Paranoia Research Paper

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Paranoia is a term commonly used to describe people who are preoccupied with the idea that others are “out to get them” or “talking about them.” This common usage of the term by the lay public reflects a key feature of the concept in the social and behavioral sciences, particularly in the mental health literature. Constant worry about harm to the self is self-referential  thinking. Self-referential thinking is a major feature of the paranoid condition. A paranoid person is also mistrustful, suspicious, and has an exaggerated sense of self-importance. These are the basic elements of paranoid thinking. The various ways that paranoia is discussed in the social and behavioral science literature include  psychiatric classification, causal theories,  and symptom-level approaches.

Psychiatric Classification

The  fourth  edition  of  the  Diagnostic and  Statistical Manual  of  Mental  Disorders, or  DSM-IV  (American Psychiatric Association 1994), defines paranoia as a symptom of mental illness. The DSM-IV includes three types of mental illnesses or syndromes of which paranoia is a  significant symptom:  paranoid  personality disorder, delusional disorder, and paranoid schizophrenia. Paranoid personality disorder involves strong feelings of suspiciousness, jealousy (in romantic relationships), and defensiveness without justification or evidence, but the individual does not have a psychotic illness such as schizophrenia. Delusional disorder is more severe and involves psychotic thinking, but the themes of the delusions are not bizarre. Instead, the themes of the paranoid delusions involve situations that can occur in real life such as a spouse cheating, being poisoned, or contracting an infectious disease. Finally, paranoid schizophrenia is the most severe form of mental illness in this category. The delusions are more bizarre, such as the belief that other people can read the patient’s thoughts or take them out of his or her head.

Attempts have been made to conceptualize paranoid personality disorder, delusional disorder, and  paranoid schizophrenia as reflecting a continuum  from mild  to severe psychopathology, respectively. This  perspective assumes that the type of delusional symptom defines the relationship between the different types of psychiatric disorders. Genetic studies of patients with delusional disorder  using the  family history method  are one  line  of research that does not support the continuum perspective (Kendler, Masterson, and  Davis 1985;  Schanda et  al. 1983). Schanda et al. (1983) found that risk for “atypical psychosis” was higher in the first-degree relatives of delusional disorder patients than  in  those of patients with paranoid schizophrenia. Kendler et al. (1985) found that paranoid personality disorder may have a stronger familial link to delusional disorder than to schizophrenia. These two findings are at odds with the notion  that  there is greater genetic vulnerability among patients with schizophrenia. Thus it may be more useful to consider paranoid symptoms apart from diagnoses.

Causal Theories

Causal theories of paranoia fall into three basic categories: biological, psychological, and social. Biologically, Strider et al. (1985) claim that various neuropsychological impairments such as memory problems and hearing loss associated with brain injuries or the cognitive decline that accompanies old age may engender paranoia because individuals may attribute  their  inability to  find  misplaced objects  and  inaudible  conversations to  the  deliberate attempts of others to keep things from them. Moreover, both clinical and experimental data indicate that injury to the right hemisphere of the brain is more likely to produce paranoid thinking because of the inability verbally to label sensory and emotional experiences (Strider et al. 1985). Thus paranoid thinking may be manifested as a result of damage to the brain.

There may also be a genetic component to paranoia. Genetic studies of patients with delusional disorder using the family history method indicate that the percentage of first-degree relatives (i.e., parents, siblings, or offspring) with schizophrenia ranges from 0 percent to 3 percent and affective disorder ranges from  3  percent  to  6  percent (Kendler, Masterson, and  Davis 1985;  Schanda et  al. 1983). Bentall et al. (2001) argued that because diagnoses include multiple symptoms that involve multiple genes, heritability estimates may be higher for diagnoses than for paranoid symptoms alone. Taken together, these findings suggest that paranoid conditions have very limited inheritability, which may manifest differently in various forms of psychopathology.

Classical and  modern  psychological theories view paranoia as a defense against threats to the self. The classical theory of Freud defines paranoia as an unconscious defense against repressed homosexuality, chronic problems of self-esteem regulation, and sensitivity to narcissistic injury (Bone and Oldham 1994). The idea that paranoia protects  against threats  to  self-esteem is the only aspect of Freudian theory that survives in modern theories of paranoia. Bentall et al. (2001) propose an attribution–self-representation model of persecutory delusions (i.e., paranoia). In their model, individuals make attributions for positive or negative events based on available selfrepresentations stored in memory, which, in turn, influence future attributions in an ongoing cycle. Paranoia occurs when the individual attempts to engage in selfesteem regulation after experiencing a  negative event, where the cognitive search does not yield a negative selfrepresentation to explain the event, resulting in a shift to external-personal causes (Bentall et al. 2001). In  other words, the person maintains a positive view of the self because those self-representations could not account for the negative event.

