Paranoid Schizophrenia: Signs, Symptoms, And Treatments

The World Health Organization (WHO) estimates that one in 300 people worldwide experience schizophrenia, with many cases developing in young adulthood. Schizophrenia is one disorder that is frequently associated with symptoms related to paranoia. While paranoid schizophrenia is no longer a diagnosable disorder, understanding how paranoia can impact individuals with schizophrenia can still be beneficial. It can be important to note that paranoia is not always indicative of a mental illness, and individuals experiencing paranoia symptoms may benefit from speaking with a licensed therapist.

What is paranoid schizophrenia?

Paranoid schizophrenia was one of several subtypes listed in the DSM-IV, along with disorganized, catatonic, undifferentiated, and residual schizophrenia. The paranoid subtype had its own distinct set of symptoms, which were dropped along with all of the other schizophrenia subtypes in the DSM-V.

Paranoid schizophrenia symptoms 

According to the DSM-IV, those with paranoid schizophrenia typically experience a preoccupation with one or more frequent auditory hallucinations or delusions. Additionally, developing schizophrenia can result in disorganized speech, flat or inappropriate affect, and disorganized or catatonic behavior. However, when this was still an official diagnosis, these symptoms couldn’t be prominent features for a paranoid schizophrenia diagnosis to be given. 

While paranoid schizophrenia may no longer be diagnosed, many individuals are still diagnosed with schizophrenia spectrum disorder. The symptoms of schizophrenia may be more noticeable during acute phases. Although schizophrenia is usually chronic, these periods of acute schizophrenia may be referred to as schizophrenic episodes.

Are there signs people with schizophrenia are having an acute episode?

Although mild symptoms of schizophrenia may not be as noticeable, there can be clear signs that someone is entering a period of acute schizophrenia. According to the American Psychiatric Association (APA), three key signs and symptoms of acute schizophrenia or a psychotic episode can be hallucinations, delusions, and disorganized thoughts or speech. 

Sign #1: Hallucinations

Hallucinations can be described as sensory experiences of nonexistent stimuli. These hallucinations can be realistic and vivid, often making it challenging for the individual to distinguish them from reality. Types of hallucinations may include the following:

• Auditory hallucinations: These tend to be one of the most common types of hallucinations experienced by those with schizophrenia. Auditory hallucinations typically involve hearing voices or sounds that aren’t occurring. Individuals may hold discussions with these voices, even if others cannot hear the person or people with whom they believe they are talking. 
• Visual hallucinations: Visual hallucinations can lead someone to see objects or people that are not there. These may be people they know, such as deceased loved ones, or beings that may not exist, such as demons or angels. 
• Tactile hallucinations: Tactile hallucinations usually involve the sensation that one is being touched, or that something is on or under their skin. For example, a person may feel a hand touching their shoulder or think that bugs or animals are crawling over them. 
• Olfactory and gustatory hallucinations: Olfactory and gustatory hallucinations normally affect an individual's sense of smell and taste. While these may be less common, they can still occur in those living with schizophrenia. 

Sign #2: Delusions

Delusions can refer to false beliefs that aren’t based in fact or reality. Those with schizophrenia could experience paranoid delusions, which may lead them to believe that an individual or group intends to do them harm or is monitoring them. Other types of delusions may include those discussed below:

• Referential delusions: Referential delusions can involve someone seeing patterns in their environment that they believe relate to them directly. For example, a person may think that a radio host is talking to them, or that advertisements on billboards were put there to communicate a special message to them specifically. 

• Grandiose delusions: Delusions of grandeur can lead a person with schizophrenia to believe they are more powerful, wealthy, or important than they actually are. In some cases, these individuals may believe they have special powers, not unlike a superhero or supernatural being. 

• Somatic delusions: Somatic delusions can lead someone to misinterpret conditions related to their own body. For example, a person with schizophrenia may believe they live with a physical health condition without having any symptoms, or that they have some sort of deformity that they don’t really have. 

