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Am I Paranoid, or Is It Schizophrenia? Here’s the Difference

What does it feel like to be paranoid, and how is it distinct from schizophrenia

Key points

  • Paranoid personality disorder and paranoid schizophrenia belong to separate diagnostic categories in the DSM, but people often confuse the two.
  • Just because you have paranoid tendencies does not mean you have schizophrenia; not all people with schizophrenia are paranoid.
  • Schizophrenia can involve hallucinations and delusions, but paranoid disorder does not have those symptoms, just extreme suspiciousness.
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Type “Am I paranoid?” into Google, and you might find a load of thoughtful, expert advice mixed in with a bunch of weird, not-so-helpful links.

If you are worried that entering those words into a search engine will trigger a covert government operation designed to invade your mind and track your deepest darkest thoughts, then you may have some paranoid tendencies. But it does not mean you have schizophrenia.

Paranoid personality disorder and paranoid schizophrenia are two different disorders. They have different diagnostic criteria and causes, and the DSM classifies them into separate categories of psychopathology.

Let’s take a look at both.

Paranoid Personality Disorder

Fear that others will manipulate, harm, or take advantage of an individual, drives a paranoid personality disorder. Because of these symptoms, the condition often results in social withdrawal, tenseness, irritability, and lack of emotion. The condition's prevalence in people receiving outpatient mental health treatment is 2–10 percent. Rates of paranoid personality disorder in a population of people in psychiatric inpatient facilities are 10–30 percent.

This Is Who You Are

Ego-dystonic is a psychoanalytic term describing impulses, wishes, or thoughts that are unacceptable or repugnant to the ego or self. In other words, something does not feel right with you, and you are aware of this. Depression, bipolar, PTSD, and OCD are just a few examples of disorders that are typically ego-dystonic.

On the other hand, ego-syntonic means that your thoughts, wishes, impulses, and behavior are consistent with your ego. Most personality disorders are considered ego-syntonic because they do not conflict with your sense of identity. They are woven into the very fabric of who you are, and because of this, you may have a hard time seeing why they are problematic. Also, you express these symptoms across the board from one situation to the next with little variation.

Personality Disorders in General

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies 10 unique personality disorders, each belonging to one of three groups known as "clusters."

Cluster A contains paranoid, schizoid, and schizotypal disorders. In cluster B, one will find borderline, narcissistic, histrionic, and antisocial disorders. The DSM outlines diagnostic criteria for avoidant, dependent, and obsessive-compulsive personality disorders in cluster C.

A personality disorder is a mental illness in which you have trouble perceiving and relating to situations and people–including yourself. There are many specific types of personality disorders.

In general, having a personality disorder means you have a rigid and unhealthy pattern of thinking and behaving no matter the situation. This type of thinking leads to significant problems and limitations in relationships, social encounters, work, and school. Sometimes, you may not realize your personality disorder because your way of thinking and behaving seems natural, and you may blame others for your challenges.

Paranoid Schizophrenia

Schizophrenia is a family of disorders that exists separately from all personality disorders, including paranoid personality disorder. It is a brain disorder that often features distorted thoughts and perceptions and loss of contact with reality. The lifetime prevalence is around 1 percent.

Common symptoms of schizophrenia include Incoherent thinking, delusions (false beliefs), hallucinations (sensory experiences that occur in the absence of actual stimulation), disturbance of affect (inappropriate emotional responses), and bizarre behavior. Not all people exhibit all these symptoms because everyone’s experience is unique.

A person with paranoid schizophrenia can have these symptoms, plus they may have the classic symptoms of paranoia discussed above. The difference between a paranoid schizophrenic and a paranoid personality is the lack of hallucinations and delusions in the paranoid personality. In other words, they are suspicious about the motives of others, but they do not hear voices or have visual hallucinations found in schizophrenia.

What if I or someone I know is in crisis?

If you are thinking about harming yourself or know someone who is:

  • Call your doctor.
  • Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
  • If you are in a crisis, make sure you are not left alone.
  • If someone else is in a crisis, make sure they are not left alone.

When to Contact a Medical Professional

See your health care provider or mental health professional if you or someone you know has symptoms of a personality disorder or schizophrenia.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.

© 2022 Kevin Bennett Ph.D. All rights reserved.

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