Paranoia

Paranoia

It is common to have suspicious thoughts or worries about other people from time to time. These fears are described as paranoid when they are exaggerated and not based in fact. There are three key features of paranoid thoughts:

    * you fear that something bad will happen
    * you think that others are responsible
    * your belief is exaggerated or unfounded.

However, the central thought which is present with paranoia is a sense of threat.
 
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What Is Paranoia?

Paranoia is a term that in common, everyday language is used to mean everything from feeling nervous about a person or situation to being convinced that somebody is "out to get you." In his song "Almost Cut My Hair," David Crosby expressed this common usage well when he said, "It increases my paranoia, like looking in my mirror and seeing a police car." I'll wager almost everyone feels uneasy (and watches speed, signals and everything else) when police officers are right behind them.

People may call that type of experience paranoia, but medically, the definition of paranoia is more precise. 

Psychiatrists use the term paranoia to describe a disordered way of thinking or an anxious state that attains the level of a delusion. 

For example, a person who believes the FBI is tracking her every move through the fillings in her teeth is exhibiting paranoid behavior. On the other hand, a criminal who believes the FBI is listening in on his telephone calls is not likely paranoid, because it may well be true.

The key to true paranoia is that the person exhibits an unreasonable and/or exaggerated mistrust and suspicion of others. This suspicion is not based on fact and often grows into delusions. Thus, paranoia is a symptom that can be part of several syndromes, including delusional disorder, paranoid personality disorder, psychotic and mood disorders (including bipolar disorder and schizophrenia), as well as other conditions (such as brain toxicity that may be caused by drug or alcohol abuse, mineral poisoning, etc).

The community member who asked about paranoia may be experiencing these symptoms due to bipolar disorder, but they could be indicating another condition. It is important to discuss feelings of paranoia with one's psychiatrist and work toward methods to control them, as symptoms like these are certainly unpleasant and could be disruptive.

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 There are different types of threat or harm that you may feel paranoid about;  for example:

    * psychological or emotional harm – bullying, spreading rumours about you.

    * physical harm – trying to physically hurt or injure you, or even trying to kill you.

    * financial harm – stealing from you, damaging your property or tricking you into giving away your money.

You might feel threatened by one person, a group of people, an organisation, an event or an object.
 
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  Depending on what your paranoid thoughts are, they can bring up a wide range of emotions. 

You may feel:
 
    * anxious and stressed
    * scared/terrified
    * mistrustful of other people and organisations
    * victimised or persecuted
    * isolated
    * tired - from worrying all the time

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What are the different types of paranoia?

* Certain types of paranoid thought are believed to be common in the population and are closely related to anxiety. These thoughts can be distressing and leave you feeling under threat, but will not normally stop you from living your normal life.

* More severe paranoid thoughts are less common, but have a more significant impact on day-to-day life. They are likely to be very alarming, and leave you feeling terrified, isolated and exhausted.

* If you experience mild paranoia over a short time period, you will probably have some insight into your thoughts and realise that although they are worrying, your suspicions might be groundless or exaggerated. It can be difficult to share these thoughts with others, as you might worry that they will judge you.

* If your thoughts are more extreme, or have been present for a long time, it will feel that your fears are real. This can be very isolating, as other people are unlikely to share your views. Having to cope with your own feelings of alarm and not being believed can be very distressing.

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Paranoia and mental health problems:
 
As outlined in the previous sections, paranoid thoughts can be very  distressing, and can lead to problems such as anxiety and depression;  however, the measures that doctors use to diagnose mental health problems do not currently recognise paranoia as a diagnosis in its own right. More severe paranoid thoughts are likely to be seen as symptoms or indicators of some of the less common mental health diagnoses.

Paranoid schizophrenia

Paranoid schizophrenia is a particular type of schizophrenia that features extreme paranoid thoughts. If you experience paranoid schizophrenia, then you may also hear voices, which might confirm your paranoid feelings and cause you further distress by mocking or threatening you. You might also feel that you are an important or powerful person, such as a religious figure or royalty, which is why you are being persecuted.
Delusional or paranoid disorder

If you experience delusional disorder you are likely to develop one particular dominating, paranoid idea, of great complexity, that puts you in conflict with those around you. You are more likely to contact the police or a lawyer than a psychiatrist for help, as you will feel your persecution is real.

