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In popular culture, the term paranoia is usually used to describe excessive concern about one's own well-being, sometimes suggesting a person holds persecutory beliefs concerning a threat to themselves or their property and is often linked to a belief in conspiracy theories.
In psychiatry, the term paranoia was used by Emil Kraepelin to describe a mental illness in which a delusional belief is the sole, or most prominent feature. This usage is now largely obselete and the term is more typically used in a general sense to signify any self-referential delusion, or more specifically, to signify a delusion involving the fear of persecution. The exact use of the term has changed over time, and because of this, psychiatric usage may vary.
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 that was later to be renamed schizophrenia.
In the original Greek, παράνοια (paranoia) means self-referential, and it is this meaning which was adopted by Kraepelin. Notably, in this definition the belief does not have to be persecutory to be classified as paranoid, so any number of delusional beliefs which are centred around the self can be classified as paranoia. For example, a person who has the sole delusional belief that they are an important religious figure (such as Jesus or the Dalai Lama) would be classified by Kraepelin as having 'pure paranoia'.
Although the diagnosis of pure paranoia is no longer used (having been superceded by the diagnosis of delusional disorder) the use of the term to signify the presence of delusions in general, rather than persecutory delusions specifically,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:
Paranoia is often associated with psychoticPsychosis is a psychiatric classification for a mental state in which the perception of reality is distorted. Persons experiencing a psychotic episode may experience hallucinations (often auditory or visual hallucinations), hold paranoid or delusional bel illnesses, particularly schizophrenia, although attenuated features may be present in other primarily non-psychotic diagnoses, such as paranoid personality disorderParanoid personality disorder is a psychiatric diagnosis that denotes a personality disorder with paranoid features. The use of the term paranoia in this context is not meant to refer to the presence of frank delusions or psychosis, but implies the presen.
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 erotomaniaErotomania is a rare disorder in which a person holds a delusional belief that another person, usually of a higher social status, is in love with them. Erotomania is also called de Clerambault's syndrome after the French psychiatrist Gaetan Gatian de Cler or de Clerambault syndrome).
Other common paranoid delusions include the belief that the person has an imaginary disease or parasiticA parasite is an organism that lives in or on the living tissue of a host organism at the expense of it. The biological interaction between the host and the parasite is called parasitism. Parasitism is a type of symbiosis, by one definition, although anot infection ( delusional parasitosisDelusional parasitosis or Ekbom's Syndrome is a rare disorder in which a person holds a delusional belief they are infested with parasites. It is not to be confused with Wittmaack-Ekbom or restless legs syndrome. Unfortunately, this is also referred to in); 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 state he was finally poisoned). Might it be that with enough enemies, it is impossible to be clinically paranoid? This raises interesting philosophical questions about the criteria by which we can diagnose a belief as paranoid or delusional.