Paranoid schizophrenia

Paranoid schizophrenia was long diagnosed as the most common type of schizophrenia,[1] but this sub-type is no longer used in the United States since the 2013 change in the DSM-V that classifies the range of symptoms of former sub-types all under "schizophrenia".[2] Schizophrenia is defined as “a chronic mental disorder in which a person is withdrawn from reality."[3] Prior to 2013 schizophrenia had been divided into subtypes based on the “predominant symptomatology at the time of evaluation."[4] The subtypes were classified as: paranoid, disorganized, catatonic, undifferentiated, and residual type. However, they are not completely separate diagnoses, and cannot predict the progression of the mental illness.[5]

Paranoid schizophrenia
Other namesSchizophrenia, paranoid type
Art made by a person with paranoid schizophrenia
SpecialtyPsychiatry, psychology 
SymptomsDelusions, hallucinations

This disorder is considered dominated by relatively stable and often persecutory delusions that are usually accompanied by hallucinations, particularly of the auditory variety (hearing voices), and perceptual disturbances. These symptoms can have a huge effect on a person's functioning and can negatively affect their quality of life. Paranoid schizophrenia is a lifelong disorder, but with proper treatment, a person with the illness can attain a higher quality of life.[3]

Although these two symptoms are especially pronounced in what had been defined as paranoid schizophrenia, this type also lacks certain symptoms common to the other forms. The following symptoms are not prominent: “disorganized speech, disorganized or catatonic behavior and flat or inappropriate affect.”[4] Those symptoms are present in another form of schizophrenia, disorganized-type schizophrenia. The criteria for diagnosing paranoid schizophrenia must be present from at least one to six months.[4] This helps to differentiate schizophrenia from other mental disorders, such as bipolar disorder.[4]

In the United States, paranoid schizophrenia is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), 4th Edition, but was dropped from the 5th Edition in 2013, along with the other four subtypes of schizophrenia (disorganized, catatonic, undifferentiated, and residual).[6] The five subtypes of schizophrenia were eliminated from the DSM by the American Psychiatric Association (APA) due to the lack of clear distinction among the subtypes and low validity of classification.[7] Targeted treatment and treatment response vary from patient to patient, depending on his or her symptoms. Treatment options must be based on the severity of the symptoms in the patient.


Paranoid schizophrenia manifests itself in an array of symptoms. Common symptoms for paranoid schizophrenia include auditory hallucinations (hearing voices or sound effects) and paranoid delusions (believing everyone is out to cause the sufferer harm).[3] Two symptoms have been defined as separating this form of schizophrenia from other forms.

One such criterion is delusion. A delusion is a belief that is held strongly even when the evidence shows otherwise. Some common delusions associated with paranoid schizophrenia include, “believing that someone is monitoring every move you make, or that a co-worker is poisoning your lunch."[3] In all but rare cases, these beliefs are irrational, and can cause the person holding them to behave abnormally. Another frequent type of delusion is a delusion of grandeur, or the “fixed, false belief that one possesses superior qualities such as genius, fame, omnipotence, or wealth."[8] Common ones include “the belief that you can fly, that you're famous, or that you have a relationship with a famous person."[3]

Another criterion present in patients with paranoid schizophrenia is auditory hallucinations, in which the person hears voices or sounds that are not really present. The patient will sometimes hear multiple voices and the voices can either be talking to the patient or to one another.[3] These voices can influence the patient to behave in a particular manner. Researchers at the Mayo Foundation for Medical Education and Research provide the following description: “They [the voices] may make ongoing criticisms of what you’re thinking or doing, or make cruel comments about your real or imagined faults. Voices may also command you to do things that can be harmful to yourself or to others."[3] A patient exhibiting these auditory hallucinations may be observed "talking to them" because the person believes that the voices represent people who are present.

Early diagnosis is critical for the successful treatment of schizophrenia.


According to the DSM-5, in order to be diagnosed with schizophrenia an individual must express at least two of the common symptoms for a minimum of six months. Symptoms include but are not limited to delusions, hallucinations, disorganized speech, and disorganized behavior.[7] As previously stated, the DSM no longer recognizes any distinct subtypes of schizophrenia, including paranoid schizophrenia, due to their lack of validity.[6] In previous editions of the DSM, paranoid schizophrenia was differentiated by the presence of hallucinations and delusions involving the perception of persecution or grandiosity in one's beliefs about the world.[9] With the removal of the subtypes of schizophrenia in the DSM-5, paranoid schizophrenia will no longer be used as a diagnostic category. If a person expresses symptoms of schizophrenia, including symptoms previously associated with paranoid schizophrenia, they will be diagnosed with schizophrenia and be treated accordingly.[6]

