The Clinical Features of Paranoia in the 20th Century and Their Representation in Diagnostic Criteria From DSM-III Through DSM-5

This review traces, through psychiatric textbooks, the history of the Kraepelinian concept of paranoia in the 20th century and then relates the common reported symptoms and signs to the diagnostic criteria for paranoia/delusional disorder in DSM-III through DSM-5. Clinical descriptions of paranoia appearing in 10 textbooks, published 1899 to 1970, revealed 11 prominent symptoms and signs reported by 5 or more authors. Three symptoms (systematized delusions, minimal hallucinations, and prominent ideas of reference) and 2 signs (chronic course and minimal affective deterioration) were reported by 8 or 9 of the authors. Four textbook authors rejected the Kraepelinian concept of paranoia. A weak relationship was seen between the frequency with which the clinical features were reported and the likelihood of their inclusion in modern DSM manuals. Indeed, the diagnostic criteria for paranoia/delusional disorder shifted substantially from DSM-III to DSM-5. The modern operationalized criteria for paranoia/delusional disorder do not well reflect the symptoms and signs frequently reported by historical experts. In contrast to results of similar reviews for depression, schizophrenia and mania, the clinical construct of paranoia/delusional disorder has been somewhat unstable in Western Psychiatry since the turn of the 20th century as reflected in both textbooks and the DSM editions

Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis

Background: Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between ‘poor me’ and ‘bad me’ paranoia, we aimed to test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness). Method: We used data from 117 participants from the Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2) trial of cognitive–behaviour therapy, comparing them with samples of psychiatric in-patients and healthy students from a previous study. Multi-level modelling was utilized to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness. Results: Our sample of at-risk mental state participants was not as paranoid, but reported higher levels of ‘bad-me’ deservedness, compared with psychiatric in-patients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness. Conclusions: This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis

Strategic cognition in paranoia: the use of thought control strategies in a non-clinical population

Background: Recent work in the area of cognition and emotion has focused on the process as well as the content of thought. Metacognitive approaches have included studies of people's relationship with internal experience (cf. Teasdale and Barnard, 1993), and the overarching beliefs that guide allocation of internal resources to manage distress (cf. Wells, 2000). At the same time, cognitive models of psychosis have emphasized the clinical value of a multidimensional understanding of paranoia (Chadwick, 2006; Freeman and Garety, 2004b). Method: This study examined paranoia in a non-clinical group, specifically (i) the relationship between a single measure of trait paranoia and dimensions of paranoid thought frequency, belief conviction and distress, and (ii) the metacognitive strategies that people use. It was predicted that trait paranoia would be associated with (i) dimensions of thought frequency, belief conviction and distress, and (ii) the internal strategies of “punishment” and “worry.” Results: Regression analyses showed that trait paranoia uniquely predicted frequency, conviction and distress associated with paranoid thoughts. Trait paranoia accounted for the use of “reappraisal”, whereas “punishment” and “worry” were accounted for by anxiety. Conclusions: The implications for clinical work and further research are discussed

Eudaimonic Pathways of Activating Compassion Reduce Vulnerabilities to Paranoia

This study aimed to identify if compassion benefits paranoia and, if so what type of compassion. Following a series of different compassionate exercises in 104 participants it was found that mindfulness approaches were the most significant in reducing paranoia suggesting a new approach for psychological problems characterised by paranoia

A normal paranoia? The emergence of distrust between parents of autistic children and public officials

This paper explores the development of distrust and paranoia among parents and carers of autistic children in their interactions with public officials charged with such children’s diagnosis, education and care. The suspicion and distrust framework of Fein and Hilton (1994), and Kramer’s typology of organisational paranoia (1998, 2001) are used to show how distrust impacts on client experiences. Antecedents of distrust are identified, and the ‘normalcy’ of paranoia in this context is demonstrated. These findings should permit public sector staff dealing with parents and carers of autistic children to address such perceptions and build trust where little seems to exist

Suspicious minds : the dramatisation of paranoia in Victorian poetry : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in English at Massey University

This thesis contains readings of a number of Victorian poems by Alfred Tennyson, Robert Browning and Dante Gabriel Rossetti which dramatise paranoia and jealousy. A range of twentieth-century theories of paranoia (including clinical, Freudian and Lacanian) have been used as explanatory tools for interpreting the representations of paranoia in the poems. The reading of Tennyson's Maud is based on Freud's theory of homoerotic motives. The reading of Browning's "'Childe Roland to the Dark Tower Came'" is based on the Lacanian concepts of foreclosure and the Name-of-the-Father. The readings of the jealousy poems are based on both theories, and this section includes a discussion of the limitations of the theories as explanatory tools. The general approach has been to apply clinical and psychoanalytical constructs and explanations to each poem separately, although there is some discussion involving the comparison of paranoid behaviours and motives across all the poems. Areas for further research are suggested in the concluding chapter

