Paranoia

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Paranoia is an instinct or thought process believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory, or beliefs of conspiracy concerning a perceived threat towards oneself (e.g. "Everyone is out to get me", which is an American parochial phrase). Paranoia is distinct from phobias, which also involve irrational fear, but usually no blame. Making false accusations and the general distrust of others also frequently accompany paranoia. For example, an incident most people would view as an accident or coincidence, a paranoid person might believe was intentional. Paranoia is a central symptom of psychosis. It is also a matter of personal tolerance for the individual that might be in conflict with psychiatric diagnoses.

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Signs and symptoms

A popular symptom of paranoia is the attribution bias. These individuals typically have a biased perception of reality, often exhibiting more hostile beliefs. A paranoid person may view someone else's accidental behavior as though it is with intent or threatening.

An investigation of a non-clinical paranoid population found that feeling powerless and depressed, isolating oneself, and relinquishing activities are characteristics that could be associated with those exhibiting more frequent paranoia. Some scientists have created different subtypes for the various symptoms of paranoia including erotic, persecutory, litigious, and exalted.

Due to the suspicious and troublesome personality traits of paranoia, it is unlikely that someone with paranoia will thrive in interpersonal relationships. Most commonly paranoid individuals tend to be of a single status. According to some research there is a hierarchy for paranoia. The least common types of paranoia at the very top of the hierarchy would be those involving more serious threats. Social anxiety is at the bottom of this hierarchy as the most frequently exhibited level of paranoia.

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Causes

Social and environmental

Social circumstances appear to be highly influential on paranoid beliefs. Based on data collected by means of a mental health survey distributed to residents of Ciudad Juárez, Chihuahua (in Mexico) and El Paso, Texas (in the United States), paranoid beliefs seem to be associated with feelings of powerlessness and victimization, enhanced by social situations. Potential causes of these effects included a sense of believing in external control, and mistrust which can be strengthened by lower socioeconomic status. Those living in a lower socioeconomic status may feel less in control of their own lives. In addition, this study explains that females have the tendency to believe in external control at a higher rate than males, potentially making females more susceptible to mistrust and the effects of socioeconomic status on paranoia.

Emanuel Messinger reports that surveys have revealed that those exhibiting paranoia can evolve from parental relationships and dis-trustworthy environments. These environments could include being very disciplinary, stringent, and unstable. It was even noted that, "indulging and pampering (thereby impressing the child that he is something special and warrants special privileges)," can be contributing backgrounds. Experiences likely to enhance or manifest the symptoms of paranoia include increased rates of disappointment, stress, and a hopeless state of mind.

Discrimination has also been reported as a potential predictor of paranoid delusions. Such reports that paranoia seemed to appear more in older patients who had experienced higher levels of discrimination throughout their lives. In addition to this it has been noted that immigrants are quite susceptible to forms of psychosis. This could be due to the aforementioned effects of discriminatory events and humiliation.

Psychological

While many more mood-based symptoms, grandiosity and guilt, may underlie functional paranoia.

Colbi (1981) defined paranoid cognition in terms of persecutory delusions and false beliefs whose propositional content clusters around ideas of being harassed, threatened, harmed, subjugated, persecuted, accused, mistreated, wronged, tormented, disparaged, vilified, and so on, by malevolent others, either specific individuals or groups (p. 518). Three components of paranoid cognition have been identified by Robins & Post: a) suspicions without enough basis that others are exploiting, harming, or deceiving them; b) preoccupation with unjustified doubts about the loyalty, or trustworthiness, of friends or associates; c) reluctance to confide in others because of unwarranted fear that the information will be used maliciously against them (1997, p. 3).