Social theories of paranoia emphasize that it is a reaction to threatening environments or inadequate resources (Mirowsky 1985; Marcus 1994). Marcus (1994) extends the  psychoanalytic perspective to  paranoid  tendencies expressed by social groups in organizational contexts. He considers the  paranoid  reaction  in  social groups  and organizations a manifestation of a survival instinct when there are behavioral constraints on members because of unequally distributed resources that are hidden or protected (Marcus 1994). Mirowsky (1985) proposes a similar theoretical explanation for paranoia in social groups. It is a form of self-protection from exploitation and oppression among social groups that are powerless. He demonstrated that paranoid beliefs in the general population are the product of interactions between feelings of mistrust and exposure to social environments that are threatening (Mirowsky 1985). This may be why paranoia appears to be more common among individuals in the lower social classes and  among  ethnic/minority  groups  (Mirowsky 1985; Whaley 1998). Self-protection is a theme that links biological, psychological, and social theories of paranoia. In this way, paranoia may be a coping response that is adaptive. However,  extreme paranoia  as evidenced in paranoid schizophrenia with no basis in social reality is dysfunctional.

Symptom-Level Approaches

Paranoia is not an all-or-none condition. It is best to think of paranoid symptoms as falling on a continuum of severity, with the mild end being represented by suspiciousness, mistrust, and self-consciousness and the severe end represented by delusions of persecution often involving hallucinatory experiences (Fenigstein 1996;  Whaley 1998). Both mentally ill patients and normal persons have these types of paranoid tendencies, and the difference between them is a matter of degree or severity (Fenigstein 1996). Whether a person recovers from a mental illness depends more on the diagnosis (e.g., paranoid personality disorder versus schizophrenia) than on the presence of paranoid symptoms. The  notion  “once  paranoid—always paranoid” is not correct; people with paranoid conditions can recover (Retterstol 1991). Finally, the types of cultural experiences that people have may influence whether they exhibit paranoid behaviors.

Immigrants are at increased risk for developing paranoid responses (Kendler 1982). Social groups that have been oppressed or discriminated against such as African Americans also develop paranoid-type coping responses (Whaley 1998). The social and psychological theories of paranoia provide some insight into why this may be the case (Bentall et al. 2001; Marcus 1994; Mirowsky 1985). Under these circumstances, the responses to real threats in the environment or adjustment to new experiences may appear similar to conditions of clinical paranoia, but these expressions often  are normative  and  not  pathological. Understanding that paranoia falls on a continuum from mild to severe, as opposed to a symptom that is either present or absent, allows us to appreciate that just because someone is paranoid does not always mean that the person’s reaction is sign of mental illness.


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  2. Bentall, P., R. Corcoran, R. Howard, et al. 2001. Persecutory Delusions: A Review and Theoretical Integration. Clinical Psychology Review 21: 1143–1192.
  3. Bone, , and J. M. Oldham. 1994. Paranoia: Historical Considerations. In Paranoia: New Psychoanalytic Perspectives, eds. J. M. Oldham and S. Bone, 3–15. Madison, CT: International Universities Press.
  4. Fenigstein, 1996. Paranoia. In Personality Characteristics of the Personality Disordered, ed. C. G. Costello, 242–275. New York: Wiley.
  5. Kendler, K. 1982. Demography of Paranoid Psychosis (Delusional Disorder): A Review and Comparison with Schizophrenia and Affective Illness. Archives of General Psychiatry 39: 890–902.
  6. Kendler, S., C. C. Masterson, and K. L. Davis. 1985. Psychiatric Illness in First-Degree Relatives of Patients with Paranoid Psychosis, Schizophrenia, and Medical Illness. British Journal of Psychiatry 147: 524–531.
  7. Marcus, R. 1994. Paranoid Symbol Formation in Social Organizations. In Paranoia: New Psychoanalytic Perspectives, eds. J. M. Oldham and S. Bone, 81–94. Madison, CT: International Universities Press.
  8. Mirowsky, 1985. Disorder and Its Context: Paranoid Beliefs as Thematic Elements of Thought Problems, Hallucinations, and Delusions under Threatening Social Conditions. In Research In Community Mental Health, ed. J. R. Greenley, 5: 185–204. Greenwich, CT: JAI Press.
  9. Retterstol, 1991. Course and Outcome in Paranoid Disorders. Psychopathology 24: 277–286.
  10. Schanda, , P. Berner, E. Gabriel, et al. 1983. The Genetics of Delusional Psychosis. Schizophrenia Bulletin 9: 563–570.
  11. Strider, A., C. Chu, C. Golden, and R. J. Bishop. 1985. Neuropsychological Dimensions of Paranoid Syndromes. International Journal of Clinical Neuropsychology 7: 196–200.
  12. Whaley, L. 1998. Cross-Cultural Perspective on Paranoia: A Focus on the Black American Experience. PsychiatricQuarterly 69: 325–343.

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