Sleep quality and paranoia: the role of alexithymia, negative emotions and perceptual anomalies

Recent evidence suggests that sleep problems are associated with psychotic like experiences including paranoia. However, the mechanisms underpinning this association are not well understood and thus studies modelling hypothesised mediating factors are required. Alexithymia, the inability to recognise and describe emotions within the self may be an important candidate. In two separate studies we sought to investigate factors mediating the relationship between sleep quality and paranoia using a cross-sectional design. Healthy volunteers without a mental health diagnosis were recruited (study 1, N= 401, study 2, N= 402). Participants completed a series of measures assessing paranoia, negative emotions, alexithymia and perceptual anomalies in an online survey. In study 1, regression and mediation analyses showed that the relationship between sleep quality and paranoia was partially mediated by alexithymia, perceptual anomalies and negative affect. In contrast, study 2 found that the relationship between sleep quality and paranoia was fully mediated by negative affect, alexithymia and perceptual anomalies. The link between sleep quality and paranoia is unclear and reasons for discrepant results are discussed. Novel findings in this study include the link between alexithymia and paranoia

Self-affirmation and nonclinical paranoia

Background and ObjectivesThis experiment examined whether reflecting on a core value—value-affirmation—was effective in attenuating state paranoia in students.MethodsUniversity students (N = 55) were randomised to either a value-affirmation or non-affirmation control condition before exposure to a paranoia-induction manipulation (high self-awareness plus failure feedback). Paranoid cognitions were measured before (T1) and after (T2) the value-affirmation task and after the paranoia-induction task (T3). Depressive cognitions were also measured at T3.ResultsAffirming a valued domain had a direct and significant effect on reducing state paranoia prior to the paranoia-induction task (T2), such that the overall impact of the paranoia-induction on state paranoia was not significantly different from baseline. This effect was not attributable to differential changes in depression across groups.LimitationsUse of a nonclinical sample limits generalisation to clinical groups. Repeat testing of key variables is a limitation, although this was necessary to assess change over time, and use of randomisation increased the internal validity of the study.ConclusionsThese findings suggest that self-affirmation is effective in reducing state paranoia in a nonclinical sample

A randomised controlled trial of a brief online mindfulness-based intervention on paranoia in a non-clinical sample

Paranoia is common and distressing in the general population and can impact on health, emotional well-being and social functioning, such that effective interventions are needed. Brief online mindfulness-based interventions (MBIs) have been shown to reduce symptoms of anxiety and depression in non-clinical samples, however at present there is no research investigating whether they can reduce paranoia. The current study explored whether a brief online MBI increased levels of mindfulness and reduced levels of paranoia in a non-clinical population. The mediating effect of mindfulness on any changes in paranoia was also investigated. One hundred and ten participants were randomly allocated to either a two week online MBI including 10 minutes of daily guided mindfulness practice or to a waitlist control condition. Measures of mindfulness and paranoia were administered at baseline, post-intervention and one-week follow-up. Participants in the MBI group displayed significantly greater reductions in paranoia compared to the waitlist control group. Mediation analysis demonstrated that change in mindfulness skills (specifically the observe, describe and nonreact facets of the FFMQ) mediated the relationship between intervention type and change in levels of paranoia. This study provides evidence that a brief online MBI can significantly reduce levels of paranoia in a non-clinical population. Furthermore, increases in mindfulness skills from this brief online MBI can mediate reductions in non-clinical paranoia. The limitations of the study are discussed

Do paranoid delusions exist on a continuum with subclinical paranoia? A multi-method taxometric study

Background There is widespread interest in whether psychosis exists on a continuum with healthy functioning. Previous research has implied that paranoia, a common symptom of psychosis, exists on a continuum but this has not been investigated using samples including both patients and non-patients and up-to-date taxometric methods. Aim To assess the latent structure of paranoia in a diverse sample using taxometric methods. Method We obtained data from 2836 participants, including the general population as well as at-risk mental state and psychotic patients using the P-scale of the Paranoia and Deservedness Scale. Data were analysed using three taxometric procedures, MAMBAC, MAXEIG and L-MODE (Ruscio, 2016), and two sets of paranoia indicators (subscales and selected items from the P scale), including and excluding the patient groups. Results Eleven of the twelve analyses supported a dimensional model. Using the full sample and subscales as indicators, the MAMBAC analysis was ambiguous. Overall, the findings converged on a dimensional latent structure. Conclusions A dimensional latent structure of paranoia implies that the processes involved in sub-clinical paranoia may be similar to those in clinical paranoia