Paranoid cognition has been conceptualized by clinical psychology almost exclusively in terms of psychodynamic constructs and dispositional variables. From this point of view, paranoid cognition is a manifestation of an intra-psychic conflict/disturbance. For instance, Colby (1981) suggested that the biases of blaming others for one's problems serve to alleviate the distress produced by the feeling of being humiliated, and helps to repudiate the belief that the self is to blame for such incompetence. This intra-psychic perspective emphasize that the cause of paranoid cognitions are inside the head of the people (social perceiver), and dismiss the fact that paranoid cognition may be related with the social context in which such cognitions are embedded. This point is extremely relevant because when origins of distrust and suspicion (two components of paranoid cognition) are studied many researchers have accentuated the importance of social interaction, particularly when social interaction has gone awry. Even more, a model of trust development pointed out that trust increase or decrease as a function of the cumulative history of interaction between two or more persons.

Another relevant difference can be discerned among "'pathological and non-pathological forms of trust and distrust"'. According to Deutsch, the main difference is that non-pathological forms are flexible and responsive to changing circumstances. Pathological forms reflect exaggerated perceptual biases and judgmental predispositions that can arise and perpetuate them, are reflexively caused errors similar to a self-fulfilling prophecy.

It has been suggested that a 'hierarchy' of paranoia exists, extending from mild social evaluative concerns, through ideas of social reference, to persecutory beliefs concerning mild, moderate, and severe threat.

Physical

A paranoid reaction may be caused from a decline in brain circulation as a result of high blood pressure or hardening of the arterial walls.

Drug-induced paranoia, associated with amphetamines, methamphetamine and similar stimulants has much in common with schizophrenic paranoia; the relationship has been under investigation since 2012. Drug-induced paranoia has a better prognosis than schizophrenic paranoia once the drug has been removed. For further information, see Stimulant psychosis and Substance-induced psychosis.

Based on data obtained by the Dutch NEMISIS project in 2005, there was an association between impaired hearing and the onset of symptoms of psychosis, which was based on a five-year follow up. Some older studies have actually declared that a state of paranoia can be produced in patients that were under a hypnotic state of deafness. This idea however generated much skepticism during its time.

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Mechanisms

Abnormal reasoning

Many researchers believe that individuals with paranoia have some sort of cognitive deficit or impairment in reasoning ability or lack social credibility. Studies have shown that there may not be a direct relationship between the impairments and psychotic delusions, but they rather effect other areas of an individual's life, such as social circumstances can be important factors about delusions. Other researchers have shown that cognitive abilities may be altered, such as when cameras or recordings are involved. This phenomenon appears to be a common theme among those exhibiting psychotic delusions. An investigation involving one hundred delusional patients did indeed reveal that these individuals may have a tendency to jump to conclusions rather than look for other potential information.

Anomalous perceptual experiences

A very prominent example of this theory is the Capgras delusion or syndrome named after the psychiatrist Joseph Capgras. This involves an individual perceiving that a certain important person within their life has been taken over by an impersonator. Ellis and Young (1990) report that the Capgras delusion may be a result of an impaired ability of recognition such as brain damage. Those suffering from the Capgras syndrome tend to have more suspicious personalities and have unusual visualizations about the world and surrounding environments.

Hyper-acute attention is said to be more common in those with paranoia by being able to attend to unfavorable emotions at a higher level. It is also likely that because paranoid personalities focus on threatening events and believe that most intentions are against them, they will be more inclined to recognize these behaviors more frequently.

Motivational factors

The attribution model has been well talked about regarding paranoid or delusional individuals. The idea is that they like to assign issues to external events. A motivation behind this characteristic may involve the need for that person to develop a better self-image and maintain self-confidence. There have been debates about whether or not paranoid individuals are more likely to have a low or high self-perception, and results have been generated for both of these hypotheses. Researchers have made a distinction between positive self-esteem and negative self-esteem revealing that paranoid delusional individuals have more of a negative self-evaluation.

