The Lived Experience of Paranoia: Systematic Review of Qualitative Studies
Angela Muscettola, Giulia Drusiani, Martina Desenzani, Ludovico Belluardo, Giovanni Antonio de Bellis, Lisa Bortolotti, Chiara Montemitro, Andrea Escelsior, Luigi Zerbinati, Tommaso Toffanin, Rosangela Caruso, Maria Giulia Nanni, Luigi Grassi, Martino Belvederi Murri
Schizophrenia Bulletin Open 2026 DOI: 10.1093/schizbullopen/sgag027 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative systematic review with thematic synthesis Peer reviewed |
|---|---|
| Population | Qualitative, experiential, or mixed-methods studies on paranoia, suspiciousness, mistrust, and persecutory threat |
| Key findings | Paranoia is a multidimensional lived experience involving interpersonal threat, self-vulnerability, trauma, sociocultural context, coping, and meaning-making. Clinical and higher-severity accounts were more pervasive, embodied, self-referential, and reality-defining, while lower-severity accounts were more localized, reflective, and negotiable. |
Abstract
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.