paranoia

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Definition

Paranoia is an unfounded or exaggerated distrust of others, sometimes reaching delusional proportions. Paranoid individuals constantly suspect the motives of those around them, and believe that certain individuals, or people in general, are "out to get them."

Description

Paranoid perceptions and behavior may appear as features of a number of mental illnesses, including depression and dementia, but are most prominent in three types of psychological disorders: paranoid schizophrenia, delusional disorder (persecutory type), and paranoid personality disorder (PPD).

Individuals with paranoid schizophrenia and persecutory delusional disorder experience what is known as persecutory delusions: an irrational, yet unshakable, belief that someone is plotting against them. Persecutory delusions in paranoid schizophrenia are bizarre, sometimes grandiose, and often accompanied by auditory hallucinations. Delusions experienced by individuals with delusional disorder are more plausible than those experienced by paranoid schizophrenics; not bizarre, though still unjustified. Individuals with delusional disorder may seem offbeat or quirky rather than mentally ill, and, as such, may never seek treatment.

Persons with paranoid personality disorder tend to be self-centered, self-important, defensive, and emotionally distant. Their paranoia manifests itself in constant suspicions rather than full-blown delusions. The disorder often impedes social and personal relationships and career advancement. Some individuals with PPD are described as "litigious," as they are constantly initiating frivolous law suits. PPD is more common in men than in women, and typically begins in early adulthood.

— Paula Anne Ford-Martin

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n.

1. A psychotic disorder characterized by delusions of persecution with or without grandeur, often strenuously defended with apparent logic and reason.
2. Extreme, irrational distrust of others.

[Greek, madness, from paranoos, demented : para-, beyond; see para–¹ + nous, noos, mind.]

A mode of thought, feeling, and behavior characterized centrally by false persecutory beliefs, more specifically referred to as paranoidness. Commonly associated with these core persecutory beliefs are properties of suspiciousness, fearfulness, hostility, hypersensitivity, rigidity of conviction, and an exaggerated sense of self-reference. These properties are evident with varying degrees of intensity and duration.

The paranoid mode can be triggered at either biological or psychological levels. Common precipitating biological causes are brain trauma or tumor, thyroid disorder, cerebral arteriosclerosis, and intoxication with certain drugs, including alcohol, amphetamines, cocaine, other psychostimulants, and hallucinogens such as mescaline or lysergic acid diethylamide (LSD). They can produce disordered activity of central dopaminergic and noradrenergic pathways. At the psychological level, triggering causes include false arrest, birth of a deformed child, social isolation, deafness, and intensely humiliating experiences. See also Noradrenergic system.

The paranoid mode is resistant to modification by psychotherapeutic or pharmacological methods. Acute psychotic states of paranoidness accompanied by high levels of anxiety are usually responsive to neuroleptic medication. See also Psychopharmacology.

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(per′ə-noi′ə)
n

1. psychosis characterized by delusions and hallucinations that are well systematized. 2. the irrational belief that one is the object of special persecution by others or by fate.

For more information on paranoia, visit Britannica.com.

A mental disorder characterized by persistent delusions. The sufferer may show no symptoms of mental illness and apparently has an intact personality. The term is commonly applied more loosely to a person who feels unduly persecuted.

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Paranoia has individual and institutional, social and cultural forms and determinants. There is probably at least a germ of paranoia in everyone which may be activated in regressive states with increased vulnerability. Clinically, paranoia may be found in mild transient forms, paranoid states of varying degree and duration, fixed paranoid traits and paranoid character, and borderline schizophrenia. The range of paranoid conditions doubtless depends upon constitutional, characterological, and experiential variables.

Unlike other types of psychosis, a paranoid psychosis is usually well-defined, and more or less circumscribed in a delusional part of the personality. The disturbance may remain encapsulated or systematized without generalized tendencies toward deterioration of the overall personality.

