One week ago a patient was talking to me in the office and disclosed that he was paranoid about a particular upcoming experience. He was using the word as a synonym for anxious, tense, apprehensive. This represents a colloquial slang usage of the word "paranoid." Psychiatrists use the word paranoid to mean suspicious, mistrustful. I will not be addressing a common form found in paranoid schizophrenia, because that would be mixing two confusing diagnoses, i.e., paranoid and schizophrenia. Paranoia is a way of thinking or feeling that is pervasive and whose severity varies from relatively mild to loss of reality as, for example, in delusions. The more severe, the more normal functioning is compromised.
Traits of people who are often paranoid include those who are emotionally constricted, fearful, and suspicious. Others are rigidly arrogant and more aggressively suspicious.The trait or attitude of suspiciousness involves the continual expectation of trickery and if chronic leads to a way of thinking. Rigidity refers to having something on a person's mind which causes that person to look at their experience with certain expectations and search for confirmation of those expectations. If someone tries to dissuade the individual from his original view, that person will become an object of suspicion. So, the paranoid person does not pay attention to new facts, doesn't see apparent meaning, but "looks through" the obvious and sees an aspect that confirms the original view, i.e., examination of the data takes place with prejudice so that there is confirmation of the original thought. Anything that contradicts this is dismissed as mere appearance. The paranoid individual is incapable of any other type of attention. His attention is tense, rigid, actively searching with a biased purpose and intensely concentrating.
Everyone has some expectations to help guide them in their view. We are all influenced by what we see and what we don't expect. Those people that are suggestible are easily influenced by whatever striking fact or view or opinion presents itself. People with strong views impose their anticipation on the facts. Paranoid people seek confirmation of their anticipations and these in turn allow them to disregard apparent contradictory facts. In this way the paranoid's mind becomes an instrument of bias and leads to "brilliantly perceptive mistakes", that is, the perception can be correct but the judgment wrong. They are hypersensitive and hyperalert. Anything out of the ordinary or surprising triggers their suspiciousness and heightens their extreme tension. What would appear to be obvious to most people in a given circumstance is to them mere appearance and disregarded. They need to look beyond. They listen for clues. In this was they loose the tone and color of experience and those features that modify and qualify experience or convey a sense of proportion or scale. They are over represented in fanatics. These are the cognitive mechanisms that lead to a distortion of reality or in the extreme a loss of reality.