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What is paranoid schizophrenia? 

yael coopermangina-allegretti

Reviewed by Yael Cooperman, MD, written by Gina Allegretti, MD

Last updated: Jan 19, 2022
7 min read


If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

We’ve all had moments like this: during a bad week at work, you might think the boss is targeting you specifically. Maybe you’re driving and wonder for a moment if the car behind you is following you. 

Whatever the scenario, we usually recognize these passing thoughts—what people would describe as “paranoia”—as irrational and brush them off with ease. But for people with schizophrenia, this distinction is much harder to make. Once called paranoid schizophrenia, this term was phased out in favor of the more accurate term schizophrenia, which we’ll explain below. 


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What is paranoid schizophrenia? 

Schizophrenia is a common, complex mental health condition that can be difficult to diagnose. Close to 1% of adults in the United States (about 1.5 million people) have schizophrenia (NAMI, 2021). 

The main feature of schizophrenia is psychosis—a state in which your thoughts and feelings don’t match reality. Common signs of psychosis include paranoia, hallucinations (seeing, hearing, or feeling things that don’t exist outside one’s mind), and delusions.

Paranoid schizophrenia was once used for people living with both schizophrenia and paranoia. However, it became clear that many––if not most––people with schizophrenia experience paranoia as a symptom rather than a separate diagnosis. 

Signs and symptoms of schizophrenia 

Schizophrenia has two main types of symptoms: positive and negative. Positive symptoms are added, meaning you’re experiencing thoughts or behaviors that you normally wouldn’t. 

Positive symptoms include (Kuperberg, 2010; Slowinsky, 2017):

  • Paranoia: Having false beliefs that you are being persecuted, leading to fear, suspicion, and mistrust of others.
  • Auditory hallucinations: Hearing voices or sounds that aren’t there. These voices are often critical or abusive.
  • Visual hallucinations: Seeing people or things that aren’t there.
  • Delusions: Having false beliefs or delusions, such as thinking someone is spying on you.
  • Abnormal motor activity: An example of this is dystonia, which is abnormal jerking and muscle spasms. 
  • Abnormal speech: Disorganized, unclear, or hard to follow speech.
  • Bizarre behavior: Engaging in impulsive behavior or unusual activities.

On the other hand, negative symptoms occur when thoughts, emotions, and behaviors are removed. Though positive symptoms are usually more noticeable, negative symptoms can be very dangerous. Negative symptoms to watch out for include (Galderisi, 2021):

  • Anhedonia, or the inability to enjoy things you typically like
  • Lack of motivation to complete tasks
  • Lack of self-care (for example, not bathing or eating)
  • Slow or decreased speech
  • Lack of emotions (both good and bad)
  • Flat facial expressions (also called blunted affect)
  • Catatonia (absence of movement and speech)

Having at least two core symptoms (such as hallucinations and delusions) for one month, followed by some level of disturbance for six months, suggests you could have schizophrenia. These symptoms interfere with personal relationships, your job, or daily activities (SAMHSA, 2016). 

Symptoms usually begin between the ages of 16–30. Slightly more men are diagnosed with schizophrenia than women, and some research has shown an earlier onset of schizophrenia in men (between ages 18 and 25) than women (between ages 25 and 35) (Abel, 20108; Mueser, 2004). 

Causes of schizophrenia 

The exact cause of schizophrenia remains a mystery. Researchers suggest there’s a genetic predisposition, meaning you’re more likely to develop schizophrenia if someone in your family has it. 

But genetics alone isn’t enough. Other contributing factors could include infections, inflammation, childhood trauma, complications at birth, and drug (cannabis) use (Feigenson, 2014; Davis, 2016). 

Schizophrenia treatment 

The goal of schizophrenia treatment is to lessen positive and negative symptoms, as well as help you overcome social and occupational challenges. Treatment usually involves a combination of medication and talk therapy. Let’s take a look at each.

Antipsychotic medication

Antipsychotic drugs are a big part of schizophrenia treatment. Starting these medications immediately is critical since research has shown that schizophrenia causes the most brain changes early on. Especially in younger people, repeated psychotic episodes and treatment delay can have negative effects and can impact a person’s quality of life down the road (Patel, 2014; Norman, 2007). 

Some studies show people who exhibited signs for only a short time before treatment were more likely to recover fully or have long-term remission of symptoms (Robinson, 2004).  

Most antipsychotic medications work by affecting a brain chemical called dopamine. Dopamine is essential to feelings of pleasure and motivation, but an imbalance can cause psychosis (Patel, 2014). Drugs that help control dopamine are good at treating positive schizophrenia symptoms. 

Common side effects of these drugs include sleepiness, dry mouth, weight gain, constipation, and dizziness. They can also have serious adverse effects called extrapyramidal symptoms, which are movement disorders. One example is tardive dyskinesia, which causes severe twitching and jerking in the face and body that can be irreversible. 

There are newer antipsychotics that work on other brain chemicals like serotonin. These drugs are effective at treating positive and negative symptoms, and may have less risk of causing movement disorders. 


Mental health professionals can educate people with schizophrenia about their condition and help them stick to their medications. Family members and loved ones are encouraged to be involved in the care plan and for support. Research has shown having a strong support system allows people with schizophrenia to function better socially and lowers their risk of hospitalization (Patel, 2014). 

Psychotherapy is crucial because those with this condition often have other mental health concerns like anxiety, depression, substance abuse, and suicidal thoughts. Following up with a therapist can help identify these issues early so they can be properly addressed.  

It is scary to experience paranoia and delusions or to receive a diagnosis of schizophrenia. But there are treatment options available for it, and new medications are continually being developed. A mental health professional will work with you or a loved one to find a treatment plan that best suits your unique situation.

If you or someone you know is experiencing thoughts or behaviors of suicide or self-harm, help is available for free. Contact the National Suicide Prevention Hotline.

National Suicide Prevention Hotline: 1-800-273-8255

Or text TALK to 741741 to text with a trained crisis counselor


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Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.