The paranoid personality is characterized by a number of common traits: basic distrust; suspiciousness; readiness to feel slighted, injured or persecuted; a tendency to collect grievances and grudges; and vindictiveness. The paranoid personality either anticipates or fears being exploited and abused; is irrationally suspicious of hidden dangers or threats; and expects or believes in the infidelity of a spouse, the disloyalty of friends, and notions of hostile conspiracy. Betrayals are anticipated or assumed, so that for the paranoid friend may immediately become foe, and seeming affection may be replaced by an implacable animosity. Self-esteem issues are also apparent—connected with both the extraordinary sensitivity to narcissistic injury and humiliation, and concomitant grandiosity which may extend to megalomania.

The psychoanalytic understanding of paranoia was initiated by Freud (1911c) who, prior to the Schreber case, had already linked the defense mechanism of projection to the paranoia personality. Via projection, the paranoid defends against unacceptable impulses, especially hate and aggression, which are also related to paranoid defiance. The importance of regression to narcissism, with attendant hypersensitivity to narcissistic mortification and grandiosity associated with infantile omnipotence, was highlighted in the Schreber case. Grandiosity could also be a compensatory reaction to unconscious feelings of inadequacy and inferiority. However, Freud shifted the dynamic understanding of paranoia at the same time to a core oedipal conflict. The paranoid defense constellation warded off unconscious homosexual wishes. In the paranoid male the unconscious proposition: "I, a man, love him, a man," is contradicted in the following ways: (1) delusions of jealousy: "It is not I who love the man; it is she," (2) delusions of persecution: "I do not love him, I hate him. Because of this he hates and persecutes me," (3) erotomania: "I do not love him. I love her, and she loves me," (4) megalomanic disavowal: "I do not love anyone else, but only myself."

It should be noted that Freud's formulations in the Schreber case were based upon the utilization of the libido theory and an attempt to understand paranoia in terms of psychosexual disturbance, which reversed his earlier formulation of repressed hostility. Subsequent contributions have confirmed the importance of malignant narcissism and the defense of projection, but also of hatred, aggression, and splitting of the ego and of self and object representations.

This defensive splitting off (Klein, Melanie, 1932) is also recognizable in group processes, as in the tendency to idealize one's own group and to distrust and project evil and hostility to those outside the group, especially against defenseless minorities unable to counterattack. Paranoid processes may be discerned in various sects and ideologies, where there is devaluation and persecution of those who are seen as opposed to the sect or group's narcissistically-invested belief system. In such dynamics, those who diverge may be scapegoated, and those who deviate or depart may be persecuted as heretics. Individuals with paranoid proclivities are far more readily attracted and susceptible to paranoid demagogues and groups. Paranoid leaders may foment and foster group paranoid reactions among vulnerable individuals. On the other hand, paranoid tendencies may contribute to individuals being vigilant guardians of civil liberty, ever-ready to detect a base of power and threats of exploitation. Feelings of being watched and scrutinized, so commonly seen with paranoid superego regression and externalization, may also have adaptive functions.

Contemporary understanding of the paranoid personality sometimes relates to circumstances in which a traumatic reality is embedded in fantasy, and historical truth in delusion (Freud, 1937d; Blum, 1994). There is often a history of childhood paranoia, so that pronounced narcissistic and paranoid features are already present in childhood. Feelings of mistrust, suspicion, and susceptibility to feelings of insult and injury may have been lifelong. The nightmares of paranoid patients may leave a hangover effect, so that the paranoid nightmare and terror of attack invades reality.

Traumatic experience with the terror of helplessness and inevitable narcissistic mortification may also be associated with severe and enduring vulnerability to narcissistic hurt and humiliation. Some cases involve selective identifications with paranoid parents. Paranoid dispositions may be anchored in familial styles of paranoid suspicion and scapegoating, or blaming and vengeful familial attitudes.

