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Classification according to ICD-10
F20.0 Paranoid schizophrenia
F22.0 Delusional disorder / paranoia
F22.8 Other delusional disorder / paranoia of old age
F23.3 Paranoid reaction / psychogenic psychosis
F60.0 Paranoid personality disorder
ICD-10 online (WHO version 2019)

Paranoia ( Greek παράνοια paránoia , from παρὰ parà “against” and νοῦς noûs “mind”; literally “against the mind”, “crazy”, “insane”) is in the narrower sense the name for a mental disorder , at the center of which is delusional stand. More often, however, the term appears in its adjectival form paranoid (see Infobox ICD 10), which indicates paranoia or fears of persecution. Those affected suffer from a distorted perception of their surroundings in the direction of a hostile (in the extreme viciously persecuting) attitude towards themselves. The consequences range from fearful or aggressive mistrust to the conviction that others are conspiring against you.

The spectrum of paranoid reactions ranges from neurotic forms of a paranoid tendency through a paranoid personality disorder to severe psychotic manifestations. The neurotic paranoid personality is characterized by an exaggerated sensitivity to rejection, particular vulnerability and mistrust. She tends to interpret criticism as hostile or contemptuous. Frequently recurring and unjustified suspicions regarding the sexual fidelity of the spouse or sexual partner ( delusional jealousy ) and contentious insistence on one's own rights are found. Affected people, on the other hand, tend to be overly self-centered (ICD-10).


Paranoid symptoms are very diverse and occur as a side effect of many underlying diseases, including neuroses , psychoses such as schizophrenia , many personality disorders and some degenerative diseases. The course forms are different here. They are also part of the symptoms of people who have had to suffer from real or perceived persecution for a long time, but are not actually psychotic or personality disorders . Paranoid symptoms can also occur as a result of other triggering factors, such as somatic agents (active substances), neurological and / or psychiatric illnesses. Examples are:


The patient feels like they are being persecuted and develops conspiracy theories . A paranoid person often believes that others are intent on harming, cheating, or even killing him. Often he can also present “evidence” that seems completely convincing to him, but says nothing at all to outsiders. These beliefs are delusional . There is nothing to dissuade the patient from them, rational arguments and attempts to convince outsiders are unsuccessful and are rather counterproductive, as they only increase the suspicion of the paranoid person.

If paranoia does not appear as an independent, but as an accessory symptom of an underlying disease , such as paranoid schizophrenia or bipolar disorder , it can only be treated in the context of this disease . In principle, psychotherapy , drug treatments or even operations (e.g. for brain tumors) may be necessary.

The object of paranoia varies greatly from case to case. Sometimes, for example, the secret service of the respective country is suspected to be behind the persecution. The methods of monitoring in the delusional scenario tend to be adapted to the current state of the art. When the system changes (e.g. after the Second World War, after the reunification of Germany), the supposed persecutor often changes (e.g. Stasi - BND ). This shows that paranoia mainly consists of a deviation from the norm in the thought processes, while the thought content can vary.

Again, organized action can also take on delusional traits, in that excessive actions are constructed as inevitable to ward off possible dangers.

Concept history

The term paranoia has been in use as a general term for mental disorders since ancient times. JCA Heinroth (1773–1843) also used the term in 1818 and tried to define it from a moral-philosophical point of view as the “lack of freedom of the spirit”, which was accompanied by exaltation, but in which the “sensory perception” was undisturbed. Ludwig Snell (1817-1892) reported in 1865 on paranoia in connection with monomania , "whereby the entirety of intellectual life remains largely intact". Only Emil Kraepelin defined in 1893 with the 4th edition of his textbook: "When craziness we call the chronic development of a lasting delusional system with complete preservation of a sound mind." This was for Kurt Schneider 1949, the paranoia in schizophrenia rise or in the endogeneity .

