The Paranoid Schizophrenia Subtype: Finding Support
Schizophrenia can be defined as a complex mental health disorder that typically causes symptoms like paranoia, psychosis, delusions, and hallucinations. In the past, schizophrenia spectrum disorders were usually diagnosed in subtypes, including the paranoid schizophrenia subtype. However, with updates to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) from the DSM-IV, this label is no longer used clinically. Understanding the full spectrum of schizophrenia symptoms may help you understand this condition in yourself or others. You may also benefit from learning various strategies for reducing paranoia through sessions with a licensed mental health professional.
What is the paranoid schizophrenia subtype?
In the fourth edition of the DSM, schizophrenia was diagnosed in subtypes, including the following:
- Paranoid type
- Disorganized type
- Catatonic type
- Undifferentiated type
- Residual type
The paranoid subtype was normally diagnosed when the following criteria were met alongside typical schizophrenia diagnostic criteria:
- Preoccupation with one or more delusions or hallucinations
- The absence of disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect
- Paranoia
This subtype tended to differ from other types in that it involved more significant paranoid symptoms.
The DSM-5 criteria for schizophrenia
The current diagnostic criteria for all schizophrenia spectrum disorders include the following:
- Negative symptoms, like a lack of emotional expression
- A lack of proper function in several significant areas, including, but not limited to, professional, social, and personal
- Delusions
- Hallucinations
- Abnormal psychomotor behavior
- Disorganized speech or catatonic behavior
In general, the above symptoms must not be due to schizoaffective disorder or bipolar disorder. In addition, if an individual was diagnosed with autism spectrum disorder (ASD) in childhood, a schizophrenia diagnosis may only be made if prominent delusions and hallucinations are present for at least one month in adulthood. Symptoms also cannot be due to a substance use disorder or the misuse of substances.
Signs of paranoia and its impact on mental health
Paranoia is not considered an official symptom of schizophrenia in the DSM-5. However, it may still occur alongside other symptoms. For that reason, it may be helpful to understand the signs of paranoia, which Mental Health America (MHA) defines as the following:
- Severe fear and anxiety
- An extreme fixation on delusions and hallucinations
- Intense mistrust and suspicion of others
- Hypervigilance, such as looking for threats or signs that delusions are true
- Difficulty forgiving others
- Defensiveness or aggression in response to imagined threats or criticism
- Fear of the hidden “motives” of others
- Fear of others taking advantage of them
- Difficulty coping or self-regulating
- Argumentative behavior
Paranoia can occur alongside any mental illness. However, severe paranoia alongside delusions and hallucinations tends to be unique to schizophrenia spectrum disorders. Paranoia with the absence of hallucinations might occur in delusional disorder, which generally involves symptoms related primarily to delusions.
How to manage symptoms of paranoia
Paranoia, as a symptom of schizophrenia, can be challenging to manage. There are a few lifestyle changes and coping strategies you might consider when seeking to reduce paranoia, including the following.
Keep a fact-checking diary
Paranoia often occurs in episodes, especially during psychosis. Episodes might last a few hours to a few days or weeks. When outside of an episode, it may be easier for an individual with schizophrenia to understand the facts of a situation. It may be helpful to keep a journal where you write down facts or indisputable information that could be helpful to read when experiencing paranoia.
You can also try this activity during an episode with the help of another person. Write out the thoughts you’re experiencing and have your therapist or someone you trust help you reframe them to fit what is truly occurring. Repeat the facts to yourself when paranoid thoughts arise.
Consider a support group
Schizophrenia can seem isolating, and paranoid thoughts may make it appear that everyone is against you. Having a safe space to talk to others could be helpful. A schizophrenia support group can offer a place to connect with others who understand the experience of paranoia. These groups are often free to attend and led by a group leader. However, note that a licensed professional may not always lead support groups. Research support groups before signing up or attending to see if the group might be a fit for you.
