Paranoid Schizophrenia

Of all the types of schizophrenia, paranoid schizophrenia is probably the most frequently diagnosed. Compared to the other types of schizophrenia, delusions and / or auditory hallucinations are much more prominent. Also, the paranoid type has the best overall prognosis.

Characteristics and Symptoms

To qualify for a diagnosis of paranoid schizophrenia, two primary criteria must be met:

  1. Frequent experience of auditory hallucinations or preoccupation with at least one delusion.
  2. The following symptoms are not prominent: blunted or inappropriate emotional expression, disorganized behavior, catatonic behavior, or speech which is disorganized.

More About Delusions and Hallucinations

Delusions are firmly held beliefs which are not based in reality. An example of a delusion would be the belief that aliens have removed one’s brain and replaced it with an alien brain.

In paranoid schizophrenia, the delusions often involved the belief that they are the victim or target of persecution. They may believe someone is spying on them or plotting to do them harm. The delusion may also be grandiose in nature; for example, a belief that s/he has supernatural powers or is on a mission to save the world. Other types of delusions may also occur, such as ones involving their bodies.

Auditory hallucinations are usually experienced as voices. The voices may be talking to them or about them. Sometimes the voices comment on their activity or tell them they are in danger. The voices may also order them to do certain things, such as commit suicide or stop taking their medication. Most of the time, the hallucinations are related to the delusional beliefs.

Other features which are typical of paranoid schizophrenia are an attitude of superiority or a tendency to be patronizing towards others. They may be aloof or argumentative. Anger and feelings of anxiety are also not uncommon. They can be very intense when interacting with others, or unusually formal.

Typically, the paranoid schizophrenic’s speech, cognitive functioning, and emotional expression are less impaired than in some of the other subtypes.

Additional Diagnostic Criteria

In order to meet the diagnosis of schizophrenia, regardless of the type, these other criteria must also be met:

  • A marked decline in functioning, after the onset of symptoms, in at least one of the primary aspects of the person’s life (e.g., work, school, relationships, self-care).
  • Signs of the disorder are present continuously for a period of at least 6 months. For at least one month of that time period (less if they subside due to effective treatment), the active-phase symptoms (for paranoid type that would be delusions and / or hallucinations) must be present.
  • Schizoaffective disorder (a disorder similar to schizophrenia but with prominent mood episodes) or other mood disorder have been ruled out.

Suicide and Violence

Paranoid schizophrenics may be prone to suicide as a result of the belief that they are persecuted or harassed. They may also attempt to harm themselves or others if they are hearing voices telling them to do so. If they have grandiose beliefs as well, they may be more inclined to become violent towards others, such as harming someone they perceive as a threat or being in their way.

Other Factors

People who develop paranoid schizophrenia often start having symptoms at a later age than the other types. The defining features of this disorder also tend to remain fairly stable over time.

Compared to the other subtypes, paranoid schizophrenics are often more likely to be able to live independently and hold down a job.

written by Dr. Cheryl Lane, PsyD

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