The defining feature of the paranoid subtype is the presence of auditory hallucinations or prominent delusional thoughts about persecution or conspiracy. However, people with this subtype may be more functional in their ability to work and engage in relationships than people with other subtypes of schizophrenia. The reasons are not entirely clear, but may partly reflect that people suffering from this subtype often do not exhibit symptoms until later in life and have achieved a higher level of functioning before the onset of their illness. People with the paranoid subtype may appear to lead fairly normal lives by successful management of their disorder.

People diagnosed with the paranoid subtype may not appear odd or unusual and may not readily discuss the symptoms of their illness. Typically, the hallucinations and delusions revolve around some characteristic theme, and this theme often remains fairly consistent over time. A person’s temperaments and general behaviors often are related to the content of the disturbance of thought. For example, people who believe that they are being persecuted unjustly may be easily angered and become hostile. Often, paranoid schizophrenics will come to the attention of mental health professionals only when there has been some major stress in their life that has caused an increase in their symptoms. At that point, sufferers may recognize the need for outside help or act in a fashion to bring attention to them.

Since there may be no observable features, the evaluation requires sufferers to be somewhat open to discussing their thoughts. If there is a significant degree of suspiciousness or paranoia present, people may be very reluctant to discuss these issues with a stranger.

There is a broad spectrum to the nature and severity of symptoms that may be present at any one time. When symptoms are in a phase of exacerbation or worsening, there may be some disorganization of the thought processes. At this time, people may have more trouble than usual remembering recent events, speaking coherently or generally behaving in an organized, rational manner. While these features are more characteristic of other subtypes, they can be present to differing degrees in people with the paranoid subtype, depending upon the current state of their illness. Supportive friends or family members often may be needed at such times to help the symptomatic person get professional help.

Common Symptoms of Paranoid Schizophrenia

  • a. Delusions of persecution, reference, exalted birth, special mission, bodily change, or jealousy;
  • b. Hallucinatory voices that threaten the patient or give commands, or auditory hallucinations without verbal form, such as whistling, humming, or laughing;
  • c. Hallucinations of smell or taste, or of sexual or other bodily sensations; visual hallucinations may occur but are rarely predominant.

How It’s Diagnosed

The general criteria for a diagnosis of schizophrenia must be satisfied for this subtype to be diagnosed. In addition, hallucinations and/or delusions must be prominent, and disturbances of emotion, volition and speech, and catatonic symptoms must be relatively inconspicuous. The hallucinations will usually be of the kind described in (b) and (c) above. Delusions can be of almost any kind of delusions of control, influence, or passivity, and persecutory beliefs of various kinds are the most characteristic. In terms of a differential diagnosis, epileptic and drug-induced psychoses typically need to be excluded. Persecutory delusions might be directly related to a person’s country of origin or their culture.