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Diagnosis

In the DSM-IV-TR, paranoia is diagnosed in the form of:

paranoid personality disorder (F60.0)
paranoid schizophrenia (a subtype of schizophrenia) (F20.0)
the persecutory type of delusional disorder, which is also called "querulous paranoia" when the focus is to remedy some injustice by legal action. (F22.8)

According to clinical psychologist P. J. McKenna, "As a noun, paranoia denotes a disorder which has been argued in and out of existence, and whose clinical features, course, boundaries, and virtually every other aspect of which is controversial. Employed as an adjective, paranoid has become attached to a diverse set of presentations, from paranoid schizophrenia, through paranoid depression, to paranoid personality--not to mention a motley collection of paranoid 'psychoses', 'reactions', and 'states'--and this is to restrict discussion to functional disorders. Even when abbreviated down to the prefix para-, the term crops up causing trouble as the contentious but stubbornly persistent concept of paraphrenia".

At least 50% of the diagnosed cases of schizophrenia experience delusions of reference and delusions of persecution. Paranoia perceptions and behavior may be part of many mental illnesses, such as depression and dementia, but they are more prevalent in three mental disorders: paranoid schizophrenia, delusional disorder (persecutory type), and paranoid personality disorder.

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History

The word paranoia comes from the Greek ???????? (paranoia), "madness", and that from ???? (para), "beside, by" and ???? (noos), "mind". The term was used to describe a mental illness in which a delusional belief is the sole or most prominent feature. In this definition, the belief does not have to be persecutory to be classified as paranoid, so any number of delusional beliefs can be classified as paranoia. For example, a person who has the sole delusional belief that he is an important religious figure would be classified by Kraepelin as having 'pure paranoia'.

According to Michael Phelan, Padraig Wright, and Julian Stern (2000), paranoia and paraphrenia are debated entities that were detached from dementia praecox by Kraepelin, who explained paranoia as a continuous systematized delusion arising much later in life with no presence of either hallucinations or a deteriorating course, paraphrenia as an identical syndrome to paranoia but with hallucinations. Even at the present time, a delusion need not be suspicious or fearful to be classified as paranoid. A person might be diagnosed with paranoid schizophrenia without delusions of persecution, simply because their delusions refer mainly to themselves.

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Relations to violence

It has generally been agreed upon that individuals with paranoid delusions will have the tendency to take action based on their beliefs. More research is needed on the particular types of actions that are pursued based on paranoid delusions. Some researchers have made attempts to distinguish the different variations of actions brought on as a result of delusions. Wessely et al. (1993) did just this by studying individuals with delusions of which more than half had reportedly taken action or behaved as a result of these delusions. However, the overall actions were not of a violent nature in most of the informants. The authors note that other studies such as one by Taylor (1985), have shown that violent behaviors were more common in certain types of paranoid individuals, mainly those considered to be offensive such as prisoners.

Other researchers have found associations between childhood abusive behaviors and the appearance of violent behaviors in psychotic individuals. This could be a result of their inability to cope with aggression as well as other people, especially when constantly attending to potential threats in their environment. The attention to threat itself has been proposed as one of the major contributors of violent actions in paranoid people, although there has been much deliberation about this as well. Other studies have shown that there may only be certain types of delusions that promote any violent behaviors, persecutory delusions seem to be one of these.

Having resentful emotions towards others and the inability to be able to understand what other people are feeling seem to have an association with violence in paranoid individuals. This was based on a study of paranoid schizophrenics' (one of the common mental disorders that exhibit paranoid symptoms) theory of mind capabilities in relation to empathy. The results of this study revealed specifically that although the violent patients were more successful at the higher level theory of mind tasks, they were not as good at being able to interpret others' emotions or claims.

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Paranoid social cognition

Social psychological research has proposed a mild form of paranoid cognition, paranoid social cognition, that has its origins in social determinants more than intra-psychic conflict. This perspective states that in milder forms, paranoid cognitions may be very common among normal individuals. For instance, it is not strange that people may exhibit in their daily life, self-centered thought such as they are being talked about, suspiciousness about other' intentions, and assumptions of ill or hostility (i.e. people may feel as if everything is going against them). According to Kramer, (1998) these milder forms of paranoid cognition may be considered as an adaptive response to cope with or make sense of disturbing and threatening social environment.

