What Is Paranoid Schizophrenia?

Medically Reviewed by Zilpah Sheikh, MD on July 24, 2024
Written by Terri D'Arrigo, Frances Gatta
8 min read

Paranoid schizophrenia is a term that was used to mean a type of psychosis, which means your mind doesn't agree with reality. But the American Psychiatric Association declared it outdated in 2013, and experts no longer use the term; instead, they describe it as schizophrenia. 

Paranoid schizophrenia involves: 

  • Paranoia, which means you feel distrust, suspicious, and fearful of someone without any good reason, 
  • Delusions, which means you believe something that people without the condition know is unreal as real. 

These symptoms can affect how you think and behave and can show up in different ways and at different times, even in the same person. Having paranoid schizophrenia can also make it hard for them to hold a job, run errands, have friendships, and even go to the doctor.

The illness usually starts in late adolescence or young adulthood. Although it's lifelong, medicines and therapy can help you manage your symptoms and make them easier to live with.

Delusions are fixed beliefs that seem real to you, even when there's strong evidence they aren't. Paranoid delusions, also called delusions of persecution, reflect profound fear and anxiety along with the loss of the ability to tell what's real and what's not real. They might make you feel like:

  • A co-worker is trying to hurt you, like poisoning your food.
  • Your spouse or partner is cheating on you.
  • The government is spying on you.
  • People in your neighborhood are plotting to harass you.

These beliefs can cause trouble in your relationships. And if you think that strangers are going to hurt you, you may feel like staying inside or being alone.

People with schizophrenia aren't usually violent. But sometimes, paranoid delusions can make them feel threatened and angry. If someone is pushed over the edge, their actions usually focus on family members, not the public, and it happens at home.

You could also have related hallucinations, in which your senses aren’t working right. For example, you may hear voices that make fun of you or insult you. They might also tell you to do harmful things. Or you might see things that aren’t really there. Learn more about the symptoms of paranoia.

Schizophrenia is, basically, a biological problem that has to do with changes in your brain.

It could happen when: 

  • You have imbalances in chemicals that brain cells use to communicate within your brain.
  • You have brain problems that started before you were born.
  • Your brain has trouble communicating in different areas. 

But no one knows exactly what causes schizophrenia. 

How common is it?

Schizophrenia isn’t as common as many other mental health problems, but many people know of it. About 24 million, or one in 300, people worldwide have it. 

Who gets it?

A person’s genes can explain about 80% of the risk for schizophrenia. Environmental factors also play a role in who gets this condition. You’re more likely to have schizophrenia if:

  • It runs in your family.
  • You use recreational drugs like cannabis.
  • You’ve been exposed to harmful substances in the environment.
  • You’ve had a brain infection.
  • Your parent had birth-related problems before, during, or after your birth, like not having had enough oxygen during delivery, having an emergency cesarean section, and bleeding during pregnancy.
  • You're lonely or isolated.
  • You belong to a lower socioeconomic class. Maybe you’re unemployed, live in a stressful environment, and have a low income.

Also, people assigned male at birth are diagnosed with this condition almost twice more often than people assigned female at birth.

Paranoid schizophrenia triggers

Experts are unsure about what could particularly trigger schizophrenia. But it could potentially happen with:

  • A stressful life event
  • A brain infection
  • Taking recreational drugs, particularly cannabis

A doctor, likely a psychiatrist, will diagnose schizophrenia by:

  • Asking about your symptoms, medical history, and personal and family history
  • Doing a physical exam, checking your general appearance and vital signs like blood pressure and heart rate
  • Doing lab and imaging tests to check if your symptoms are due to other conditions

They might diagnose you with schizophrenia, following the Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR), if:

  • You’ve had delusions, hallucinations, or speech problems, and one other schizophrenia symptom, like disorganized behavior. 
  • These symptoms seriously affect your work, social life, school, and relationships.

Your doctor will create a treatment plan that includes medicines, therapy, and lifestyle changes to help you manage your symptoms and function in everyday life. 

Paranoid schizophrenia medication

Your doctor may prescribe an antipsychotic drug to prevent or stop symptoms like delusions. It could be pills, a liquid, or shots. It can take a few weeks for these drugs to work fully, but you could start to feel a little calmer quickly. You might need to try more than one to find a medication or combination that's right for you.

Even when you feel better, keep taking your medicine. If you stop, your delusions will probably come back.

Avoid using marijuana, alcohol, nicotine, cocaine or other stimulants, and street drugs. They can keep antipsychotic medicines from working well. They can also cause paranoia or make it worse.

You might have to take different kinds of drugs for other symptoms, too. Get more information about medications used to treat schizophrenia.

