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Paranoid Schizophrenia: Symptoms, Causes, Treatment

Paranoid schizophrenia is one of the 5 main subtypes of schizophrenia characterized by an intense paranoia which is often accompanied by delusions and hallucinations. Most people with paranoid schizophrenia have auditory hallucinations (i.e. they hear voices) and may experience delusions that people are “plotting” against them. For example, someone with this illness may believe that their friends are conspiring to poison them. People with this disease may spend a lot of time trying to think of ways to protect themselves from other individuals who they believe are out to get them.

Of the 5 subtypes, paranoid schizophrenia is the most commonly diagnosed. In comparison to other subtypes, individuals with paranoid schizophrenia are most likely to experience positive symptoms rather than negative symptoms and cognitive symptoms. In other words, they are more likely to be plagued with hallucinations and delusions and have less difficulties with focus, concentration, thinking, and mood. With proper treatment and support, individuals with the paranoid subtype are able to lead productive, stable lives.

Paranoid Schizophrenia Symptoms

Before the paranoid subtype can be properly diagnosed, an individual needs to first meet general diagnostic criteria for schizophrenia. Once it is established that the person has schizophrenia, then a psychiatrist can evaluate the specific subtype. Below are a list of symptoms that apply specifically to people with the paranoid subtype.

  • Abnormal sleeping patterns: The person with paranoia may have difficulty sleeping if they are convinced that someone is out to get them. They may stay up all night and for long periods of time. The illness affects their entire sleep pattern to the point that their sleep cycle becomes totally unpredictable. Eating patterns may also be affected.
  • Aggression: The person may become very aggressive and defensive which is linked to anger and violence in some cases. They may be confrontational and the delusions that they experience may cause them to act out in an aggressive manner.
  • Anger: People with paranoid schizophrenia can get extremely angry and hostile towards others. They may start arguments and make false accusations as a result of the delusions that they experience. Although not everyone with this subtype of the illness may experience anger, many people get very angry and perhaps can even rage.
  • Anxiety: The person may experience intense levels of anxiety and fear accompanied by paranoia. This causes the person to become stressed out and if the anxiety gets out of control, it can actually make the symptoms worse by increasing paranoia.
  • Argumentative: The individual may get involved in many arguments with other people. They may falsely accuse others of plotting against them, spying on them, and/or trying to kill them. If the person is unable to calm down, the argument may escalate to an act of violence.
  • Auditory hallucinations: The person may hear voices in their head or other sounds that aren’t based in reality. Often times these voices will be unfriendly, say mean things to the person, and make the person feel threatened. It is one thing to hear voices in your head, it is another to hear voices that are mean and of a persecutory nature. The person may hear a single voice or multiple voices. The person may talk back to the voices and/or yell at them.
  • Condescending/Self-Importance: The person may think that they know things that other people don’t know and thus may assume that they are of high importance. This may result in the person speaking to others in a condescending tone.
  • Delusions: The person may hold false beliefs that have no basis in reality. Many times these beliefs contribute to increased paranoia. For example, the person may believe that their family has been plotting to poison them or that the government has tapped their phones and is listening to all of their conversations. This is one of the key symptoms that distinguishes paranoid schizophrenia from the other types. People think that other people are spying on them and monitoring their life.
    • Delusions of grandeur: These are specific types of delusions that make people think that they are famous, omnipotent, or that they have supernatural powers. A person may think that they are a spiritual figure (e.g. Jesus Christ) or that they are able to fly, predict the future, or communicate with gods.
  • Emotional distancing: The person may distance themselves emotionally from other people. For periods of time they may appear reserved and exhibit a general sense of aloofness.
  • Illicit drug usage: The person may resort to illicit drugs and alcohol to help cope with what they are experiencing. Drug abuse may contribute to the worsening of paranoid symptoms, delusions, and hallucinations. There is a clear link between illicit drug usage and schizophrenia.
  • Mood swings: It is less common for individuals with paranoid-type schizophrenia to experience major mood swings. They are usually stuck in a state of paranoia when the illness is not under control or being properly treated. However, in some cases you may notice that they experience unfavorable mood swings.
  • Paranoia: This is the distinct symptom that distinguishes this type of schizophrenia from the others. Paranoia is characterized by anxiety/fear to the point that the person thinks irrationally and experiences delusions. This intense fear is often accompanied by persecutory beliefs that people are plotting against the person or that “everyone is out to get them.” This is differentiated from phobias because in phobias, there is no person to blame. In paranoia, someone always gets blamed for the feelings.
  • Social withdrawal: This is a symptom in all types of schizophrenia, but in this case, the withdrawal has to do with the fact that the person is hearing voices and thinks that other people cannot be trusted. The positive symptoms may cause the person to become reclusive.
  • Suicidal thoughts/attempts: People with paranoid schizophrenia may attempt suicide as a result of the voices that they hear and the delusions that they experience. In some cases the person with this subtype may say that they want to die or kill themselves. If these feelings are not addressed the person may actually make a suicide attempt.
  • Violence: In some cases the person with this disease will resort to violence as a result of the intense paranoia and delusions. If a person believes that someone else is trying to harm them, poison them, or spy on their life, they may think of violence as a means of self-defense. The person may become very aggressive and lash out if they think that they are in danger. Certain individuals with this illness have a history of getting into fights.