Paranoid cognition captures the idea that dysphoric self-consciousness may be related with the position that people occupies within a social system. This self-consciousness conduces to a hypervigilant and ruminative mode to process social information that finally will stimulate a variety of paranoid-like forms of social misperception and misjudgment. This model identifies four components that are essential to understand paranoid social cognition: Situational antecedents, Dysphoric self-consciousness, Hypervigilance and rumination, and Judgmental biases.

Situational antecedents

Perceived social distinctiveness, perceived evaluative scrutiny and uncertainty about the social standing.

Perceived social distinctiveness: According to the social identity theory, people categorize themselves in terms of characteristics that made them unique or different from others under certain circumstances. Gender, ethnicity, age, or experience may become extremely relevant to explain people's behavior when these attributes make them unique in a social group. This distinctive attribute may have influence not only in how people are perceived, but may also affect the way they perceive themselves. For instance, a young member in an organization interacting with more experienced colleagues may become more self-conscious because he may feel different in the group, tending to overestimate the extent to which he is evaluated by others, and constructing interaction with other members in a self-referential way.
Perceived evaluative scrutiny: According to this model, dysphoric self-consciousness may increase when people feel under moderate or intensive evaluative social scrutiny. For instance, when an asymmetric relationship is analyzed, as the relationship among a doctoral student and their advisors, students tend to remember more behaviors and events that they interpret as affecting their level of trust in the relationship compared to their advisors, suggesting that students are more willing to put attention to their advisor that the advisor are motivated to pay attention to them. Also students spent more time ruminating about the behaviors, events, and their relationship in general.
Uncertainty about social standing:The knowledge about the social standing is another factor that may induce paranoid social cognition. Many researchers have argued that experiencing uncertainty about a social position in a social system constitutes an adverse psychological state, one which people are highly motivated to reduce. For instance, a younger member in a social organization is more likely to experience uncertainty, probabilistically, about his social standing as compared to an older member in the same organization, all else being fairly equal. The chief difference is tenure (time in service), in which an experienced member of the organization is more comfortable and familiar with social norms and rules. As a result of one's own moral ambivalences, new members are prone to experience heightened self-awareness and hypervigilance and might interpret others' behavior in a self-referential way.

Dysphoric self-consciousness

Refers to an aversive form of heightened public self-consciousness characterized by the feelings that one is under intensive evaluative scrutiny. Becoming self-tormenting will increase the odds of interpreting others' behaviors in a self-referential way. According to this model it means that if one is dysphoric, it could be because someone is watching, and if someone is watching, it's because something must be wrong. Whatever the danger or fault may be, the self-torment is projected onto the group.

Hypervigilance and rumination

Self-consciousness was characterized as an aversive psychological state. According to this model, people experiencing self-consciousness will be highly motivated to reduce it, trying to make sense of what they are experiencing. These attempts promote hyper vigilance and rumination in a circular relationship: more hyper vigilance generates more rumination, whereupon more rumination generates more hyper vigilance. Hyper vigilance can be thought of as a way to appraise threatening social information, but in contrast to adaptive vigilance, hyper vigilance will produce elevated levels of arousal, fear, anxiety, and threat perception. Rumination is another possible response to threatening social information. Rumination can be related to the paranoid social cognition because it can increase negative thinking about negative events, and evoke a pessimistic explanatory style.

Judgmental biases

Three main judgmental consequences have been identified:

The sinister attribution error: This bias captures the tendency that social perceivers have to overattribute lack of trustworthiness to others.
The overly personalistic construal of social interaction: Refers to the inclination that paranoid perceiver has to interpret others' action in a disproportional self-referential way, increasing the belief that he or she is target of others' thoughts and actions. A special kind of bias in the biased punctuation of social interaction, which entail an overperception of causal linking among independent events.
The exaggerated perception of conspiracy: Refers to the disposition that the paranoid perceiver has to overattribute social coherence and coordination to others' actions. Under this point of view, the paranoid perceiver will attribute linkages among people who are engaged in independent actions.