Therapy

Once your symptoms are under control, therapy can help you get along with others, hold a job, go to school, take care of yourself, and have friends.

People with schizophrenia who get counseling are also more likely to stick with their medications.

A kind of therapy called cognitive behavioral therapy can teach you how to manage symptoms that don't go away, even when you take your medicine. You'll learn to identify whether you're having delusions and how to manage them.

Positive, encouraging support from family and friends helps, too.

Because some antipsychotic drugs can make you gain weight, you might also want to get help with diet and exercise. Read more on the different types of therapy for schizophrenia.

​​Hospitalization

There might be times when your symptoms are so severe that you have to go to the hospital. You can be admitted voluntarily if you recognize that you're having trouble. But if you think you don't need help when you do, the law may allow a doctor or other mental health professional to admit you involuntarily if you are unable to care for yourself or may potentially cause harm to yourself or someone else. Call the doctor or 911 for severe psychosis symptoms with schizophrenia.

Schizophrenia can affect your physical, emotional, mental, and social health, all of which make living with it a challenge. 

You might have thinking problems that affect how you can do daily activities. You might withdraw from interacting with people, which could cause you to become lonely. Keeping your personal hygiene, job, and home can also be a struggle with symptoms of schizophrenia. It’s also likely that you might have other health problems, like heart disease. 

With the right support system, which includes having a solid relationship with your doctor, loved ones, and support groups, you can learn to live actively and intentionally with schizophrenia. 

  • Follow your treatment plan as prescribed, take your medicine as often as possible, and meet your doctor and therapy appointments.
  • Talk to your doctor about any new or distressing symptoms you have.
  • Your doctor will likely put you on a program to treat any substance use disorder. Try not to take any recreational substances or alcohol. They can make your symptoms worse. 
  • Join support groups to meet people you can relate to and learn from. Support groups can help ease the loneliness common with schizophrenia, too. You can find support groups near you at the National Alliance on Mental Illness and Schizophrenia & Psychosis Support. 
  • Create a strong support system that includes your loved ones and doctor, and talk to them as often as you need when facing any distress. 

Schizophrenia stigma

Many people tend to link schizophrenia with violence, aggression, and strange behavior, especially due to how the media depicts it. This misconception only adds to the difficulties of living with schizophrenia, causing people with the condition to struggle with having meaningful social interactions and relationships. In reality, people with schizophrenia are less likely to be violent, compared to those without the condition, and are more likely to be harmed by others. 

The only times a person with schizophrenia can be violent is when they don’t get any treatment for their condition or have an untreated substance use disorder. 

People with schizophrenia are often discriminated against and have their rights violated. This unfair treatment makes it harder for them to have things that support a decent and comfortable life, like health care, a home, and employment.

You might still feel disconnected from a loved one with schizophrenia even when you try to unlearn any negative beliefs about schizophrenia and better understand their condition and relate to them. Even so, you can still build a trusting relationship with them and help them as best as you can by:

  • Following them to their appointments whenever they need you to, and encouraging them to keep up with their treatment plans
  • Not dismissing their symptoms. Talk with them about them, no matter how strange their behavior might seem to you.
  • Being respectful and kind to them, without accepting any inappropriate behavior from them
  • Learning more about their condition through family education programs and support groups. You can find these resources at the National Alliance on Mental Illness.
  • Getting medical help right away if they show symptoms of serious paranoia or agitation, act violently, or talk about harming themselves or someone else

Get emergency help right away if you’re thinking of harming yourself or others.

  • Call or text the Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org.
  • Call 911 or your local emergency services number.
  • Call the National Suicide Prevention Lifeline by dialing 800-273-TALK (800-273-8255).

Schizophrenia is a serious mental health problem that can seriously interfere with your relationship with yourself, the people around you, and your environment. If you think you have schizophrenia symptoms or worry about your mental health, talk to your doctor. They might refer you to a mental health professional like a psychiatrist for diagnosis and treatment. Also, try to maintain a close relationship with your family, friends, and doctors, and consider joining support groups, too. Get medical help right away if you have any thoughts of harming yourself or others. 

What is the behavior of someone with paranoid schizophrenia?

People with paranoid schizophrenia may have hallucinations, delusions, and unusual ways of thinking and expressing themselves. They might lose interest in activities that might seem enjoyable to others, be isolated from people, and find it difficult to understand and use information.

Can a person with paranoid schizophrenia live a normal life?

A person with paranoid schizophrenia can create a life that is normal and functional for them, and they can live well when they get treatment and have a strong support system. 

Is paranoid schizophrenia lifelong?

Yes, schizophrenia is lifelong, but treatment can help manage symptoms and improve daily functioning. 

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