The Paranoid Schizophrenia Subtype: Finding Support

Medically reviewed by April Justice, LICSW and Melissa Guarnaccia, LCSW
Updated November 16, 2024by BetterHelp Editorial Team

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.

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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 

Since the release of the DSM-5 in 2013, the category for schizophrenia was changed from “Schizophrenia and Other Psychotic Disorders” to “Schizophrenia Spectrum and Other Psychotic Disorders.” Classifying schizophrenia as a spectrum generally allows diagnostic providers to take into consideration the whole, unique spectrum of symptoms that individuals with the condition may experience, instead of boxing them into categories that may not fully represent their symptoms.

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 
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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: 

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. 

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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

As of 2013, paranoid schizophrenia is no longer considered an official clinical diagnosis. However, paranoia can still be a common symptom connected to delusions and hallucinations, which tend to occur in people with schizophrenia. If you’re experiencing paranoia and schizophrenia, consider reaching out to a licensed therapist online or in your area for guided professional support.
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The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
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