The major symptoms of this reaction type are poorly organized, internally illogical, changeable delusions, often accompanied by vivid hallucinations.Delusions of persecution are the most common type. The patient may insist that his relatives or associates are talking about him, watching him, or conspiring against him, or he may complain that he is being followed, poisoned, or subjected to lethal rays by unknown enemies. He may conclude that since he is the center of so much attention, he must be an extremely important person. As a consequence, he may develop delusions of grandeur such as the belief that he is a saint, the president, Caesar, or Napoleon. These delusions are frequently reinforced with auditory, visual, or tactile hallucinations. The patient may hear a heavenly choir sing his praises or a tribunal denouncing him for overthrowing the government; he may watch his enemies slowly close in on him, or feel “molecular missiles” penetrating his brain.Paranoid reactions are the most common form of schizophrenia, comprising over half of all cases admitted to mental hospitals. The disorder develops later than the other types, most commonly between the ages of twenty-five and forty, and is usually preceded by a long history of poor relationships with other people. During the prepsychotic period the paranoid patient has generally been cold, mistrustful, and suspicious; and in many cases he has been argumentative, bitterly aloof, or hostile toward practically everyone.The first clear sign of psychosis usually consists of ideas of reference— that is, the patient feels that other people are whispering or talking about him. As his grasp on reality loosens still further, limited delusions begin to appear. The onset can frequently be traced to some precipitating stress, and in the early stages it is often possible to relate the character and content of the delusions to gnawing anxieties and disturbing experiences.As the psychosis develops, the patient may suddenly attack people he thinks are persecuting him, or respond to inner voices that order him to commit acts of violence. As his personality disintegrates, his delusions and hallucinations become less systematized and logical, growing in time more and more fantastic, absurd, and changeable. If the patient is asked to talk about them, his explanations become extremely vague, incoherent, and full of neologisms. He now becomes increasingly “flat” and apathetic emotionally, except for periods of irritability and occasional surges of uncontrollable rage. If he remains untreated, he may eventually regress to childish behavior, such as hoarding objects of no value or performing ritual acts.The most prominent mechanisms of paranoid schizophrenia are projection and displacement. The patient reacts to inner tensions by blaming others and transferring his feelings of hostility and his unacceptable impulses to them: he is not aggressive, his enemies are, and he is only defending himself against their machinations; he is not unethical —rather, others are making false accusations against him or suggesting illicit behavior—which is often of a homosexual nature. This fact led Freud to maintain that homosexual conflicts are a major source of anxiety and hostility in these cases. Some recent investigations (Klaf and Davis, 1960; Moore and Selzer, 1963) appear to have supported this hypothesis. Their studies have revealed a far greater preoccupation with homosexuality, more latent homosexual trends, and more homosexual experiences among paranoid patients than in other groups of disturbed persons. Interesting, too, is the fact that the “persecutors” of these paranoid patients were found to be male in practically all cases. Studies of female paranoid schizophrenics, however, failed to reveal similar conflicts. The exact connection between homosexual tendencies and the disorder is therefore still unclear.Most paranoid schizophrenic reactions are of the acute type and respond to treatment within several weeks or months. In cases where the disorder has developed gradually and there is no evidence of precipitating stress, it is more likely to become chronic and incurable. See SCHIZOPHRENIC REACTIONS (THERAPY).Illustrative Case: An ex-college student, after years of unshared pondering, fantasying, watching, and cautious questioning, came to the wholly unfounded conclusion that acquaintances of his had been involved in crimes of rape and incest. On the basis of bizarre misinterpretations of ordinary city street scenes, such as the exchange of greetings between pedestrians and shouts or laughter from people in passing automobiles, he organized an extravagant pseudocommunity of plotters and counterplotters. This pseudocommunity he peopled with the acquaintances whom he suspected, and with imagined persons who talked to him at night. In his preoccupations —which were deep enough to make him lose one job after another for inattention to duty —the patient fixed upon first one and then another person as the ringleader of the criminals. Finally he “realized the truth,” heard the same night that his discovery would cost him his life, sought out the man who he “knew” was the mastermind, and assaulted him with almost fatal results. (Cameron, 1947)

Cite this page: N., Sam M.S., "SCHIZOPHRENIA (PARANOID TYPE)," in, November 28, 2018, (accessed August 9, 2022).


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