Paranoid Schizophrenia Causes

Researchers are unsure as to what causes schizophrenia, let alone any of the subtypes. There are hypotheses as to what could cause the person to experience delusions and hallucinations – most of them linked to dysfunctional dopamine activity in the brain.

  • Dopamine hypothesis: It is thought that excess dopamine receptor activity may be a contributing factor to hallucinations, delusions, and paranoia. Dysfunction in the dopamine system is likely what leads to an individual experiencing the paranoid subtype.

Paranoid Schizophrenia Treatment

This illness requires constant treatment with antipsychotic medications in order for them to lead a normal life. As was already mentioned, most people with this illness do not experience major cognitive deficits and negative symptoms. This means that as long as most of the positive symptoms are successfully treated, they can function pretty well in society.

  1. Atypical antipsychotics: These medications work by blocking dopamine receptors from being flooded with high amounts of dopamine. “Atypical” antipsychotics are a newer class of medications that are supposed to have fewer side effects than older “typical” antipsychotics. However, there isn’t really much evidence supporting the claim of fewer side effects.
  2. Electroconvulsive Therapy (ECT): In some cases if the patient doesn’t respond well to medication, electroconvulsive therapy may be utilized to help reduce symptoms. This involves a series of shocks to the brain which induces a “controlled seizure.” It is thought that this helps reset brain activity and neurotransmitter functioning in the brain.
  3. Hospitalization: The individual with paranoid schizophrenia may need to be hospitalized for a period of time in order to come to terms and overcome symptoms. This may require medical supervision as well as a long-lasting injection of medication. The patient is usually released once the paranoid symptoms are under control.
  4. Natural treatments: There are some natural remedies for schizophrenia that people may want to pursue. Many natural options can be used along with an antipsychotic for an additional benefit and reduction of symptoms.
  5. Psychotherapy: The individual may need to see a psychotherapist to help get a grasp on coping with their symptoms. There are many good psychologists and licensed professionals that know about symptoms and that will implement the best types of therapies for dealing with this illness. Consistent psychotherapy can help improve the person’s ability to cope with their illness and function in society.
  6. Typical antipsychotics: This is the older class of antipsychotics that is associated with significantly more side effects. If a person doesn’t respond well to treatment with the “atypical” class, an older typical antipsychotic may be prescribed to help manage symptoms.
  7. Vocational skills training: This helps teach people with paranoid schizophrenia to learn a craft so that they can contribute to society. This training is ideal for people that need to build skills to help them with an occupation. Going through this training increases chances of landing a stable job so that the individual with paranoid schizophrenia can support themselves.

Note: It should be noted that many people with paranoid schizophrenia have difficulties staying on their medication to treat symptoms. This is because medications come with an array of unwanted side effects including weight gain, high blood pressure, high cholesterol, and increase risk of diabetes. They also increase risk of motor problems, which may lead to neuroleptic malignant syndrome and/or tardive dyskinesia. It is important to work with a doctor to find the best medication to suit your individual physiology.

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{ 18 comments… add one }
  • Pedro December 4, 2015, 8:34 pm

    Hi! I’ve been diagnosed with this disease 7 years ago. With medication I was able to reduce hallucinations, but they didn’t disappeared completly. I learned from myself how to deal with it, but I didn’t learn yet how to deal with some hallucinations that make me feel frightened. Can you give me some praticle advice on how to overcome this? Thank you.

  • Teresa December 29, 2015, 11:23 pm

    I have schizophrenia my doctor didn’t narrow it down to a subtype but I’ve felt everything this article talks about. Ended up in jail for one day because of an episode where I believed to be Native American. I’m not. I became aggressive. I also thought I was the daughter of a make-believe master. And that I owned Jupiter and that soon we were going to go live there and that I would rule it. There isn’t enough space for me to tell you all the bizarre things I believed. I take my meds and I never want to be in the state I’ve been in. I want to be well and live a normal life.

  • Kimberly brooks January 15, 2016, 5:30 pm

    Hi, I think my mom has Paranoid Schizophrenia. She experiences most of the symptoms on the list, however she doesn’t want to admit it because she thinks it’s normal. Is there anyway I can help? I really don’t want her admitted into a Mental Hospital, but she needs to get well and to be able to live her life normally.

    • Oliver July 9, 2016, 5:57 am

      I took a sleeping injection from doctor to get well. It all started with exam stress. Two sleepless nights. Paranoia. I believed I got job in Google. And Google search engine is trying to communicate with me. I am special agent for my country. I want to live that life once more. It was a good feeling.

  • Brooke March 10, 2016, 6:41 am

    Hi there. I am a 20 year old female who lives with a man with this disease. At first things were fine, but now he has stopped taking his meds, he is argumentative all the time and he keeps smoking pot and drinking beer. I’m starting to worry as it’s my best friends dad but everyone thinks it’s normal. Please can someone help me!?

