Paranoia as a Symptom of Schizophrenia

In the current version of the DSM (DSM-5, released in 2013), there are no longer subtypes of schizophrenia. Previously, there was paranoid schizophrenia, along with disorganized, catatonic, undifferentiated, and residual types. It was determined that these were not helpful to clinicians when treating the disorder.

While you can no longer be diagnosed with paranoid schizophrenia, you can experience "paranoid" symptoms. In fact, paranoia remains one criterion for diagnosing schizophrenia and is known as a "positive symptom."

This means it is part of the normal day-to-day living for people with schizophrenia and is in excess or added to normal mental functioning. In the most general sense, the term paranoia is used to imply a sense of distrust.

In schizophrenia, it can be an irrational fixed belief that one is going to be harmed. Those struggling with this symptom of schizophrenia experience hallucinations and delusions that often leave them feeling confused, fearful, and mistrusting of others.

Delusions

Someone with schizophrenia with paranoia will experience a preoccupation with delusions. Delusions refer to a fixed false belief. No matter how much information is presented to you showing that the belief is false or misperceived, you continue to hold on to the belief. There are many types of delusions, although the following are most common:

• Control: Belief of being controlled or manipulated by an outside influence
• Grandiosity: Beliefs of special or exceptional powers or abilities
• Jealousy: Belief that a spouse or partner is being unfaithful
• Persecution: Belief of being interfered with or the center of a conspiracy
• Reference: Belief that certain environmental cues, such as the radio, are directed at oneself.
• Somatic: Irrational beliefs about the body or illness.
• Thought insertion: Belief that ideas are being put into your mind by others

Hallucinations

A hallucination is a false sensory perception and can affect any of the five senses. The types of hallucinations are referred to as:

• Auditory (sound)
• Visual (sight)
• Olfactory (smell)
• Tactile (touch)
• Gustatory (taste)

The senses that are often impacted by schizophrenia with paranoia are sight and sound. In other words, you may see and hear things that are not present. It is important to note these hallucinations happen while the person is awake and conscious.

Examples of auditory (sound) and visual (sight) hallucinations in someone with paranoia may include:

• Hearing voices coming from an outside source, such as a speaker or other object
• Hearing voices commanding or conversing inside your mind
• Hearing abrupt sounds or music when there is nothing present
• Hearing sounds such as humming, whistling or laughing when no one is around
• Seeing faces and bodies
• Seeing images of a situation or event

Living With Paranoia

Because the experience of delusions and hallucinations can be so intrusive, confusing and unsettling, you may find it difficult to let anyone know what you are experiencing. It can be challenging when you are left feeling scared, alone, and unable to trust others.

Interactions with others can feel threatening and attending social events can feel risky, which can lead people to become reclusive in an effort to feel safe.

Schizophrenia treatment specialist, Dr. Lisa Cowley, shares that one of the greatest challenges in reaching out for help for those with paranoia and schizophrenia is a lack of awareness or understanding of their condition.

"To these folks, their symptoms appear like they are really happening," Dr. Cowley shares. "So, if they feel like the government is spying on them through cameras in their home, they wouldn't go see a psychiatrist or psychologist, they would try to contact authorities."

As symptoms progress, someone dealing with paranoia may become aware that they have an illness and seek help. In this case, family members or support services may be necessary to help with treatment challenges like transportation and lack of problem-solving skills when their symptoms are high and their thinking is muddled, Dr. Cowley notes.

Treatment for Paranoia 

Although there is no known cure for schizophrenia with paranoia, there are treatment options available that can help you live a full and productive life. Medications, particularly antipsychotics, can help calm disruptive delusions and hallucinations.

Try to keep in mind that your doctor may have you try a few different medications before finding a regimen that works best for you. Once the best medication regimen is determined, then things like individual therapy, group therapy, and other support services can be of help, depending on the resources available in your area.

Supporting a Loved One

Dr. Cowley urges loved ones offering help and support to someone with schizophrenia with paranoia read the book I am Not Sick, I Don't Need Help! by Xavier Amador.

"This book directly addresses how families can help, especially with people who don't realize they are ill," she says.

She also recommends setting healthy limits and doing your best to stay patient; the stabilization process can take time. Getting family therapy or joining an online or in-person support group is also helpful, adds Cowley. Here are a few more tips to help you cope with and support your loved one with schizophrenia and paranoia.

• Be an advocate. Encourage your loved one to work with his or her mental health professional to find the right medication and therapy—and to comply with the determined plan of treatment.       
• Don’t argue. Instead, do your best to make your loved one feel safe and truly listen if he wants to talk about the paranoia.
• Provide space. Your loved one may feel trapped or surrounded, so it’s important to stay close to your loved one while providing ample personal space.
• Plan for paranoia. During a time when your loved one is not paranoid, make a plan for handling any fears or threats that occur during paranoia.
• Shift the focus on what's real. It may be helpful to redirect your loved one away from the paranoid fears to more reality-based concerns.
• Get help. If you think your loved one is in danger of harming herself or someone else, don’t hesitate to reach out to his mental health professional and/or call 911. 
• Practice self-care. Self-care is not selfish; just the opposite. By caring for your own physical and mental health, you will have more energy to help your loved one get a handle of schizophrenia with paranoia.