Awareness and treatment

According to the Mayo Clinic in 2013, before the subtype was dropped from the DSM, paranoid schizophrenia should be treated as early as possible and the person should maintain the treatment throughout life.[10] Continuing treatment will help keep the serious symptoms under control and allow the person to lead a more fulfilling life. While the illness is typically not preventable, it is important that the disorder be diagnosed and treated as soon as possible. Some common signs to be aware of are changes in mood, lack of motivation, irregular sleep, and disorganized behavior.[11]

Schizophrenia has a strong hereditary component, with a first-degree parent or sibling often affected. Environmental influences may include "prenatal exposure to a viral infection, low oxygen levels during birth (from prolonged labor or premature birth), exposure to a virus during infancy, early parental loss or separation, and verbal, physical or sexual abuse in childhood".[12] Eliminating any of these factors could help reduce an individual's future risk of developing paranoid schizophrenia.

Persons at high risk of being diagnosed with schizophrenia are among the homeless population; that is, many may be homeless because schizophrenia interferes with their functioning in life. Some studies indicate that as much as twenty percent of the homeless population is suffering from schizophrenia.[13] Because of their circumstances, a large portion of those suffering will go undiagnosed and untreated.


Paranoid schizophrenia is an illness that typically requires lifelong treatment with neuroleptics or 5-HT2A antagonists to enable someone with the disorder to have a relatively stable and normal life.[14] In order to be successfully treated, a person with schizophrenia should seek help from family or primary care doctors, psychiatrists, psychotherapists, pharmacists, family members, case workers, psychiatric nurses, or social workers.[14] In some cases, the person may not be able to do so, as many people with the disorder are unable to accept their condition. This denial can also result in lack of compliance with taking neuroleptics, especially if the patient considers the side effects (such as extrapyramidal symptoms) to be more debilitating than the condition itself.[15] The main options offered for the treatment of paranoid schizophrenia are the following: neuroleptics, psychotherapy, hospitalization, electroconvulsive therapy, and vocational skills training, often in combination.[14]

Many different types of disorders have symptoms similar to those of schizophrenia. Psychiatrists typically perform tests to achieve a correct diagnosis. These evaluations include "psychiatric evaluation, in which the doctor or psychiatrist will ask a series of questions about the patient's symptoms, psychiatric history, and family history of mental health problems; medical history and exam, in which the doctor will ask about one's personal and family health history and will also perform a complete physical examination to check for medical issues that could be causing or contributing to the problem; laboratory tests in which the doctor will order simple blood and urine tests can rule out other medical causes of symptoms".[12] As noted, side effects are associated with antipsychotic medication. Neuroleptics can cause high blood pressure and high cholesterol.[14] Many people who take them exhibit weight gain and have a higher risk of developing diabetes.[14]


Since the early 19th century, schizophrenia has been recognized as a psychiatric disorder. It was described in 1878 by Emil Kraepelin as dementia praecox, or the premature deterioration of the brain. He identified four types: simple, paranoid, hebephrenic and catatonic, based on how they presented clinically. He classified patients presenting with simple dementia praecox as exhibiting slow social decline, apathy, and withdrawal. Patients that were classified as having paranoid dementia praecox exhibited a high amount of fear and persecutory delusions. The hebephrenic type was described as being "silly." Finally, the catatonic type were those with increased motor symptoms (increased muscle tone and perseverance of posture). His definition of schizophrenia was primarily defined by early onset rather than deterioration.[16] During Kraepelin's time, very few people were diagnosed with dementia praecox, due to the small range of symptoms recognized specifically as signs of this disorder. In 1908, Eugen Bleuler found that schizophrenia was less definitive than Kraepelin believed and that it could range from severe to mild cases.[16] He used this information and coined the term schizophrenia, which literally means "split mind", to cover the range of the disorder.

Bleuler thought that the disorder could be distinguished as cases that were beneficial or harmful and acute or chronic. He defined four main characteristics associated with the disease, commonly referred to as "the four As." The characteristics were as follows: autism (preoccupation with internal stimuli), affect (may present as blunt or inappropriate in social situations), associations (may have illogical or fragmented thought processes), and ambivalence (contradictory thinking). This categorization was accepted widely in the United States for most of the 20th century, as Bleuler's hypothesis was broader than Kraepelin's and included many other assumed mental processes.