Furthermore, the paranoid often not only detects the latent envy and hostility of others, but tends to activate and evoke hostile reactions as well. The paranoid's expectation of social slights and hurts becomes a self-fulfilling prophecy as their own suspiciousness and hostility arouses similar mistrusts and hostility in others. Freud (1922b) observed the tendency of the paranoid personality to recognize but exaggerate the imagined infidelity present in both partners. Since blame and guilt are projected, the paranoid remains indignant about innocent victimization and may become litigious. Narcissistic rage over feelings of injury and compensatory aggrandizement serve to undo and reverse traumatic helplessness and avenge prior narcissistic hurts and humiliations (Kohut, 1972). The paranoid's own urge toward betrayal becomes a means of vengeance, vindication, and mastery. A preemptive strike may be related to the paranoid's expectation of attack, betrayal, and the rationalization of a defensive counterattack. Any narcissistic frustration, disappointment, or traumatic disturbance may regressively activate a paranoid persecutory system. All levels of personality development may contribute to the paranoid persecutory system.

Current explanations of paranoia involve recognition of diffuse developmental disturbance without a single point of developmental fixation or deficit, appreciating the possibility of complex overdetermination. In paranoia, murderous hostility is now considered far more important than repressed homosexual love. There is a stress on preoedipal roots, leading to failure of oedipal resolution, and to the patient's vulnerability to malignant narcissistic regression (Kernberg, 1975).

Freud's proposition of the delusional reconstruction of the lost object world is still accepted by many analysts, while others have proposed different views concerning impaired reality testing and paranoid object relations. Reality testing, cognition, and affect regulation may be constitutionally fragile and further impaired by projection, traumatic injury, and ego regression. The paranoid personality may have many areas of intact ego, but it has been proposed (Blum, 1981; 1994) that the persecutor is a narcissistic object or a part object (Klein, 1932), incompletely differentiated from the self representation. In addition to the splitting of representations, there is a regressive failure of object constancy with incomplete separation-individuation (Mahler, Margaret, 1971), and a desperate effort to reestablish object constancy within a constant persecutory relationship. The persecutory narcissistic object is sought, followed, or is imagined to be following the paranoid patient. The split-off dangerous object is the lesser evil when compared to objectless disorganization and fragmentation. Extreme ambivalence prevails, with the dominance of hate over love and with predominant projection of destructive rage, hatred, and self-hatred. Fear of being attacked by an invading or engulfing object is readily fused and confused because of unstable self-object differentiation, intrapsychic representation, and ego integration. Masochistic wishes to be attacked are less unpalatable to the paranoiac than the potentially malignant narcissism.

In national and social paranoia, concern with ego boundaries and narcissistic injury is reflected in concerns about national boundaries and enemy betrayal. The nation's integrity, and its boundaries, must then be defended because of fear of destructive invasion and engulfment.

The paranoid personality, depending upon the degree and fixity of the underlying disturbance, may be variably amenable to psychoanalytic treatment. Mistrust and lack of confidence in the analyst or therapist, fear of humiliation and abuse, coupled with an entrenched and entitled narcissism make the paranoid patient a major therapeutic challenge. For those patients amenable to psychoanalysis, consistent interpretation of paranoid transference manifestations, management of paranoid regression, and awareness of the patient's ego fragility and extreme ambivalence are of critical importance.

Bibliography

Blum, Harold P. (1994). Paranoid betrayal and jealousy: the loss and restitution of object constancy. In J. Oldham, S. Bone (Eds.), Paranoia: New psychoanalytical perspectives. Madison: International Universities Press, p. 97-114.

Freud, Sigmund. (1911c [1910]). Psycho-analytic notes on an autobiographical account of a case of paranoia (dementia paranoides). SE, 12: 1-82.

——. (1922b [1921]). Neurotic mechanisms in jealousy, paranoia and homosexuality. SE, 18: 221-232.

——. (1937d). Constructions in analysis. SE, 23: 255-269.

Kernberg, Otto. (1975). Borderline conditions and pathological narcissism. New York: Jason Aronson.

Kohut, Heinz. (1972). Thoughts on narcissism and narcissistic rage. The search for the self. (Vol. 2.) New York: International Universities Press, p. 615-65.

Further Reading

Auchincloss, Elizabeth L., and Weiss, Richard W. (1992). Paranoid character and the intolerance of indifference. Journal of the American Psychoanalytic Association, 40, 1013-1038.