Sign #3: Disorganized thoughts or speech

Individuals with schizophrenia may find it difficult to think and communicate clearly. This disorganization of thoughts and speech can lead those with schizophrenia to repeat phrases, suddenly stop speaking, or struggle to make sense of their rapid thoughts. 

Individuals with schizophrenia can experience other symptoms as well, particularly negative symptoms, which involve a lack of typical behaviors. For example, those with schizophrenia may not feed or bathe themselves and may withdraw socially. 

What can people with schizophrenia do during an acute episode? 

Individuals with schizophrenia or their loved ones who notice acute symptoms are occurring should contact a medical or mental health professional. These professionals can identify risk factors and recommend treatments that could be beneficial, while also providing details on what family members can do to support their loved ones. 

In addition, a medical or mental health professional can decide whether it is necessary to contact local emergency services. For those who have not been diagnosed with schizophrenia, mental health professionals could also determine whether they are experiencing another disorder or condition.

Does any other mental illness involve paranoid symptoms? 

Several mental illnesses can involve paranoid symptoms. According to the Victoria Department of Health, two other disorders that may have similar symptoms include delusional disorder and paranoid personality disorder. 

Delusional disorder

Delusional disorder is a mental health condition that usually involves a preoccupation with a specific delusion. In many cases, these individuals may not display any other signs of mental illness. Besides paranoia, the symptoms that those with delusional disorder can experience may vary. For example, if they believe they are being followed by a government organization, they could experience emotional outbursts if they see a representative of that organization. 

Paranoid personality disorder

Paranoid personality disorder can have mild symptoms that may result in a general distrust of others and a person’s environment. Individuals with paranoid personality disorder can become wary of loved ones, reluctant to share personal information, and sensitive to criticism. These individuals may also interpret benign remarks or actions as malicious, which can lead to strained relationships and social isolation. 

Is paranoia always a sign of a mental illness? 

Paranoia isn’t always a sign of mental illness, and it's possible for anyone to experience paranoid thoughts at times. Conditions like those listed below can also cause paranoia:

While paranoia can occur on its own or as a symptom of these physical health conditions, it often arises as a symptom of certain mental health disorders, including schizophrenia. To address paranoia and schizophrenia, it may be necessary to explore various mental health treatments. 

Can mental health treatments help those with schizophrenia?

While each case of schizophrenia tends to be unique, various mental health treatments may help those experiencing this disorder. According to the UK National Health Service (NHS), these treatments may include a combination of medication and therapy. Medications for schizophrenia typically include antipsychotic medications (sometimes referred to as “antipsychotic drugs”). Always talk to your doctor before starting, stopping, or changing the way you take medication.

As for therapeutic approaches, one common type of therapy that may help those with schizophrenia is cognitive behavioral therapy (CBT). 

Is paranoia affecting your mental health?

Discuss coping strategies with a therapist

What mental health treatments are used for those with schizophrenia?

While different therapeutic approaches may be useful, CBT can be an effective way to help treat schizophrenia, typically when combined with prescription medication. A CBT provider may help individuals with schizophrenia understand potentially harmful thought patterns and how these thoughts can influence their behavior. CBT can also be a way to reduce symptom severity and address other challenges related to schizophrenia, such as the stigma that can sometimes be associated with this condition. 

While CBT may be beneficial for those experiencing schizophrenia and other mental health conditions, in-person forms of therapy may not always be locally available or convenient. In these situations, exploring online therapy can be beneficial, although it may be important to note that people currently experiencing active psychosis or acute schizophrenia symptoms may require in-person care. 

Research suggests that online therapy can be as effective as in-person therapy for the treatment of certain conditions. In a 2022 study, researchers compared data from multiple therapeutic trials to determine the differences between in-person and online therapy. They found no significant differences between these therapeutic formats. These results took numerous outcomes into account, including symptom severity, function, working alliance, client satisfaction, and overall improvement.