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Use in psychiatry
In his original attempt at classifying different forms of mental illness, Emil Kraepelin used the term pure paranoia to describe a condition where a delusion was present, but without any apparent deterioration in intellectual abilities and without any of the other features of dementia praecox, the condition later renamed schizophrenia.
In the original Greek, παράνοια (paranoia) means simply madness (para = outside; nous = mind). Kraeplin's developed a definition from this root involving delusional beliefs. Notably, in his definition, the belief does not have to be persecutory to be classified as paranoid, so any number of delusional beliefs can be classified as paranoia. For example, a person who has the sole delusional belief that he is an important religious figure would be classified by Kraepelin as having 'pure paranoia'.
Although the diagnosis of pure paranoia is no longer used (having been superseded by the diagnosis of delusional disorder) the use of the term to signify the presence of delusions in general, rather than persecutory delusions specifically, lives on in the classification of paranoid schizophrenia, which denotes a form of schizophrenia where delusions are prominent.
More recently, the clinical use of the term has been used to describe delusions where the affected person believes they are being persecuted. Specifically, they have been defined as containing two central elements:
- The individual thinks that harm is occurring, or is going to occur, to him or her.
- The individual thinks that the persecutor has the intention to cause harm.
Paranoia is often associated with psychotic illnesses, particularly schizophrenia, although attenuated features may be present in other primarily non-psychotic diagnoses, such as paranoid personality disorder.
Examples of clinical paranoia
In the unrestricted use of the term, common paranoid delusions can include the belief that the person is being followed, poisoned or loved at a distance (often by a media figure or important person, a delusion known as erotomania or de Clerambault syndrome).
Other common paranoid delusions include the belief that the person has an imaginary disease or parasitic infection (delusional parasitosis); that the person is on a special quest or has been chosen by God; that the person has had thoughts inserted or removed from conscious thought; or that the person's actions are being controlled by an external force.
Many despotic rulers (for example Stalin) allegedly suffered from paranoia. This presents an interesting question because in Stalin's case, it is quite likely that many people really were out to get him (some theories concerning his death hypothesize that he was poisoned). Might it be that with enough enemies, it is impossible not to be clinically paranoid? It still might be possible to identify a paranoid in that situation via his unrealistic assessment of the relative threat presented by various enemies, but it is not clear that non-paranoid persons are all that good at this. This raises interesting philosophical questions about the criteria by which we can diagnose a belief as paranoid or delusional, as well as prompting the joke that "Just because you're paranoid doesn't mean they're not out to get you".