Develop a paranoia safety plan
When you’re not experiencing an episode, consider drafting a paranoia safety plan that you can reference when paranoid thoughts and beliefs occur. This plan might include details on how to cope with symptoms safely, people you can contact, and crisis resource services in your area. Write down coping strategies that can help you reframe your mindset as well. Turn to this plan when an episode occurs and ask for help if you’re unsure how to start. For crisis support, consider adding the following hotlines to your plan:
- National Domestic Violence Hotline: 1-800-799-SAFE (7233)
- 988 Suicide Lifeline: Call or text 988 for support
- Veterans Crisis Line: Call 1-800-273-8255 (and press 1) or text 838255. For support for the deaf and hard of hearing community, please use your preferred relay service or dial 711 then 1-800-273-8255
- Trevor Lifeline (LGBTQIA+ Lifeline): 866-488-7386
- SAMHSA National Helpline (Substance Use): 1-800-662-HELP (4357)
- ANAD Eating Disorders Helpline: Call 1-888-375-7767 from Monday through Friday, 9 am to 9 pm CST
- Child Help Hotline: Call 1-800-422-4453 or use the online chat feature
- National Anti-Hazing Hotline: 1-888-NOT-HAZE (1-888-668-4293)
- Physician Crisis Support Line: Call 1-888-409-0141 if you are a first responder or medical provider experiencing crises related to COVID-19
- Sexual Assault Hotline: Call RAINN at 1-800-656-4673
- BlackLine: Call 1-800-604-584 for peer support if you are a Black American experiencing a mental health crisis
- The Network/La Red Hotline: Call 617-742-4911 for LGBTQIA+-oriented support if you are experiencing abuse in an LGBTQIA+ relationship. This hotline is accepting of people in polyamorous relationships.
Practice mindfulness-oriented self-care
Paranoia often occurs alongside racing thoughts and disorganized thinking. To slow down your mind, it may be helpful to practice mindfulness-oriented self-care, including deep breathing practices, guided meditation, and bodily awareness exercises. Studies have found that mindfulness-based interventions may reduce paranoia symptoms.
You can also reach out to a licensed therapist to learn more about mindfulness. They can teach you practices unique to your situation that you can use at home and on the go.
Discuss it with a trusted friend
Having someone else to help you ground yourself in the present can be helpful. Finding someone you trust with whom to talk about your paranoia symptoms may remind you that you’re not alone in your experiences. When you notice symptoms arising, let your loved one know and ask them if they can help you reframe your thought patterns. If you don’t have someone in your life that you trust in this way, it might be helpful to reach out to a schizophrenia therapist.
Talk to a therapist for mental health support
Friends, family members, and support groups can be helpful resources when attempting to reduce paranoia. However, it can be challenging to trust others when experiencing these symptoms. Talking to a professional may be more effective, as professionals are usually trained to address the paranoia symptoms that can be common in conditions like schizophrenia and other psychotic disorders.
If you don’t feel comfortable speaking to a professional in your area, you can also try online therapy through a platform like BetterHelp. With an online platform, you can choose to meet with a therapist from home via phone, video, or live chat sessions. If you don’t want the therapist to see your face, chat sessions might be especially helpful. Please note that individuals currently experiencing acute psychosis may require care in person.
The benefits of online therapy for people with schizophrenia
Studies show that online therapy can be effective for people living with schizophrenia. In a 2021 study, researchers found that young people living with first-episode psychosis typically found online treatment effective in reducing visits to emergency rooms for psychiatry admission. In addition, it helped them distance themselves from distress and provided a more flexible option for receiving support. This aspect often increased motivation to attend sessions.
Takeaway
What are 5 of the main symptoms of schizophrenia?
Five key symptoms of schizophrenia are delusions, hallucinations, disorganized speech and thoughts, unusual behavior, and negative symptoms. Negative symptoms are things that are abnormally absent, like a lack of facial expressions, decreased speech, or reduced desire for social contact.
What is it like to live with paranoid schizophrenia?
According to the American Psychiatric Association, effective treatment can help many people with schizophrenia lead productive, rewarding lives. People respond to treatment differently; some do extremely well, while others need ongoing support. When the primary symptoms of schizophrenia are controlled with antipsychotic medications, therapy and other types of support can help people learn how to manage stress, identify signs of relapse, and learn social skills.
Symptoms of schizophrenia typically appear during early adulthood, but early-onset schizophrenia can occur in children under age 18. Some people with this condition can benefit from learning life-management skills, and most communities have mental health services or programs to help people with mental health conditions access educational, employment, and housing opportunities.
A strong support system can be vital for people with schizophrenia. Friends, family, and mental health professionals can support people with schizophrenia through their course of illness, helping them address challenges and recognizing and nurturing their personal strengths.
What is the main paranoid schizophrenia subtype?