Since Ludwig Snell, the clinical term paranoia has often referred to multiple delusions, which can also be associated with other characteristics such as fanaticism or severe complaint . This psychosis is also characterized “by the development of a single delusion or of several related delusions, which generally last for a long time, sometimes for a lifetime; the content of the delusional or delusional system is very different ”. Finally, the most serious form, paranoid schizophrenia, is “characterized by constant, often paranoid delusions, usually accompanied by acoustic hallucinations and perceptual disorders ; Disturbances of mood, drive and speech, catatonic symptoms [on the other hand] are either absent or are less noticeable ”. Remarkably, the cognitive abilities of the paranoid person are preserved, with the exception of the distorted perception of reality in relation to the delusional topos. Paranoia as a delusional disorder is essentially characterized by the presence of “non-bizarre” delusions that last for at least a month (DSM-IV-TR). In contrast to bizarre ones , these fears could in principle be real, but regularly they are not. A person suffering from delusional disorder was often called a "paranoid" in the past.

Today, a distinction is primarily made between five forms: In the grandiose, self-superior direction, these are erotomania (madness of love) and megalomania . On the other hand there are delusions of jealousy (pathological jealousy ), delusions of persecution and somatic delusions ( hypochondria ); there is also a mixed variant and a non-specific type. Paranoia can be an independent pathology or a symptom of other diseases (e.g. bipolar disorder , senile dementia or organic brain damage , delirium tremens ).

Paranoia as an individual pathological, psychiatric syndrome has been well researched since the mid-19th century. The work of the German psychiatrist Emil Kraepelin (1856–1926), whose textbook on psychiatry in the 1899 edition defined the psychotic expression as “the creeping development of a permanent, unshakable delusional system resulting from internal causes, was particularly groundbreaking which goes hand in hand with clarity and order in thinking, willing and acting ”. Even Sigmund Freud dealt with the paranoia. In the past, a general mental disorder or paraphrenia (paranoid form of schizophrenia) was referred to as paranoia . The term paraphrenia is still used today by Leonhard's classification, in which it describes one of the three systematic schizophrenias .

Max Wertheimer , the founder of Gestalt theory , and the German psychiatrist Heinrich Schulte proposed a socio-psychological model for understanding paranoia: Accordingly, paranoia should be understood as a special form of delusional relationship - a person who does not succeed in being part of a we and who Cannot bear this gap between himself and the others, builds a bridge to the others, in that he sees himself connected to them at least in a “substitute we” of persecutors and the persecuted. Accordingly, the chance of healing is seen primarily in the restoration of good social relationships . However, this is only one of the many models that were developed under the term "paranoia".

Colloquial and literary uses of the term

Despite the seriousness of paranoid perceptual disorders and the often devastating consequences for those affected, especially in social coexistence, the aspect of paranoia in particular often serves as a "funny" scenario for television series , conspiracy theories or games . For example, there is a satirical pen and paper role-playing game called Paranoia . The subject is also very often found in literature. Andy Grove , co-founder of Intel , called his business autobiography Only the paranoid survive (German: Only the paranoid survive ). Also known is the quote “ Just because you're paranoid doesn't mean they're not after you ” (German: “ Just because you're paranoid doesn't mean they aren't after you ”) Attributed to various formulations, including Joseph Heller ( Catch-22 ) and Henry Kissinger , and taken up by Kurt Cobain (Territorial Pissings) and Terry Pratchett (Strata) .


