All About Paranoid Schizophrenia

Paranoid schizophrenia is one of several classifications of schizophrenia that were used in a former version of the DSM, the DSM-IV-TR.

This version described five main types of schizophrenia and their symptoms, including:

• Paranoid type: Hallucinations or delusional beliefs about being persecuted, pursued, or conspired against.
• Disorganized type: Disorganized, incoherent speech and thoughts.
• Catatonic type: Lack of movement and affect, loss of speech, or repetitive actions.
• Undifferentiated type: Fluctuating symptoms that aren’t well-formed enough to fit clearly into any of the above categories, or symptoms from each of the above categories.
• Residual type: This describes a form of schizophrenia where symptoms are no longer as prominent or severe.

In the DSM-5-TR, this classification system for schizophrenia was dropped. The symptoms of these subtypes are still regarded as features of schizophrenia, but they’re not seen as distinct conditions.

The symptoms of schizophrenia currently recognized by the DSM-5-TR include:

• Hallucinations: Hearing, seeing, or otherwise perceiving things that aren’t really there.
• Delusions: A strongly-held belief in something, despite evidence that the belief is false. Paranoia can be a common theme in delusions.
• Disorganized speech: Incoherent, rambling, or loosely-connected speech that can be hard for others to understand or follow.
• Disorganized behavior: This can mean abnormal motor function, increased agitation, or catatonia.
• Negative symptoms: This describes the absence of a typical trait such as a flat affect or disorganized speech.

To be diagnosed with schizophrenia, you must experience 2 or more of the symptoms above — including at least one of the first three symptoms listed — for 1 month or longer, during a 6-month period.

When this subtype was still recognized, the key diagnostic criteria was:

• a preoccupation with delusions, especially those involving being persecuted, controlled, or harmed in some way
• frequent auditory hallucinations
• an absence of disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect

Although paranoid schizophrenia is no longer a diagnosis, paranoia is often a prominent symptom of the condition.

Paranoia is a thought process that causes a persistent feeling that people may be:

• persecuting you
• conspiring against you
• “out to get you”

In schizophrenia, paranoia usually takes the form of delusions, hallucinations, or some combination of the two.

For example, a person living with schizophrenia may believe they’re being pursued by law enforcement or that someone is trying to control them through their television or radio. Or, they may hear voices saying malicious things about them.

Paranoid personality disorder

Paranoia doesn’t always mean that a person has schizophrenia. It may also be a sign of paranoid personality disorder.

This condition doesn’t typically involve delusions or hallucinations but can cause overwhelming feelings of suspicion and distrust toward others.

Significant changes were made to the way schizophrenia is categorized for several reasons:

• the subtypes weren’t a reliable way to predict how the condition could unfold
• the subtypes didn’t help psychiatrists find effective treatment
• people living with schizophrenia don’t always experience only one category of symptoms

Schizophrenia is now described as a combination of five potential symptoms and as a spectrum, rather than a set of clearly defined categories.

Research has subsequently backed up the decision to eliminate the subtypes of schizophrenia, including paranoid schizophrenia.

According to a 2014 study, the previous subtypes of schizophrenia didn’t make a meaningful difference in how the condition is best treated. Researchers also found that there were only minor differences between people with paranoid, disorganized, and undifferentiated types.

Although the diagnostic criteria for schizophrenia changed, the actual process of being diagnosed with the condition remains the same.

There’s currently no single test that can confirm or diagnose schizophrenia. Instead, a healthcare or mental health professional will evaluate your symptoms and medical history.

They may also work to rule out other factors and medical conditions that can cause psychosis, such as:

• substance use
• brain tumors
• neurological conditions, such as encephalitis
• other psychiatric conditions, such as bipolar disorder

Once other causes have been ruled out, a diagnosis of schizophrenia may be made.

A combination of medication and psychotherapy can help treat schizophrenia.

Antipsychotic drugs can reduce the severity of distressing symptoms, such as delusions and hallucinations, and may make it easier for you to focus and think clearly.

With schizophrenia, the benefits of medication can often help improve therapy.

Cognitive behavioral therapy (CBT) is a type of talk therapy that focuses on identifying and changing unhelpful thought patterns. Research from 2020 suggests that CBT can be effective for paranoia, in particular.

Paranoid schizophrenia used to be a formal diagnosis but is now considered outmoded.

Schizophrenia is no longer clinically broken out into distinct subtypes. Instead, the DSM-5-TR lists five symptoms, which can all exist to varying degrees in a schizophrenia diagnosis.

Paranoia can be a feature of both delusions and hallucinations. It can cause someone with schizophrenia to believe they’re being controlled or experience distressing auditory hallucinations.

The symptoms of schizophrenia can be frightening and exhausting for those experiencing them, as well as their loved ones. But with ongoing research, schizophrenia is better understood now than it ever has been.

A range of effective treatment options is available to help manage schizophrenia symptoms. The first step is often seeing a healthcare or mental health professional. If you’re unsure where to start, you can check out Psych Central’s hub on finding mental health support.