While schizophrenia was divided into different subtypes in the DSM-4, the DSM-5 does not recognize distinct subtypes of schizophrenia. Schizophrenia is now seen as more of a spectrum of disorders, but some subtypes have been proposed and may be used unofficially. Some schizophrenia types are listed below.
- Catatonic schizophrenia: Catatonia occurs when the brain doesn’t manage muscle movement in a typical way, causing the person to act abnormally, with exaggerated movements, limited physical responses, or a combination of the two. Catatonic schizophrenia was included in the DSM-4 but is no longer recognized in the DSM-5.
- Undifferentiated schizophrenia: This subtype of schizophrenia was also included in the DSM-IV but is not included in the DSM-5. Undifferentiated schizophrenia was generally given as a diagnosis when someone had symptoms of the condition that did not fit into any of the other subtypes.
- Disorganized schizophrenia: Another subtype of schizophrenia that is no longer included in the DSM-5 is disorganized schizophrenia, which is characterized by disorganized behavior and speech and an inappropriate affect.
- Residual schizophrenia: This is a subtype in which someone has experienced an episode of schizophrenia, but the person’s symptoms no longer include hallucinations, delusions, or disorganized speech or behavior. Instead, they exhibit residual negative symptoms or positive symptoms that aren’t as severe, like odd beliefs.
Do people with schizophrenia know they have it?
According to the National Alliance on Mental Illness, many people who are diagnosed with schizophrenia do not believe they have it. A lack of awareness is a common symptom of schizophrenia, so someone can have it and not know.
What are the symptoms of schizophrenia with paranoia?
While paranoid schizophrenia is no longer recognized as a subtype of this condition, paranoia can be a prominent symptom. For example, someone with schizophrenia may experience paranoid delusions, where they think someone is trying to harm them or is out to get them.
How does someone with paranoid schizophrenia act?
Paranoid schizophrenia is an outdated term. Today, schizophrenia is seen more as a spectrum, and people can experience different symptoms, including the following:
- Visual or auditory hallucinations (for example, hearing voices or seeing things that aren’t real)
- Disorganized behavior
- False beliefs
- Distorted perceptions
- Confusion
- Disordered thinking
- Decreased speech
- Flat affect
- Social withdrawal
What is type 1 and type 2 schizophrenia?
Type 1 and type 2 schizophrenia have different symptoms. Type 1 is characterized by positive symptoms, like delusions, hallucinations, and thought distortions, while type 2 is characterized by negative symptoms, like social withdrawal, flat affect, or limited speech. Type 1 was thought to result from dopaminergic dysfunction, and type 2 from structural brain abnormalities.
Note that these types of schizophrenia are outdated and not used for diagnostic purposes.
What is the behavior of a paranoid schizophrenic?
The term “paranoid schizophrenic” is no longer recognized in schizophrenia research or the DSM-5. Someone with schizophrenia may exhibit a range of behaviors, including the following symptoms:
- Hallucinations
- Delusions
- Disorganized speech and thoughts
- Unusual behaviors
- Negative symptom
Can paranoid schizophrenia be cured?
There is no cure for schizophrenia, but according to the World Health Organization, at least a third of people with this mental health condition achieve complete remission.
Schizophrenia is a complex condition, but there are a variety of treatment options available. Generally, psychotic symptoms are treated with antipsychotic medications, but psychotherapy, family interventions, and other support programs can address specific symptoms.
What is the most common subtype of schizophrenia?
Subtypes are no longer used to diagnose schizophrenia. According to the DSM-5, the diagnostic criteria for this psychotic disorder include two or more symptoms of those listed below that have persisted for a significant portion of time for at least a month. These symptoms are delusions, hallucinations, disorganized speech, grossly organized or catatonic behavior, and negative symptoms. Other conditions with similar symptoms, like schizophreniform disorder or mood disorders, or any medical condition that can cause these symptoms must be ruled out.
What triggers paranoid schizophrenia episodes?
Many things can trigger a schizophrenic episode, including extreme stress like bereavement, divorce, job loss, or abuse. Drug use, particularly cocaine, cocaine, and amphetamines, can also make someone more susceptible to schizophrenia or related conditions. According to the Annual National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration from 2023, marijuana was the most commonly used illicit drug; it, too, can increase the risk of a schizophrenic episode.
Family history is also a factor, as genetics can also significantly affect one’s risk of developing this condition.
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