Paranoia and schizophrenia

A person who has a condition on the schizophrenia spectrum may experience delusions and what is commonly known as paranoia.

These delusions may give rise to fears that others are plotting against the individual. Everyone can have a paranoid thought from time to time. On a rough day, we may find ourselves saying "Oh boy, the whole world is out to get me!" But we recognize that this is not the case.

People with paranoia often have an extensive network of paranoid thoughts and ideas.

This can result in a disproportionate amount of time spent thinking up ways for the individual to protect themselves from their perceived persecutors. It can lead to problems in relationships and at work.

Fast facts on paranoia in schizophrenia

Here are some key points about paranoia in schizophrenia. More detail is in the main article.
People with schizophrenia often experience confusion and fear and they may have delusions that someone is plotting against them.
Since 2013, the subtype "paranoid schizophrenia" is not separate but a part of schizophrenia.
Medications and other treatments enable many patients to manage their condition.
Lifelong treatment is usually needed to stop symptoms from returning.

Before 2013, paranoid schizophrenia was considered a type of schizophrenia, but in 2013, the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) reclassified paranoia, or delusions, as a symptom rather than a subtype.

The subtypes were removed from the diagnostic criteria because of their "limited diagnostic stability, low reliability, and poor validity."

They were not seen as stable conditions, and they were not helping to diagnose or treat conditions related to schizophrenia.

The DSM is published by the American Psychiatric Association (APA) to help standardize diagnoses of different types of mental illness.
Signs and symptoms

Schizophrenia is a chronic, or long-term, psychiatric condition. It affects the person's thought processes and makes it difficult to think clearly.

It will impact the individual's feelings and their ability to communicate, to focus, to complete tasks, to sleep, and to relate to others.

This can lead to fear, confusion, and suicidal thoughts and behavior.

Symptoms can include:
hallucinations and delusions
disorganized thinking
lack of motivation
slow movement
changes in sleep patterns
lack of attention to hygiene
changes in body language and emotions
lack of interest in social activities
low libido, or sex drive

Not everyone with the condition will have all these symptoms.

Symptoms often emerge between the ages of 16 and 30 years.

The person may notice changes in sleep patterns, emotions, motivation, communication, and ability to think clearly. This is the early, or "prodromal phase" of the illness.

An acute episode is more severe. There may be feelings of panic, anger, and depression. This can be frightening for the individual, who most likely does not expect it to happen.

Appropriate treatment and support can help people cope with schizophrenia. Medications can stabilize the condition, and many live and work as they would without the condition. However, if the person stops taking the medication, symptoms often return.

Delusions are a common feature. A delusion is something the person believes is true, even when strong evidence suggests that it is false. For example, the person may believe that someone they know is planning to harm them.

Along with delusions, there may be auditory hallucinations, or hearing things that are not there, and perceptual disturbances. Visual hallucinations sometimes occur.

This can lead to physical and emotional detachment, social withdrawal, anger, and anxiety. Many people with symptoms of paranoia will be fearful and seek to avoid others.

Some people express their fears and frustration through aggression and violence, but many become a target for violence or exploitation.

Schizophrenia is a neuropsychiatric disorder. The exact causes are unclear, but it probably involves a combination of genetic factors and environmental triggers.

Symptoms may result from an imbalance of dopamine and possibly serotonin, both of which are neurotransmitters.

Risk factors include:

Genetics: Having a family history of schizophrenia increases the risk of developing it.

If there is no family history, the chances of developing schizophrenia are below 1 percent. If a parent had the condition, there is a 10-percent chance of developing it.

Other factors that may contribute are:
a viral infection in the mother while she was pregnant
malnutrition before birth
stress, trauma, or childhood abuse
problems during delivery

Stressful experiences often occur before a diagnosis of schizophrenia.

Before acute symptoms appear, the person may start to experience bad-temper, anxiety, and a lack of focus. This can trigger relationship problems.

These factors are often blamed for the onset of schizophrenia, but it may be that early symptoms triggered the crisis.

It is difficult to know whether schizophrenia causes certain stresses, or if it happens as a result of them.

