In this series, I dig a little deeper into the meaning of psychological terms. This week’s term: paranoia
Kind of like anxiety and depression, the word paranoia often gets tossed around fairly loosely in common parlance, but in a psychological/psychiatric sense it has far more significance. Google Dictionary defines paranoia as:
“a mental condition characterized by delusions of persecution, unwarranted jealousy, or exaggerated self-importance, typically elaborated into an organized system. It may be an aspect of chronic personality disorder, of drug abuse, or of a serious condition such as schizophrenia in which the person loses touch with reality.”
It also gives this subdefinition:
“suspicion and mistrust of people or their actions without evidence or justification”
Wikipedia differentiates paranoia from phobias and other irrational fears, as paranoia contains an element of blaming another person or other people. Someone who’s paranoid may also be likely to attribute greater significance to coincidences.
Paranoid patterns of thinking can occur outside of psychosis, but paranoia is perhaps most commonly recognized as being the basis of paranoid delusions. Delusions are a type of psychotic symptom that involves beliefs that are not based in reality but are firmly held onto despite all evidence to the contrary. Paranoid delusions occur in illnesses like schizophrenia and schizoaffective disorder, but may also occur in other illnesses including mood disorder. Drugs, particularly crystal methamphetamine, can also trigger paranoid delusions.
Paranoia may also occur in the context of paranoid personality disorder. Someone with paranoid PD does not experience delusional levels of paranoia, but they have a longstanding pattern of suspicion and mistrust.
Wikipedia lists the following DSM-5 symptoms of paranoid personality disorder:
“Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them.
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them.
Reads hidden demeaning or threatening meanings into benign remarks or events.
Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.”
Five subtypes of paranoid personality disorder have been identified by psychologist Theodore Millon: obdurate, fanatic, querulous, insular, and malignant. May I just say, I absolutely love his word choices.
Other subtypes of paranoia in general that have been identified include erotic, persecutory, litigious, and exalted.
According to Wikipedia, social circumstances have a significant influence on the tendency to develop paranoia. Feelings of powerlessness, external control over one’s circumstances, and victimization can contribute to paranoia, and lower socioeconomic status can heighten these effects.
Three key psychological biases tend to accompany paranoia. The sinister attribution error involves overestimating the untrustworthiness of others. There is a disproportionately self-referential perspective on social interaction, and the actions of others are seen as being particularly directed at the paranoid individual. There is also an exaggerated perception of conspiracy, with an overestimation of the likelihood that others’ actions are coordinated against the paranoid individual.
So, you’ve got paranoid delusions as a psychotic symptom, paranoid personality disorder, and what else? Well, that’s where we find Alex Jones of Info Wars. He’s a conspiracy theorist, and he’s pretty out there, to the least. While he may have a psychiatric condition, it’s very possible that he’s just a run of the mill non-psychiatric nutbar with non-clinical paranoia.
I think the biggest takeaway is that paranoia can show up in a few different ways, and those nuances may not always be immediately apparent when the word paranoia is used. There is a big difference between paranoia as in schizophrenia and paranoia as in Alex Jones. And personally, I would much rather spend time with someone who’s psychotically paranoid than with someone who is conspiracy theorist paranoid.
You can find the rest of my What Is series here.
My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses. It’s available on the MH@H Store, as well as Amazon and other online retailers.