“They are playing a game. They are playing at not playing a game. If I show them I see they are, I shall break the rules and they will punish me. I must play their game, of not seeing I see the game.”
R.D. Laing, Knots.
Defined in the DSM-IV as:
A type of schizophrenia in which there are:
1. Preoccupation with one or more systematised delusions or with frequent auditory hallucinations related to a single theme.
2. None of the following: incoherence, marked loosening of associations, flat or grossly inappropriate affect, catatonic behaviour, or grossly disorganised behaviour.
The essential feature of paranoid schizophrenia is a preoccupation with one or more systematised delusions or with frequent auditory hallucinations related to a single theme. In addition, symptoms characteristic of the disorganised and catatonic types—such as incoherence, flat or grossly inappropriate affect, catatonic behaviour, or grossly disorganised behaviour—are absent. When all exacerbations of the disorder meet the criteria for the paranoid type, the clinician should specify “stable type”.
Associated features of paranoid schizophrenia include unfocused anxiety, anger, argumentativeness, and violence. Often, a stilted or overly formal interpersonal style, or an extreme intensity in social interaction, is observed.
Functional impairment in paranoid schizophrenia may be minimal if delusional material is not acted upon. Onset tends to be later than in other subtypes, and distinguishing characteristics are often more stable over time. Some evidence suggests that prognosis—particularly in relation to occupational functioning and independent living—may be more favourable than in other forms of schizophrenia.