Parental age may be a factor, as people with schizophrenia are more often born to older parents.

Use of drugs that affect the mind and mental processes has been linked to schizophrenia.

It is not clear whether this is a cause or an effect.

One argument is that using psychoactive drugs may trigger symptoms in those who are susceptible.

People with the condition may use cannabis because they enjoy it more. Some say it helps them cope with their symptoms.


A doctor will ask about the patient's medical and family history and carry out a physical examination.

Diagnostic tests may include a blood test to rule out other potential causes of symptoms, such as thyroid dysfunction, alcohol, and drug use.

Imaging scans such as an MRI or a CT scan may reveal brain lesions or any abnormalities in the brain structure. An electroencephalogram (EEG) can assess brain function.

There will also be a psychological evaluation.

The psychiatrist will ask the patient about their thoughts, feelings, and behavior patterns and about their symptoms, when they began, severity, and their impact on daily life.

They will try to find out how often and when episodes have occurred, and whether the patient has had any thoughts about harming themselves or others.

Talking to friends and family can be helpful.
Diagnostic criteria

To confirm a diagnosis, specific criteria, set out by the DSM-5, must be met.

The person must have at least two of the following symptoms:
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms, such as emotional flatness, lack of pleasure in everyday life

The two symptoms must include least one of the first three listed: delusions, hallucinations, or disorganized speech.

The following criteria are also necessary:
social and occupational dysfunction
symptoms must present for at least 6 months
no diagnosis of another mood disorder or drug or alcohol abuse.

It can take some time to reach a diagnosis.

Schizophrenia and paranoia can be lifelong, but treatment can help relieve symptoms.

Treatment must continue, even when symptoms seem to have receded.

If treatment stops, symptoms often reappear, especially if they have already returned after previously stopping medications.

Options depend on the severity and type of symptoms, age, and other factors.

Antipsychotics can reduce the disturbing thoughts, hallucinations, and delusions. They may be given as pills, as liquids, or as a monthly injection. There may be some side effects.

Other drugs may include antidepressants, anti-anxiety drugs, and a mood-stabilizing medication, depending on the individual's symptoms.

A person with severe symptoms may need hospitalization. This can help keep the person safe, provide proper nutrition, and stabilize sleep. Partial hospitalization is sometimes possible.

Compliance or adherence in medicine can be difficult for people with schizophrenia. If they stop taking their medication, the symptoms can return. Hospitalization can help people get back onto their medication while keeping them safe.
Psychosocial treatment

Psychotherapy, counseling, and social and vocational skills training may help the patient live independently and reduce the chance of relapses. Support can include improving communication skills, finding work and housing, and joining a support group.
Electroconvulsive therapy

Electroconvulsive therapy (ECT) involves sending an electric current through the brain to produce controlled seizures, or convulsions. The seizure is thought to trigger a massive neurochemical release in the brain. Side effects may include short-term memory loss. ECT is effective in treating catatonia, a syndrome which occurs in some people with schizophrenia.

ECT may help patients who have not responded to other treatments.

Patients often stop taking their medication within the first 12 months of treatment, so lifelong support will be necessary.

Caregivers and family members can help the person who has a diagnosis by learning as much as possible about schizophrenia and by encouraging the patient to adhere to their treatment plan.


If the patient with paranoid symptoms of schizophrenia does not receive treatment, there is a serious risk of severe mental health, physical health, financial, behavioral, and legal problems.

These can impact every part of the individual's life.

Possible complications may include:
suicidal thoughts and behavior
inability to study
being a victim of crime
illnesses related to substance abuse and tobacco smoking

A significant number of people with schizophrenia smoke heavily and regularly. Some medications may clash with tobacco ingredients and other substances.
What schizophrenia is not

A popular misconception is that schizophrenia means a "split personality." This is not true and does not describe the condition

It is also thought that people with schizophrenia are violent.

Just as some people without schizophrenia commit violent acts, the same is true of people with schizophrenia, but there is not an inevitable link. They are more likely to endanger themselves than others.

Understanding a person with schizophrenia can help them to find a solution and to cope with the ways in which they are different.

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