  • jessica L April 29, 2016, 1:36 am

    The guy who I’ve been seeing for several months now is experiencing everything mentioned on this list and is now taking it out on me. Thinking myself and his friends are plotting against him, he believes that and I quote “creatures” are living behind his teeth and that someone/people are coming to get him.

    I’ve asked him repeatedly to go seek help but he won’t because he thinks the doctors will conspire against him to. I have no idea what to do. Please if anyone can help or give some advice that would be great. Thanks.

    • Samantha May 6, 2016, 5:23 pm

      Me too Jessica. I have been married to my husband for over a year and mostly all the things on the list he does and I am in the exact same situation as you.

  • Meghan May 11, 2016, 12:27 am

    I’ve been diagnosed with residual schizophrenia. Because I am so ashamed and afraid to tell my psychiatrist about my other symptoms I haven’t been properly diagnosed. I believe someone opened my third eye, put roots on me, and that people are out to get me. Every person I come into contact with is using telekinesis to communicate their thoughts and feelings, including sexual sensations without touching. I need help but I don’t know how to get it.

    • Rose June 20, 2016, 6:42 am

      Hi, I hope that you get the help that you need. I am not a professional, but I just wanted to tell you that. Try prayer, and watch the movie “War Room.” Is it about prayer. Not mental illness, but the point of the movie is that prayer can be used for any difficulty in life. It is not a fix, but it might at least help. Hang in there.

  • Andy June 9, 2016, 8:53 am

    Hi, I’m 19 and I experience the voices not 24/7 but it is nearly everyday. I try to acknowledge when it happens because I’m kinda used to it. If I’m really stressed out my mind races and I begin to hear them like crazy. But on a ‘normal’ day, it’s just causing paranoia. For example, when I leave the house (which is maybe 3 times a week, briefly) I get extremely anxious and my neck is stiff.

    Sometimes twitches at the thought of someone staring at me. But I know these ‘thoughts’ aren’t mine because I don’t intentionally think them, it’s the voices ‘protecting’ me, as if they knew danger is around every corner. I contemplate suicide nearly everyday, going outside is a nightmare to me.

    The twitching is what really haunts me, can’t even make eye contact half the time either. I don’t talk to anyone unless I have to. I have a girlfriend, and mother I talk to but that’s it. Can anyone help me. I feel hopeless.

    • Rose June 20, 2016, 6:41 am

      Hi, I hope that you get the help that you need. Please do not feel hopeless. I wish that there was something I could do for you, but I am not a professional. I just wanted you to know that I hope you are ok. (((Hugs))) Stay strong, and try prayer. There is a movie called “War Room” – you might want to watch it.

      • Mandi July 22, 2016, 5:54 pm

        Andy, Watching a movie isn’t going to help. Seek medical help. I won’t lie to you and say it’s easy, but if you want to get better it is what you need to do.

  • Layla July 13, 2016, 4:56 pm

    I fully believe that my “mother” has this. I say “mother” because… well… she’s not my mom anymore. She refuses any sort of help… she chose her illness over others. She’s become very cruel, she disowned my sister, treats me like a packmule and uses my grandmother as a bank. Then turns around and acts as if she’s done no wrong. Well she’s digging her own grave at this point. We’ve tried helping her but all she does is turn on us. Can’t wait til I leave and cut her off completely.

    • OMG September 4, 2016, 2:10 pm

      That’s about as cold a comment I’ve ever heard. If you believe your mother has this illness and you still feel this way, there may be no hope for you but may be some help for her.

  • Marie August 25, 2016, 2:49 pm

    I have an extreme case. My son suffers from paranoid schizophrenia. He is the most difficult person to treat. He refuses help! It’s been 10 long years battling this. He doesn’t believe he is ill he thinks everybody else is! He is angry and sometimes in a rage. He is an intelligent, talented person with musical abilities.

    He smokes pot, cig & drinks booze frequently to deal with his anger. He’s been in & out of hospital against his will. However treatment was forced upon him. Which is helping a lot but not fully. The thing is treatment is a court order and it is only temporary. Duration 6 months. Court orders are the hardest to acquire.

    We appealed and got another 6 months, but what do we suppose to do with him after this? Our lives is a living hell. We have tried everything, rehab, counseling. I feel I’m losing him.

  • C.C September 5, 2016, 2:22 am

    I been married to my husband about a year and all the symptoms on this particular subject he has them, I’m scared that he’s in denial. He thinks that myself and other people are out to hurt him. He sleeps with his keys, phone, and writes notes and accusing me of trying to poison him. I need help.

  • Karen November 12, 2016, 2:11 pm

    Thank you for this post.

  • Wayne November 23, 2016, 5:01 am

    I have been hallucinating for awhile now, but has become unbearable just recently. I stay in the apartment for days at a time, I never talk to anybody for any reason and a voice I use to hear whispering needs me to keep drawing him because he wants to be seen. He calls me his builder because he needs things and then I believe the shadows planned my isolation so they can torture and eventually get me.

    I feel a compulsive urge that my job is to write what they want to say because they can’t and they put their words into my head. I called to make an appointment as it’s taking over my life but they can’t get me in for 30 days. It’s going to be a long month for me.

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