Schizophrenia bulletin open · 2026
The Lived Experience of Paranoia: Systematic Review of Qualitative Studies.
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Muscettola Angela, Drusiani Giulia, Desenzani Martina, Belluardo Ludovico, De Bellis Giovanni Antonio, Bortolotti Lisa, Montemitro Chiara, Escelsior Andrea, Zerbinati Luigi, Toffanin Tommaso, Caruso Rosangela, Nanni Maria Giulia, Grassi Luigi, Belvederi Murri Martino
Аннотация
BACKGROUND AND HYPOTHESIS: Paranoia is commonly conceptualized along a continuum ranging from transient suspiciousness and mistrust to fixed persecutory delusions. However, similar paranoid contents may differ in conviction, flexibility, self-reference, distress, functional impact, and embeddedness in broader changes of self, agency, and world-experience. We synthesized qualitative evidence on the subjective experience of paranoia, suspiciousness, mistrust, and persecutory threat.
STUDY DESIGN: Following PRISMA and ENTREQ guidance, we searched PubMed/MEDLINE, Embase, PsycINFO, Scopus, EBSCOhost, and Ovid from inception to January 31, 2026. Thirty-six qualitative, experiential, or mixed-methods studies were included. Data were analyzed using thematic synthesis informed by phenomenological principles. Studies were classified as core evidence when paranoia was central, or contextual evidence when paranoia-related material was embedded within broader phenomena.
STUDY RESULTS: Three superordinate themes were generated: From interpersonal vigilance to a persecutory world; The threatened self: shame, vulnerability, trauma, and social injury; and Restoring meaning and safety: agency, coping, and altered reality. Paranoia emerged not only as a belief about threat, but as a situated transformation in the relation between self, others, and world. Lower-severity and non-clinical accounts were generally more localized, reflective, and negotiable. Clinical and higher-severity accounts were more pervasive, embodied, self-referential, and reality-defining, often intertwined with voices, external control, altered agency, spiritual meanings, or changes in reality-experience.
CONCLUSIONS: Paranoia is a multidimensional lived experience shaped by interpersonal threat, self-vulnerability, trauma, sociocultural context, coping, and meaning-making. Assessment should consider what paranoid beliefs mean, what they do for the person, and how they are shaped by biography, context, and lived experience.
STUDY DESIGN: Following PRISMA and ENTREQ guidance, we searched PubMed/MEDLINE, Embase, PsycINFO, Scopus, EBSCOhost, and Ovid from inception to January 31, 2026. Thirty-six qualitative, experiential, or mixed-methods studies were included. Data were analyzed using thematic synthesis informed by phenomenological principles. Studies were classified as core evidence when paranoia was central, or contextual evidence when paranoia-related material was embedded within broader phenomena.
STUDY RESULTS: Three superordinate themes were generated: From interpersonal vigilance to a persecutory world; The threatened self: shame, vulnerability, trauma, and social injury; and Restoring meaning and safety: agency, coping, and altered reality. Paranoia emerged not only as a belief about threat, but as a situated transformation in the relation between self, others, and world. Lower-severity and non-clinical accounts were generally more localized, reflective, and negotiable. Clinical and higher-severity accounts were more pervasive, embodied, self-referential, and reality-defining, often intertwined with voices, external control, altered agency, spiritual meanings, or changes in reality-experience.
CONCLUSIONS: Paranoia is a multidimensional lived experience shaped by interpersonal threat, self-vulnerability, trauma, sociocultural context, coping, and meaning-making. Assessment should consider what paranoid beliefs mean, what they do for the person, and how they are shaped by biography, context, and lived experience.