person who seems to have otherwise relatively normal thinking ability and emotions. The delusions are usually organized around a consistent theme relating either to the idea that the person is being persecuted (someone is after him or her) or that he or she has special powers; the hallucinations, when they are present, are typically related to the delusional theme. People with paranoid schizophrenia often act anxious, aloof, angry, and argumentative, and they may also exhibit either a stiff, formal attitude or be quite intense in their interactions with others.

None of the other major characteristics associated with schizophrenia, such as disorganized speech, inappropriate behavior, or inappropriate emotional reactions, are present in people with paranoid schizophrenia, and the age at which this disorder begins tends to be later than it is for the other forms of schizophrenia. People with paranoid schizophrenia are more likely to succeed in holding a job and at living independently when compared to people with other subtypes of schizophrenia.

Paranoid personality disorder

Just as there are several types of schizophrenia, there are also different types of personality disorders (for example, narcissistic, dependent, avoidant, antisocial, and paranoid). All of the personality disorders involve consistent ways of behaving inappropriately across many different situations. Personality disorders lead to problems in social, school, and work settings and to significant internal distress. The personality patterns that later develop into personality disorders typically begin during adolescence or childhood. The long-standing nature of these conditions makes them particularly difficult to treat.

The key characteristic of paranoid personality disorder is a pattern of deep distrust of others. Unlike people with paranoid schizophrenia, whose ideas may be totally bizarre or out of touch with reality, a person with a paranoid personality disorder is not out of touch with reality so much as out of step with it. The belief that other people cannot be trusted colors all of life. As a result, individuals with this disorder have difficulty forming close relationships.

Some common characteristics of people with paranoid personality disorder include:

  • suspecting, without justification, that others are trying to harm or trick them
  • doubting the loyalty of friends
  • avoiding talking about themselves for fear that the information will be used against them
  • interpreting casual remarks or events as threats or insults
  • carrying grudges and seeking revenge
  • overreacting with anger to minor slights
  • being overly jealous and suspicious about others (e.g., girlfriend, boyfriend, or spouse) without justification

One of the difficult things about paranoid personality disorder is its self-fulfilling quality; paranoid people's suspicious and combative natures may provoke a hostile response from others, thus confirming their fears that others are hostile and not to be trusted. Rather than seeing their own role in creating the situation, they might instead mistakenly conclude that their suspicions are justified.

Possible signs of paranoid personality disorder that may be seen in childhood or adolescence include difficulties making friends and relating to others, the tendency to be a loner in social situations, and poor performance in school. Paranoid personality disorder is more common in males than in females. Overall, it affects about one percent of the population. The higher likelihood of finding paranoid personality disorder among relatives of individuals with schizophrenia suggests that there may be a genetic link between the two conditions, but further research is needed to confirm this.

Resources

National Institute of Mental Health (NIMH), National Institutes of Health, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. The NIMH posts information about schizophrenia at its website.
Telephone 301-443-4513
http://www.nimh.nih.gov/publicat/schizoph.cfm

The Personality Disorders Foundation has a website that provides information about personality disorders, including paranoid personality disorder.
http://pdf.uchc.edu/

The National Alliance for the Mentally Ill (NAMI) is a nonprofit organization that provides education, support, and advocacy for people with severe mental illnesses and their families. NAMI's website provides information about many mental illnesses.
Telephone 800-950-NAMI
http://www.nami.org



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