Paranoid personality disorder:

Paranoid personality disanorder is other diagnosis which is usually considered if your paranoid feelings have been around for some time, perhaps since adolescence. If you have received this diagnosis, you are likely to feel very suspicious and find it difficult to trust other people. You might feel that people are plotting against you, and will find it difficult to accept that these feelings might be exaggerated or unfounded.

Other diagnoses:

Other diagnoses that may include paranoid feelings are bipolar disorder, schizoaffective disorder, severe anxiety or depression, and postnatal psychosis.

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 Paranoid Personality Disorder
Paranoid personality disorder (PPD) is one of a group of conditions called "Cluster A" personality disorders which involve odd or eccentric ways of thinking.  People with PPD also suffer from paranoia, an unrelenting mistrust and suspicion of others, even when there is no reason to be suspicious.
This disorder usually begins by early adulthood and appears to be more common in men than in women.

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What Are the Symptoms of Paranoid Personality Disorder?

People with PPD are always on guard, believing that others are constantly trying to demean, harm, or threaten them. These generally unfounded beliefs, as well as their habits of blame and distrust, might interfere with their ability to form close relationships. People with this disorder:

    * Doubt the commitment, loyalty, or trustworthiness of others, believing others are using or deceiving them

    * Are reluctant to confide in others or reveal personal information due to a fear that the information will be used against them

    * Are unforgiving and hold grudges

    * Are hypersensitive and take criticism poorly

    * Read hidden meanings in the innocent remarks or casual looks of others

    * Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate

    * Have recurrent suspicions, without reason, that their spouses or lovers are being unfaithful

    * Are generally cold and distant in their relationships with others, and might become controlling and jealous

    * Cannot see their role in problems or conflicts and believe they are always right

    * Have difficulty relaxing

    * Are hostile, stubborn, and argumentative

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What Causes Paranoid Personality Disorder?

The exact cause of PPD is not known, but it likely involves a combination of biological and psychological factors. The fact that PPD is more common in people who have close relatives with schizophrenia suggests a genetic link between the two disorders. Early childhood experiences, including physical or emotional trauma, are also suspected to play a role in the development of PPD.
How Is Paranoid Personality Disorder Diagnosed?

If symptoms of PPD are present, the doctor will begin an evaluation by performing a complete medical and psychiatric history and, if indicated, a physical exam. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder.

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How Is Paranoid Personality Disorder Treated?

People with PPD often do not seek treatment on their own because they do not see themselves as having a problem. When treatment is sought, psychotherapy (a form of counseling) is the treatment of choice for PPD. Treatment likely will focus on increasing general coping skills, as well as on improving social interaction, communication, and self-esteem.

Because trust is an important factor of psychotherapy, treatment is challenging since people with PPD have such distrust of others. As a result, many people with PPD do not follow their treatment plan.

Medication generally is not a major focus of treatment for PPD. However, medications, such as anti-anxiety, antidepressant or anti-psychotic drugs, might be prescribed if the person's symptoms are extreme, or if he or she also suffers from an associated psychological problem, such as anxiety or depression.
What Complications Are Associated With Paranoid Personality Disorder?

The thinking and behaviors associated with PPD can interfere with a person's ability to maintain relationships, as well as their ability to function socially and in work situations. In many cases, people with PPD become involved in legal battles, suing people or companies they believe are "out to get them."
What Is the Outlook for People With Paranoid Personality Disorder?

The outlook for people with PPD varies. It is a chronic disorder, which means it tends to last throughout a person's life. Although some people can function fairly well with PPD and are able to marry and hold jobs, others are complete disabled by the disorder. Because people with PPD tend to resist treatment, the outcome often is poor.

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Can Paranoid Personality Disorder Be Prevented?

Although prevention of PDD might not be possible, treatment can sometimes allow a person who is prone to this condition to learn more productive ways of dealing with situations.

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