Signs and Symptoms of Paranoid Schizophrenia

Medically referred to as schizophrenia with paranoia

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Paranoia is a pattern of thinking in which one feels irrationally suspicious, persecuted, or threatened. It can range from mild feelings of discomfort to an intense, extremely distressing and disabling pattern of thinking.

For people with schizophrenia, the experience of paranoia can be persistent, extremely unpleasant, and even dangerous.

Up until 2013, schizophrenia was categorized into different subtypes, with paranoid schizophrenia being one of them. It is no longer considered a definitive subtype of the disorder, so the term paranoid schizophrenia is not officially correct. However, paranoia is a common symptom of schizophrenia, so one could be described as having schizophrenia with paranoia. 

paranoid schizophrenia symptoms

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Frequent Symptoms

For those with schizophrenia with paranoia, reality may be unclear. For example, in addition to their paranoia, they may see people and hear voices that they believe are real, but in fact are not. As one could imagine, this can interfere with a person’s ability to live a normal life.

Examples of early symptoms that might reflect a prodrome for the onset of schizophrenia with paranoia include:

  • Avoiding social events and interactions
  • Insomnia
  • Irritability
  • Problems at work or school
  • Increase in problems getting motivated
  • Social isolation
  • Problems focusing or paying attention

Other signs of schizophrenia with paranoia often include:

  • Seeing things that others do not
  • Hearing voices that are not there
  • Overall fear linked with the intention of others (paranoia about being poisoned is a common fear)
  • Suspiciousness
  • Ongoing, bizarre, or unusual thoughts or beliefs
  • Trouble thinking clearly
  • Social isolation
  • A decline in overall hygiene or other aspects of self-care

Phases of Schizophrenia

There are several phases of schizophrenia as the disorder progresses from the early warning signs—referred to as the prodromal phase—to the active phase of the disease, in which distortions in perception and debilitating thoughts are present.

Having these symptoms does not necessarily indicate that a person has schizophrenia with paranoia, but the presence of symptoms does warrant an evaluation by a mental health professional.

Early intervention often equates to better treatment outcomes for people diagnosed with schizophrenia with paranoia.


Delusions are resolutely held untrue beliefs; these beliefs are maintained despite evidence to the contrary. Examples of common types of delusions that people with schizophrenia may have include:

  • Delusions of grandeur: Believing that one has special talents or gifts, immense wealth, or other important traits
  • Delusions of control: Thinking one is being controlled by entities such as aliens, the government, voices coming from the television, or other outside forces
  • Delusions of persecution: Believing that one or more people are conspiring against you or a loved one, trying to harm you, or otherwise mistreat you
  • Delusions of reference: The false belief that an unrelated occurrence has a direct reference to oneself

Approximately 90% of people who are diagnosed with schizophrenia have some type of delusions.

Although not all delusions are the same, there are some commonalities in some people. For example, believing that another person is poisoning one’s food or drinks is a common delusion of persecution.


There are several types of hallucinations, including:

  • Visual hallucinations: Seeing something that is not real or does not exist
  • Auditory hallucinations: The perception of non-existing sounds, such as perceived voices
  • Olfactory or gustatory hallucinations: Smelling scents or odors and tasting tastes that do not exist; most often the scents are unpleasant
  • Tactile hallucination: Having a sensation that one is being touched—such as something crawling on the skin—when it is not occurring

Voices can be:

  • Male or female
  • A person who is known or an unknown person
  • Sounds instead of human voices, such as a humming sound
  • Spoken by a person with a foreign accent
  • Spoken in a whispering voice or via shouting
  • Negative and disturbing
  • Ongoing or intermittent
  • More than one voice
  • Commenting or criticizing
  • Giving commands

Disorganized Speech

People with schizophrenia may have a symptom called “disorganized speech.” This doesn’t mean that a speech impediment is present; rather, it involves speech that gets derailed or is incoherent. It may involve the repetition of words and phrases, or starting to talk in the middle of a sentence instead of at the beginning.

This symptom stems from disorganized thinking that people with schizophrenia often have. Sometimes this type of speech is referred to as word salad.

Disorganized Behavior

Disorganized behavior is the overall inability to control outward behavior, including emotions and impulses.

Examples of how disorganized behavior may manifest in a person with schizophrenia with paranoia include:

  • Difficulty performing daily activities
  • Abnormal movements or lack of movements
  • Trouble with impulse control
  • Problems controlling emotions
  • Difficulty containing actions that are deemed inappropriate or odd

Disorganized behavior can have a major negative impact on a person’s job, education, and home life, interfering with personal relationships.

Suicidal Thoughts

Suicidal thoughts and attempts are at an increased risk in people with schizophrenia with paranoia. Suicidal thoughts occur more frequently in people who have untreated schizophrenia with paranoia.

Seek Help

If you or someone you know has any thoughts of self-harm, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911.


Many co-occurring conditions commonly affect a person with schizophrenia with paranoia. For instance, people with schizophrenia often use alcohol or illicit drugs to try and manage their symptoms. Another complication is the development of co-occurring mood and anxiety disorders.

Additional complications of schizophrenia may include:

  • Nicotine addiction
  • Financial problems
  • Loss of a job
  • Homelessness
  • Suicide

When to See a Doctor

If a person with schizophrenia is thinking about suicide and particularly if they admit to having formulated a plan to commit suicide, it’s of the utmost importance to seek emergency medical intervention right away.

There are many suicide crisis lines—available via a phone call—that are standing by 24/7. Among these are:

  • 911 (for emergency medical care, or visit the nearest hospital emergency room)
  • National Suicide Prevention Lifeline at 988, or text the Crisis Text Line (text HELLO to 741741)


A person with schizophrenia usually seeks treatment during the active phase of the disorder. This is when the positive symptoms of psychosis (such as hallucinations) emerge, creating a major disruption in a person’s life. Below is a sampling of the effective treatments available to manage these symptoms.

Antipsychotic Medications

Antipsychotic medications are perhaps the most common type of treatment for people with schizophrenia with paranoia. These medications work to reduce or eliminate psychosis such as hallucinations and delusions.

Antipsychotic medications may be given:

  • By mouth each day
  • In a pill or liquid form
  • Every several weeks as an injectable form (which is the preferred route of administration for those who are non-adherent with taking their medications)

Difficulty Administering Medication

People with schizophrenia with paranoia often have delusional thinking that involves the belief that they are being poisoned. This might translate to non-compliance with taking medications.

Psychosocial Treatments

Many types of psychosocial treatments are deemed effective in helping people with schizophrenia pursue their life goals.

Psychosocial treatment modalities include:

  • Cognitive behavior therapy
  • Behavioral skills training
  • Supported employment
  • Cognitive remediation
  • Family education and support
  • Coordinated Specialty Care (CSC)
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.