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Paranoid schizophrenia was once one of five subtypes of schizophrenia that was previously used to diagnose the condition. In 2013, these subtypes were removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). People previously diagnosed with paranoid schizophrenia often had delusions (false beliefs), hallucinations (false perceptions), and paranoia (intense fear or mistrust).
These symptoms are still part of schizophrenia. However, healthcare providers no longer use the term “paranoid schizophrenia” as an official diagnosis. Instead, they look at a person’s specific symptoms and their severity when making a diagnosis.
Even so, learning about the history of paranoid schizophrenia may help you better understand how schizophrenia is diagnosed today. Here’s what to know about paranoid schizophrenia, including its symptoms, possible causes, and treatment.
“Paranoid schizophrenia” is an outdated term that was used prior to 2013 for a subtype of schizophrenia. It mainly referred to schizophrenia with positive symptoms — symptoms that are added, such as delusions, hallucinations, and paranoia.
At the time, some doctors considered paranoid schizophrenia more responsive to treatment than some other former subtypes because positive symptoms often improved with antipsychotic medications. First-generation antipsychotics helped reduce positive symptoms, but they were generally less helpful for negative symptoms — symptoms that involve a decrease or loss of usual functioning, such as reduced motivation or emotional expression. Because paranoid schizophrenia was defined mainly by positive symptoms, this may help explain why it was sometimes viewed as more treatable.
Positive symptoms include delusions and hallucinations. For paranoid schizophrenia, people often presented with delusions and auditory hallucinations (hearing sounds that aren’t there). They also may have had paranoia or intense suspiciousness, such as believing someone was trying to harm them.
It was once thought that people with paranoid schizophrenia were less likely to have negative symptoms, such as flat affect (showing very little facial expression or emotional response). They were also thought to be less likely to have disorganized speech (speech that is jumbled, hard to follow, or does not clearly connect from one idea to the next).
While the term “paranoid schizophrenia” is not part of the DSM-5-TR (the most current version of the manual), the symptoms of this former subtype are still part of a schizophrenia diagnosis. They can occur in varying degrees in each person or along the schizophrenia spectrum. Here is a closer look at the primary symptoms once associated with paranoid schizophrenia.
When someone experiences delusions, they experience false beliefs that aren’t easily changed, even when they’re provided proof that what they’re thinking or believing is inaccurate. Many times, delusions involve paranoia that occurs before the delusion.
One specific type of delusion people with paranoid schizophrenia may have experienced is delusions of grandeur, or the belief that you have superior qualities. Someone who has this symptom may believe they’re a genius or a famous person.
Here are some other common types of delusions:
Auditory hallucinations are often described as hearing voices or other sounds that aren’t really there. It was a common symptom of paranoid schizophrenia and is still a recognized symptom of schizophrenia.
When someone has a hallucination, they may not realize that what they are experiencing is not real. Hallucinations can also seem to confirm delusions, so these symptoms may reinforce each other and interfere with daily life. Hallucinations may involve hearing, seeing, smelling, feeling, or tasting things that are not there.
People with schizophrenia and people without schizophrenia can both feel suspicious of other people or situations. Sometimes suspicion is understandable, such as if there have been several recent assaults in the area.
Paranoia goes beyond ordinary suspicion. It involves ongoing fear or mistrust that other people want to harm you, even when there is little or no evidence. Examples of paranoid or suspicious beliefs may include:
Because paranoid schizophrenia was once considered a subtype of schizophrenia, it was thought to share the same underlying causes and risk factors as schizophrenia overall. Researchers do not know the exact cause of schizophrenia. Most health experts believe it develops from a combination of genetic, brain-related, and environmental factors. Substance use may also raise the risk for psychosis and schizophrenia in some people.
A person might be considered genetically predisposed to this mental health condition if they have close family members (parents or siblings) with schizophrenia. In fact, they’re six times more likely to develop this condition. Likewise, environmental factors can also activate the genes associated with schizophrenia, such as being malnourished as a baby or being exposed to certain viruses or illnesses. There is even some evidence that autoimmune disorders may cause psychosis.
Other possible causes include issues with brain chemicals like dopamine and glutamate. Additionally, substance use, particularly using recreational drugs in the teen years, can lead to psychosis, which is common in schizophrenia.
Early on, people with paranoid schizophrenia were often hospitalized. The goal of hospitalization was to keep people with paranoid schizophrenia safe and distracted. They were often treated with a wide variety of relaxation methods, medications, and other interventions, like gardening, music, dance, work therapy, and art therapies. It was thought that these activities would promote socialization and help keep people with schizophrenia from becoming preoccupied with their delusions.
Electroconvulsive therapy (ECT), which involves using electric currents under general anesthesia to cause a brief seizure, was also used as a treatment. Hot and cold showers were also encouraged to reduce stress.
Today, the treatment options for schizophrenia — including those who experience paranoia, delusions, and hallucinations — look much different. Often a treatment plan will include:
A person with schizophrenia will also have a team of healthcare professionals, including a mental health professional and a primary care provider, involved in their regular care.
The schizophrenia subtypes were removed from the DSM-5 in 2013 because they didn’t help psychiatrists adequately identify schizophrenia. Not only was there little consistency in how the guidelines were used, but clinicians also discovered they weren’t helpful in predicting how schizophrenia might change over time or which treatment plan might work best.
Now, psychiatrists consider a person’s symptom patterns and the severity of those symptoms when making a diagnosis instead of trying to determine the subtype. To do this, they use a scale known as the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS). The CRDPSS makes it easier to identify symptoms, offer a diagnosis, and determine which treatment options could be beneficial.
On MyDepressionTeam, people share their experiences with depression and related conditions, get advice, and find support from others who understand.
If you have a loved one or family member with schizophrenia, has a psychiatrist used the term “paranoid schizophrenia” or mentioned paranoia? If so, how did they explain it? Let others know in the comments below.
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