In Europe, however, Kurt Schneider developed a five-rank system in 1959 intended for practical use. His system relied on physical presentations and symptoms, rather than mental assumptions. Eventually, the broad diagnosis of schizophrenia was narrowed to a set of specific types of symptoms that were necessary in order to diagnose the disorder, and was also classified as several different types: paranoid, disorganized, and catatonic (each with its own specific symptoms), along with undifferentiated and residual schizophrenia, which are a combination or very few residual symptoms of schizophrenia.[16]

During World War II, the Nazi Party attempted to eradicate schizophrenia by compulsory sterilization of patients who had it, and also the murders of psychiatric patients.[17]

It was also based on what are now known to be erroneous genetic theories and had no apparent long-term effect on the subsequent incidence of schizophrenia.

Torrey & Yolken (2010)

As of 2013, with the publication of the new DSM-5, the different subtypes of schizophrenia are no longer specified or differentiated from schizophrenia in the manual. Instead, schizophrenia is viewed as one mental disorder with an array of different symptoms. Treatment for persons suffering from schizophrenia is based on the type of symptoms that are exhibited in each individual case.[18] -->

As of 2018, the ICD-11 uses the following criteria as basis for diagnosis of schizophrenia:

"Schizophrenia is characterized by disturbances in multiple mental modalities, including thinking (e.g., delusions, disorganization in the form of thought), perception (e.g., hallucinations), self-experience (e.g., the experience that one's feelings, impulses, thoughts, or behaviour are under the control of an external force), cognition (e.g., impaired attention, verbal memory, and social cognition), volition (e.g., loss of motivation), affect (e.g., blunted emotional expression), and behaviour (e.g.,behaviour that appears bizarre or purposeless, unpredictable or inappropriate emotional responses that interfere with the organization of behaviour). Psychomotor disturbances, including catatonia, may be present. Persistent delusions, persistent hallucinations, thought disorder, and experiences of influence, passivity, or control are considered core symptoms. Symptoms must have persisted for at least one month in order for a diagnosis of schizophrenia to be assigned. The symptoms are not a manifestation of another health condition (e.g., a brain tumour) and are not due to the effect of a substance or medication on the central nervous system (e.g., corticosteroids), including withdrawal (e.g., alcohol withdrawal)."[19]


Dissociative identity disorder

Schizophrenia is often confused or associated with dissociative identity disorder (DID), a separate psychiatric condition associated with childhood trauma or abuse.[20] DID, previously known as multiple personality disorder (MPD), is described and classified in the DSM-5 and has a complete and distinct set of symptoms, causes, and treatments.[20] Confusion between schizophrenia and DID may arise due to some of the shared symptoms such as hallucinations, mood swings, and anxiety.[20] Further confusion regarding DID and schizophrenia may stem from the controversial nature of DID. Large portions of the psychological community maintain that DID is not a bona fide, distinguishable disorder.[21] Despite concerns surrounding the legitimacy of DID, it remained in the newest version of the DSM and is still diagnosed by some physicians.[22]

Paranoia vs. paranoid schizophrenia

While paranoia is an inherent symptom of paranoid schizophrenia, not everyone who experiences it has paranoid schizophrenia. Paranoia may be symptomatic of other conditions such as paranoid personality disorder,[23] delusional disorder,[24] Alzheimer's disease, or Parkinson's disease. An individual may also experience paranoia due to drug use, a sleep deficit, or even the environment.[25] Treatment for paranoia is not always the same as treatment for paranoid schizophrenia. While patients with paranoid schizophrenia are almost always advised to take prescription medication, paranoia is treated in a myriad of ways depending on the severity and origination.[26]  