  • Joseph H. Berke, Stella Pierides, Andrea Sabbadini, Stanley Schneider (Eds.): Even Paranoids Have Enemies. New Perspectives on Paranoia and Persecution. Routledge, London 1998.
  • Sigmund Freud : Remarques psychanalytiques sur l'autobiographie d'un cas de paranoïa (dementia paranoïdes). Le président Schreber , 1911, GW VIII. In: Cinq psychanalyses . 20e édition. PUF, Paris 1997, pp. 263-324.
  • Quentin Debray: L'Idéalisme passionné. PUF, Paris 1989, ISBN 2-13-042160-1
  • Farrell John: Paranoia and Modernity: Cervantes to Rousseau. Cornell University Press, Ithaca NY 2006.
  • Jacques Lacan ; De la psychose paranoïaque dans ses reports avec la personnalité . Editions du Seuil, Paris 1975 (1932).
  • Heinrich Schulte, Max Wertheimer: Attempt of a theory of paranoid self-relation and delusion . In: Psychological Research , Vol. 5, 1924, No. 1, pp. 1–23.
  • Paul Serieux, Joseph Capgras : Les folies raisonnantes. Les délires d'interprétations. Alcan, Paris 1902.
  • Paul Serieux, Joseph Capgras: Délires systématisés choniques. Traité de Sergent . In: Psychiatry , t. 1. Maloine, Paris 1926.
  • Sigmund Freud : Communication d'un cas de paranoïa en contradiction avec la théorie psychanalytique (1915) , traduit par D. Guérineau. In: S. Freud: Névrose, Psychose et perversion . 12e édition. PUF, 2002, pp. 209-218.
  • A. Sims, A. White, Coexistence of the Capgras and De Clerambault syndromes a case report . In: British Journal of Psychiatry , 1973, 123, pp. 653-657.
  • Ernst Kretschmer : Paranoïa et sensibilité, Imago Mundi. G. Monfort éditeur, 1918, 293 pp.
  • Jacques Lacan: Séminaire, Livre III, Les psychoses (1955-1956). Seuil, Paris 1981
  • Alistair Munro: Delusional Disorder. Paranoia and Related Illnesses. Cambridge University Press, Cambridge 1999.
  • David W. Swanson, Philip J. Bohnert, Jackson A. Smith: The Paranoid. Little, Brown and Company, Boston 1970.

University work (online, free of charge)

  • Fabian Lamster: Paranoia - development processes and ways out. The role of loneliness and social cognitive mechanisms as well as a treatment conceptualization for the therapy of paranoid madness. Marburg 2016, DNB 1116604221 (Dissertation University of Marburg 2016, supervisor: Stephanie Mehl full text online PDF, free of charge) -
  • Maike M. Hartmann: Influence of stress and risk factors on paranoid symptoms in people with different vulnerabilities. Hamburg, 2014 DNB 1059859807 (Dissertation Universität Hamburg 2014, supervisor: Tania Lincoln full text online PDF, accessible free of charge).

Web links

Wiktionary: Paranoia  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. Adam Banner: The NSA and Verizon: Paranoid Delusions or an Assault on Your Rights? The Huffington Post , June 10, 2013.
  2. ^ John Ericson: NSA PRISM Program May Benefit The Clinically Paranoid As They Find Out Others Are Being Watched Too ., July 1, 2013.
  3. James Turnage: NSA Paranoia Invades the World's Privacy? Guardian express, June 30, 2013.
  4. Johann Christian August Heinroth : Textbook of disorders of the mental life or the disorders and their treatment . Vogel, Leipzig 1818.
  5. a b c Uwe Peters : Lexicon of Psychiatry, Psychotherapy, Medical Psychology . 6th edition. Urban & Fischer, Munich 2007, ISBN 978-3-437-15061-6 , p. 387, .
  6. Erwin H. Ackerknecht : Brief history of psychiatry . 3. Edition. Enke, Stuttgart 1985, ISBN 3-432-80043-6 , p. 60.
  7. Ludwig Snell : About monomania as a primary form of soul disorder. In: Allgemeine Zeitschrift für Psychiatrie , 22, 1865, pp. 368-381. At Google Books .
  8. WHO: Diagnostic and Statistical Manual of Mental Disorders , 4th edition Text Revision 2000 (DSM-IV-TR) and in the International Statistical Classification of Diseases, 10th edition 1992 (ICD-10) published by the WHO.