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Notes and References

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References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR: Fourth edition Text Revision) (2000) [1]
Abu-Akel, A.; Abushua'leh, K. (2004). "'Theory of mind' in violent and nonviolent patients with paranoid schizophrenia". Schizophrenia Research. Elsevier B.V. 69 (1): 45-53. doi:10.1016/S0920-9964(03)00049-5. PMID 15145470.
Barrowclough, C.; Tarrier, N.; Humphreys, L.; Ward, J.; Gregg, L.; Andrews, B. (2003). "Self-Esteem in Schizophrenia: Relationships Between Self-Evaluation, Family Attitudes, and Symptomatology". Journal of Abnormal Psychology. American Psychological Association. 112 (1): 92-99. doi:10.1037/0021-843X.112.1.92. PMID 12653417.
Bentall, R.P.; Taylor, J.L. (2006). "Psychological Processes and Paranoia: Implications for Forensic Behavioural Science". Behavioral Sciences and the Law. Wiley InterScience. 24 (3): 277-294. doi:10.1002/bsl.718. PMID 16773623. Retrieved April 4, 2014.
Bjorkly, S. (2002). "Psychotic symptoms and violence toward others -- a literature review of some preliminary findings Part 1. Delusions". Aggression and Violent Behavior. Elsevier Ltd. 7 (6): 617-631. doi:10.1016/s1359-1789(01)00049-0.
Capgras, J.; Reboul-Lachaux, J. (1923). "Illusion des " sosies " dans un délire systématisé chronique". History of Psychiatry. Sage Publications. 5 (119): 119-133. doi:10.1177/0957154X9400501709. Retrieved 8 April 2014.
Deutsch, Albert(ed); Fishman, Helen(ed) (1963). "Paranoia". The encyclopedia of mental health, Vol IV. The Encyclopedia of Mental Health. IV. New York, NY, US: Franklin Watts. pp. 1407-1420. doi:10.1037/11547-024. Retrieved April 4, 2014. CS1 maint: Extra text: authors list (link)
Ellis, H.D.; Young, A.W. (1990). "Accounting for Delusional Misidentifications". The British Journal of Psychiatry. Royal College of Psychiatrists. 157 (2): 239-248. doi:10.1192/bjp.157.2.239. PMID 2224375. Retrieved 8 April 2014.
Freeman, D.; Garety, P.A.; Bebbington, P.E.; Smith, B.; Rollinson, R.; Fowler, D.; Kuipers, E.; Ray, K.; Dunn, G. (2005). "Psychological investigation of the structure of paranoia in a non-clinical population". The British Journal of Psychiatry. The Royal College of Psychiatrists. 186 (5): 427-435. doi:10.1192/bjp.186.5.427. PMID 15863749. Retrieved March 26, 2014.
Freeman, D.; Garety, P.A.; Fowler, D.; Kuipers, E.; Bebbington, P.E.; Dunn, G. (2004). et al 04.pdf "Why Do People With Delusions Fail to Choose More Realistic Explanations for Their Experiences? An Empirical Investigation" (PDF). Journal of Consulting and Clinical Psychology. American Psychological Association. 72 (4): 671-680. doi:10.1037/0022-006X.72.4.671. PMID 15301652.
McKenna, P.J. (1997). Schizophrenia and Related Syndromes. Great Britain: Psychology Press. ISBN 978-0-86377-790-5.
Mirowski, J.; Ross, C.E. (1983). "Paranoia and the Structure of Powerlessness". 48 (2). American Sociological Association: 228-239. JSTOR 2095107.
Phelan, Michael; Wright, Padraig; Stern, Julian (2000). Core psychiatry. Philadelphia: Saunders. ISBN 0-7020-2490-2.
Wessely, S.; Buchanan, A.; Reed, A.; Cutting, J.; Everitt, B.; Garety, P.; Taylor, P.J. (1993). "Acting on Delusions. I: Prevalence". The British Journal of Psychiatry. The Royal College of Psychiatrists. 163: 69-76. doi:10.1192/bjp.163.1.69. PMID 8353703.

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Paranoia

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Paranoia

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Signs and symptoms

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