Blum, Harold P. (1980). Paranoia and beating fantasy: psychoanalytic theory of paranoia. Journal of the American Psychoanalytic Association, 28, 331-362.

Kernberg, Otto F. (1992). Psychopathic, paranoid, and depressive transferences. International Journal of Psychoanalysis, 73, 13-28.

Meissner, William. (1986). Psychotherapy and the paranoid process. Northvale, NJ: Jason Aronson.

Oldham, John M., and Bone, Stanley. (Eds.). (1994). Paranoia: New psychoanalytic perspectives. Madison, CT: International Universities Press.

—HAROLD P. BLUM

(par-uh-noy-uh)

A form of psychosis marked by delusions of persecution and of grandeur. One who suffers from paranoia is paranoid.

In popular terminology, a “paranoid” personality is characterized by suspicion and distrust of others; a tendency to look for hidden meaning behind other people's actions; argumentativeness; complaining; low tolerance for criticism; and a constant display of one's own talents, accomplishments, independence, and rationality.

Although paranoia today is a diagnosis used to describe patients who exhibit systematized delusions of grandeur and persecution, its original meaning, as the etymology of the word indicates, was 'being out of one's mind'. Heinroth in 1818 appears to have equated paranoia with Verrücktheit (madness); Kahlbaum in 1863 was the first psychiatrist to give it its modern meaning, and although he regarded paranoia as a persistent, chronic condition, he believed that paranoid patients suffered from a disorder of intellect. The term survives as the name given to one type of functional psychosis, namely that in which the patient holds a coherent, internally consistent, delusional system of beliefs, centring round the conviction that he (or, more rarely, she) is a person of great importance and is on that account being persecuted, despised, and rejected. As Henderson and Gillespie's Textbook of Psychiatry (9th edn. 1962) puts it: 'A person so affected believes that he is right, that he is justified in his beliefs, and that anyone who opposes his point of view is behaving maliciously or at least non-understandingly towards him.' Such a person does not subscribe to the view that he is ill, does not accept treatment, does not enter hospital voluntarily, and may do great harm to himself and others: to himself by coming into active collision with a world that does not subscribe to his own exalted view of himself, and to others by attacking those he conceives to be persecuting him. Paranoiacs on occasion commit murders, not infrequently engage in futile litigation, and generally make an infernal nuisance of themselves, quarrelling incessantly with their neighbours and falsely accusing people of trespass or their spouses of infidelity.

True paranoia is, fortunately, rare; it has a bad prognosis and is not amenable to any known treatment. However, despite its rarity, it is for a variety of reasons of considerable interest and importance.

First, incoherent, internally consistent delusions of grandeur and persecution occur in other psychoses, notably in schizophrenia, where they form part of a clinical picture that includes hallucinations, emotional withdrawal, and autistic thinking (in which syntax is disrupted). These are three classes of symptoms which are conspicuous by their absence in true paranoia. Most but not all textbooks of psychiatry list 'paranoid schizophrenia' as one of three varieties of schizophrenia, the other two being hebephrenic schizophrenia, which is characterized by withdrawal, bizarre mannerisms, and neglect of the person; and catatonic schizophrenia, characterized by periods of excitement and stupor.

Secondly, many people who are not regarded as mentally ill, and who do not come under the care of psychiatrists, display a cluster of personality traits which can be, and nowadays often are, described as paranoid. These people are opinionated, touchy, and have an idea of their own importance which the rest of the world does not endorse. Such people patently suffer from a disorder of self-esteem, not of intellect — their opinions must be correct because they hold them; their families, their careers, their lives must be especially important because they are their families, their careers, their lives — and the same must presumably be so for true paranoia. According to classical psychoanalytic theory, paranoia and paranoid traits generally are narcissistic disorders, the implication being that they indicate fixation at some infantile stage of development during which the self is its own love object; but many contemporary analysts hold that narcissistic self-overestimation is a compensatory reaction to humiliation in infancy and childhood. Later research (Schatzman 1973) has shown that Daniel Paul Schreber (1842–1911), the subject of Freud's classic paper 'Psycho-analytical notes on an autobiographical account of paranoia (dementia paranoides)' (1911), was from birth subject to gross mechanical restraints by his father, who was determined to nip in the bud all signs of self-will and 'innate barbarity' in his infant son. Freud, however, made no enquiries into his subject's childhood, took his expressed devotion to his father at its face value, and interpreted his delusions of being persecuted by God as a reversal and projection of repressed homosexual longings for his father.

