What Does Paranoia Mean?

The word “paranoia” can mean different things depending on the context. Although the term “paranoia” may be commonly used in everyday language to describe a suspicion that someone has about a situation, it tends to have a slightly different use in clinical contexts. In the mental health field, paranoia generally refers to a phenomenon that leads people to experience distrust and become overly suspicious of others despite not necessarily having evidence to support their suspicions. If you or a loved one are experiencing paranoia, working with a licensed mental health professional can be helpful.

Is paranoia a mental illness? 

What is paranoid schizophrenia?

Paranoid schizophrenia is a term that was previously viewed as a subtype of schizophrenia. The American Psychiatric Association stopped using the term in 2013 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 

The term was also removed from the International Classification of Diseases, 11th Edition (ICD-11), which was published by the World Health Organization in 2019.

What is schizophrenia? 

Schizophrenia is a mental illness listed in the DSM-5-TR (Text Revision) under Schizophrenia Spectrum and Psychotic Disorders. According to the DSM-5-TR, a person must meet at least two of the following five criteria to be diagnosed with schizophrenia, and at least one of the first three criteria must be present:

1. Delusions
2. Hallucinations
3. Disorganized speech (frequently getting derailed or appearing incoherent)
4. Disorganized or catatonic behavior
5. Negative symptoms (limited ability to express emotions and experience motivation)

Also, to be diagnosed with schizophrenia, psychotic symptoms must not be due to another medical condition or substance use, which could cause short-term paranoia. 

In addition to the above symptoms, some people may experience cognitive symptoms, such as difficulty making decisions and trouble paying attention. 

According to the National Institute of Mental Health, schizophrenia is typically diagnosed after the first episode of psychosis, which usually happens between the ages of 16 and 30. The disorder can contribute to significant challenges in daily life, both at home and at work, which may lead to a pattern of job loss.

Treatment for schizophrenia

Treatment for schizophrenia typically consists of prescription medications, such as antipsychotic medications. These medications, which come in both typical and atypical varieties, are prescribed to reduce symptoms, including delusions and hallucinations. 

Always consult with a medical professional before starting, stopping or changing any medications. 

Many people living with schizophrenia also receive therapy and psychosocial support as part of treatment. This support may include cognitive behavioral therapy (CBT), cognitive remediation, and behavioral skills training. Many people with schizophrenia also experience challenges with alcohol or substance use (formerly referred to as drug use), so treatment often addresses these challenges, too. 

What is delusional disorder?

Delusional disorder is also listed in the DSM-5 under the category of Schizophrenia Spectrum and Psychotic Disorders. To be diagnosed with delusional disorder, individuals must have had at least one delusion for a minimum of one month. They typically have non-bizarre delusions, which are related to things that could happen in real life, such as being cheated on or being followed. 

If a person with delusional disorder experiences hallucinations, they are typically not prominent and are often related to the theme of their delusion. In addition, a person with delusional disorder usually does not experience obvious functional impairment or bizarre behavior.

There are various types of delusions a person can experience, including the following:

• Persecutory: A person with this type of delusion may have anxious thoughts or beliefs that they are being spied on or that someone is out to get them. 
• Grandiose: Some people may have an exaggerated sense of themselves and believe they possess special knowledge or a great talent. 
• Jealous: A person with a jealous delusion may believe that their significant other is cheating on them, despite a lack of evidence. 
• Erotomanic: Someone with this type of delusion may believe that someone famous or important is in love with them. 

Treatment for delusional disorder

Individuals living with delusional disorder don’t usually seek treatment of their own accord because they may not realize they are experiencing false beliefs. However, they may seek treatment for co-occurring anxiety or depression.

Treatments for delusional disorder typically involve medication, such as antipsychotics, and talk therapy. A therapist may help a person identify incorrect or paranoid thought patterns and replace them with healthier thoughts, which may help them correct maladaptive behaviors.

What is paranoid personality disorder?

Paranoid personality disorder is considered a rare disorder, and the DSM-5 lists it as a cluster A personality disorder. Cluster A also includes schizoid personality disorder and schizotypal personality disorder. 

According to the DSM-5-TR, paranoid personality disorder is generally characterized by a “pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts.”

Treatment for paranoid personality disorder

Treatment for paranoid personality disorder typically involves talk therapy, such as cognitive behavioral therapy (CBT). People living with paranoid personality disorder often don’t reach out for treatment on their own. Instead, a family member or coworker may refer them to treatment after noticing symptoms. 

If someone with paranoid personality disorder is referred for treatment, a therapist may focus on building trust, which may prove difficult given the common tendency of mistrust with this disorder. Therapists may also help with communication and social skills. 

Seeking help for paranoid thoughts from a mental health professional

Individuals who are experiencing paranoid thoughts may benefit from speaking with a therapist. As mentioned above, in many cases, these individuals may not recognize their symptoms. They may need encouragement from someone in their life to speak to a mental health professional. 

Online therapy for paranoid thoughts 

If a person experiencing paranoia is reluctant to attend in-person therapy, it’s possible they might agree to try something like online therapy. Online therapy can be conducted from their home via audio, videoconferencing, or live chat. This may prove to be more comfortable than commuting to an unknown therapist’s office. In addition, with online therapy, individuals can reach out to their therapist 24/7 via in-app messaging, and the therapist will usually respond as soon as they can. This may be useful for those who experience suspicion or paranoid ideation in between therapy sessions. 

How effective is online therapy?

In recent years, numerous peer-reviewed journals have published studies demonstrating the effectiveness of online therapy for several mental health disorders that can be comorbid with schizophrenia, a common cause of paranoia. 

For example, one study published in 2017 found that online therapy could be an effective form of treatment for anxiety, depression, panic disorder, and substance use disorder, all of which may co-occur with schizophrenia. 

Online therapy may also be helpful for friends and family members of individuals experiencing paranoia. It can be challenging to watch a loved one experience psychological distress. With online therapy, individuals can be matched with a therapist who has experience helping the loved ones of people experiencing paranoia.