Paraphrenia symptoms and treatment

Paraphrenia is a type of psychosis that isn’t an officially recognized disorder. But many experts argue it’s distinct enough from other psychotic disorders, like schizophrenia, to warrant its own diagnosis. Paraphrenia was previously used to describe symptoms of psychosis in older adults, although some researchers claim it can affect younger people as well.

Whether you live with paraphrenia or another psychotic disorder like schizophrenia, treatment can help. Psychosis can be frightening, but it doesn’t have to control your life.

Paraphrenia symptoms

Paraphrenia is a complex and rare psychosis that typically affects older adults — although some research suggests it can affect people in their 30s or younger. People with paraphrenia experience delusions but no other effects to their personality and thinking process.

Paraphrenia isn’t officially listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD), which are texts health professionals use to make diagnoses. But many healthcare providers and researchers continue to recognize its existence — especially to differentiate people who present with paraphrenia symptoms from people with schizophrenia.

Since paraphrenia isn’t officially recognized as a medical condition, there’s no official set of diagnostic criteria or symptoms for it. But past researchers have proposed symptoms of paraphrenia, which they claim makes it distinct from other conditions. 

These symptoms include:

• Preoccupation with one or more semisystemized delusions, which are delusions (strong, false beliefs) that somewhat follow an internal flow of logic. For example, thinking your coworker is trying to get you fired by making up rumors or tampering with your work. 
• Auditory hallucinations (hearing things that aren’t really there)
• Delusional beliefs that affect other areas of the person’s life.
• No change to affect, meaning the person with paraphrenia is able to continue making appropriate emotional and facial expressions and interacting with people around them 
• No cognitive changes, intellectual decline, visual hallucinations, or disorganized or incoherent speech or behavior 
• If there’s disturbed behavior (like irritability or agitation), it’s understandable in relation to the person’s experience of delusions and hallucinations. For example, being irritated at the coworker that you suspect is trying to get you fired. 

In addition, researchers claim that to meet the criteria for paraphrenia, the person must not meet the full diagnostic criteria for schizophrenia or have any neurological conditions (like Alzheimer’s). 

An example of paraphrenia 

Even after reading these symptoms, it can be difficult to imagine what paraphrenia may look like. One research study provided a case example of a 54-year-old man with paraphrenia, which might help illustrate the condition.

This man presented with paranoid delusions and auditory hallucinations. He was very agitated and frightened because he believed that his neighbors had set up cameras inside his house to observe him. He described hearing insults and comments from this neighbor. 

He had begun to engage in strange behaviors, but they made sense within the context of his delusions. For example, he’d started covering himself up while showering because he didn’t want to be seen naked on camera. Otherwise, there was no deterioration to his intellectual functioning or personality.

This man eventually became so distressed that he attempted suicide.* He also presented with co-occurring symptoms of depression and anxiety related to his delusions.

*A note on safety: If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors.

Paraphrenia vs. late-onset schizophrenia

One of the reasons why paraphrenia isn’t included in the DSM or the ICD is because it hasn’t been sufficiently differentiated from late-onset schizophrenia, which is when people develop symptoms of schizophrenia after the age of 45. 

Schizophrenia and paraphrenia share some overlapping symptoms, like delusional thinking and auditory hallucinations. But advocates of paraphrenia as a distinct condition say that paraphrenia is different from schizophrenia in three primary ways:

1. People with schizophrenia experience flat affect, a lack of emotional expression or facial expressions. People with paraphrenia still express themselves. 
2. People with schizophrenia also experience very disorganized speech and thought processes. People with paraphrenia have delusions, but they follow a semi-coherent logic. Their thought process isn’t otherwise disorganized.
3. People with paraphrenia are more likely to experience delusions of persecution or that someone is out to get them. People with schizophrenia can have paranoid delusions, but their delusions can also be more bizarre.

However — especially because paraphrenia isn’t an officially recognized condition — people with paraphrenia may sometimes be misdiagnosed with schizophrenia or psychotic disorder not otherwise specified.

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Causes and risk factors

The research on paraphrenia is limited, so we don’t yet know what exactly causes it. We can, however, find overlapping themes that may contribute to risk factors

Potential risk factors include:

• Living with a cluster A personality disorder, which includes schizoid personality disorder
• Sensory deficits (especially auditory)
• Social isolation
• Experiencing stressful life events, including migration

Some researchers have claimed that paraphrenia is caused by a buildup of tau protein in the hippocampus, an area of the brain responsible for memory consolidation. Tau protein is also involved in the development of Alzheimer’s disease.

Having a family history of schizophrenia or psychosis hasn’t been shown to increase your risk of developing paraphrenia, which could suggest that there’s no genetic link between these two conditions. That being said, more research needs to be done on paraphrenia to understand any potential genetic risk factors. 

How is paraphrenia treated?

Research has shown paraphrenia may have a better short-term outcome than schizophrenia when treated early. 

Because paraphrenia isn’t recognized as a distinct condition, there are no official clinical guidelines for how to treat it. Often, it’s treated with antipsychotic medications. Therapy may also be helpful — especially if you live with a co-occurring personality disorder.

Therapy, like cognitive behavioral therapy (CBT), can help you approach your paranoid or irrational thoughts in a different way. CBT is all about connecting your thoughts, behaviors, and emotions. If your thinking patterns are making you feel frightened or agitated, a CBT therapist can help you reframe those thoughts so they’re not as upsetting.

A therapist can also help you make changes in your behavior that could help you feel better. For example, they could help you learn new coping skills to deal with the stressful events in your life or build stronger relationships with your community.

Find care with Rula

Paraphrenia can be frightening to live with — especially because there’s still so much more we need to understand about the condition. But all psychotic disorders, like schizophrenia, can be treated. With the right support, you can learn to manage their symptoms and achieve your goals.

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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