See also


  1. Varcarolis, Elizabeth. "Psychiatric nursing care plans" 2006
  2. "Schizophrenia". University of Michigan Department of Psychiatry. Archived from the original on 2013-04-03. Retrieved 2013-06-24.
  3. Mayo Foundation for Medical Education and Research (2013). Paranoid Schizophrenia. Mayo Clinic. Retrieved from "Schizophrenia - Symptoms and causes". Archived from the original on June 18, 2013. Retrieved December 23, 2013.
  4. Cold Spring Harbor Laboratory. DSM-IV Criteria for Schizophrenia. DNA Learning Center. Retrieved from
  5. Jones, Christopher; Hacker, David; Meaden, Alan; Cormac, Irene; Irving, Claire B; Xia, Jun; Zhao, Sai; Shi, Chunhu; Chen, Jue (2018-11-15). Cochrane Schizophrenia Group (ed.). "Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia". Cochrane Database of Systematic Reviews. 11: CD008712. doi:10.1002/14651858.CD008712.pub3. PMC 6516879. PMID 30480760.
  6. "Updates to DSM-5 Criteria & Text". Retrieved 2019-02-21.
  7. Tandon, Rajiv (2014). "Schizophrenia and Other Psychotic Disorders in Diagnostic and Statistical Manual of Mental Disorders (DSM)-5: Clinical Implications of Revisions from DSM-IV". Indian Journal of Psychological Medicine. 36 (3): 223–225. doi:10.4103/0253-7176.135365. ISSN 0253-7176. PMC 4100404. PMID 25035542.
  8. Grohol, John M. (2012). "Delusion of grandeur", Psych Central Retrieved from
  9. McLean, Duncan; Thara, Rangaswamy; John, Sujit; Barrett, Robert; Loa, Peter; McGrath, John; Mowry, Bryan (September 2014). "DSM-IV "criterion A" schizophrenia symptoms across ethnically different populations: evidence for differing psychotic symptom content or structural organization?". Culture, Medicine and Psychiatry. 38 (3): 408–426. doi:10.1007/s11013-014-9385-8. ISSN 0165-005X. PMC 4140994. PMID 24981830.
  10. Mayo Foundation for Medical Education and Research (2013). Paranoid Schizophrenia. Mayo Clinic. Retrieved from
  11. "Schizophrenia". National Alliance on Mental Illness. 24 February 2019.
  12. Smith, M., Segal J. (2013). Schizophrenia signs, symptoms, and causes. Archived 2013-12-24 at the Wayback Machine
  13. "New Study Offers Hope for Homeless People with Schizophrenia". National Alliance to End Homelessness. 2015-12-03. Retrieved 2019-02-25.
  14. Mayo Foundation for Medical Education and Research (2013). Paranoid Schizophrenia. Mayo Clinic. Retrieved from
  15. Haddad, P. M.; Brain, C; Scott, J (2014). "Nonadherence with antipsychotic medication in schizophrenia: Challenges and management strategies". Patient Related Outcome Measures. 5: 43–62. doi:10.2147/PROM.S42735. PMC 4085309. PMID 25061342.
  16. Schiopu, B; Nel, M; Hiemstra, La; Latecki, B (April 2005). "Relevance of Schneider's first-rank symptoms in Zulu patients with paranoid schizophrenia". South African Family Practice. 47 (3): 55–60. doi:10.1080/20786204.2005.10873203. ISSN 2078-6190.
  17. Torrey EF, Yolken RH (January 2010). "Psychiatric genocide: Nazi attempts to eradicate schizophrenia". Schizophr Bull. 36 (1): 26–32. doi:10.1093/schbul/sbp097. PMC 2800142. PMID 19759092.
  18. American Psychiatric Association. (2000/2013). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, D.C.
  19. "ICD-11 - Mortality and Morbidity Statistics". Retrieved 2019-03-21.
  20. "What Are Dissociative Disorders?". Retrieved 2019-02-21.
  21. "Why DID or MPD is a Bogus Diagnosis". Psychology Today. Retrieved 2019-02-21.
  22. "Dissociative disorders - Diagnosis and treatment - Mayo Clinic". Retrieved 2019-02-21.
  23. Waldinger, Robert J. (1 August 1997). Psychiatry for Medical Students. American Psychiatric. ISBN 978-0-88048-789-4.
  24. "Delusional Disorder". Cleveland Clinic. Retrieved 2019-02-21.
  25. "Causes of paranoia | Mind, the mental health charity - help for mental health problems". Retrieved 2019-02-21.
  26. Services, Department of Health & Human. "Paranoia". Retrieved 2019-02-21.

Further reading

  • Case, Jenifer R. & Case, Donn T. Milestones and Avenues: A Story of Loss and Recovery: A biographical account of living with paranoid schizophrenia (2006)
  • Kraepelin, Emil Paranoidal Forms of Dementia praecox [Paranoid Schizophrenia] (HISTORY OF PSYCHIATRY) (1906)
  • Miller, Carolyn. Straight From the Heart: A Mother Battles Paranoid Schizophrenia, and a Girl Struggles to Grow Up (2006)
  • Parker, James N. & Parker, Philip M. Paranoid Schizophrenia: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References (2004)
  • Podsobinski, Larry (2007). In The Grip of Paranoid Schizophrenia: One Man's Metamorphosis Through Psychosis. Lulu. ISBN 978-1430322313.
  • Zucker, Luise J. Ego Structure in Paranoid Schizophrenia: A New Method of Evaluating Projective Material (1958)
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