Thirdly, paranoiac delusions bear a disconcerting, embarrassing resemblance to the beliefs held and propagated by founders of religions, by political leaders, and by some artists. Such people often make claims on behalf of themselves, their religious ideas, their country, their art, which would be regarded as grandiose and delusional if their ideas did not harmonize with the needs of their contemporaries and thereby achieve recognition and endorsement. Nowadays anyone who claimed to be the Messiah, who addressed God as his personal father, and asserted that 'he who is not for me is against me' would be at risk of being referred to a psychiatrist and diagnosed a paranoiac. But presumably in the 1st century ad his Word spoke to many — as indeed it continues to this day to do. Similarly, any politician who asserted the innate superiority of his own race and claimed that his country was the victim of an international conspiracy would today raise doubts as to his sanity, but in Germany in the 1930s Hitler found all too many people prepared to agree with him. There must, it seems, be some as yet unformulated relationship between the psychology of paranoia and that of prophets and leaders. See obedience.

Fourthly, the adjective 'paranoid' is sometimes used by psychoanalysts to describe anxiety and ideas that are inferred to be projections of the subject's own impulses, so that, for instance, a person who is unaware of his own hostility may suffer 'paranoid anxiety', imagining that everyone else is hostile towards him, or a person who is unaware of his own homosexual tendencies may have the 'paranoid idea' that other men are always about to make a pass at him. This usage derives historically from Freud's idea that the psychology of paranoia hinges on reversal and projection of unconscious homosexual impulses.

Finally, it must be mentioned that the word 'paranoid' has slipped into general use to refer to enhanced suspiciousness, often with the implication that such suspiciousness is evidence of unusual sensitivity and perceptiveness. Hence the catch-phrases 'Paranoia is total awareness' and 'The fact that you're paranoid doesn't mean that you aren't being followed'.

(Published 1987)

— Charles Rycroft

Bibliography
• Freud, S. (1911). 'Psycho-analytical notes on an autobiographical account of paranoia (dementia paranoides)'. In Complete Psychological Works, vol. xii.
• Schatzman, M. (1973). Soul Murder.

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Quotes:

"A paranoiac, like a poet, is born, not made." - Luis Bunuel

"The paranoiac is the exact image of the ruler. The only difference is their position in the world. One might even think the paranoiac the more impressive of the two because he is sufficient unto himself and cannot be shaken by failure." - Elias Canetti

"I envy paranoids; they actually feel people are paying attention to them." - Susan Sontag

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

Dansk (Danish)
n. - paranoiker

Nederlands (Dutch)
paranoia, overmatige achterdocht

Français (French)
n. - paranoïa

Deutsch (German)
n. - Paranoia, Verfolgungswahn

Ελληνική (Greek)
n. - (ιατρ., μτφ.) παράνοια

Italiano (Italian)
paranoia

Português (Portuguese)
n. - paranóia (f)

Русский (Russian)
паранойя

Español (Spanish)
n. - paranoia

Svenska (Swedish)
n. - paranoia

中文（简体）(Chinese (Simplified))
偏执狂, 妄想狂

中文（繁體）(Chinese (Traditional))
n. - 偏執狂, 妄想狂

한국어 (Korean)
n. - 편집증, 과대 망상광, 심한 공포

日本語 (Japanese)
n. - 偏執病, パラノイア

العربيه (Arabic)
‏(الاسم) جنون الاضطهاد, جنون العظمه, جنون الارتياب‏

עברית (Hebrew)
n. - ‮נטייה לא-נורמלית לאי-אימון ולחשד באחרים, שיגעון הרדיפה, פרנויה‬

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