La paranoïa : des aliénistes au DSM-5

Abstract

From ancient Greek, paranoia, made up of para “besides” and noos “thought, mind”, signifies behaviour “against understanding”. The term paranoia has taken on diverse meanings throughout years and places. In France, paranoia has corresponded to the delusion of persecution as described by Lasègue in 1852, himself a descendant of Esquirol's monomaniacal delusional descriptions. Later, the delusional interpretations of Serieux and Capgras in 1909 or of “folie raisonnante” comes closer to the paranoia described by Kraepelin in 1898 as “a lasting delusional system impossible to undermine and which is established with a complete conservation of clarity and thought order”. Classically, paranoia is thus described as a chronic psychosis of progressive installation and of relatively late emergence (after 35 years of age). In traditional French nosography, we distinguish 3 subtypes: interpretation delusions, passionate delusions (erotomanic, of jealousy and of vengeance) and sensitive delusions. Today, paranoia delusions do not appear as such in the DSM-5 but we find it in “delusional disorders” characterised by the presence of delusional ideas lasting more than one month and which do not fill the criteria of a schizophrenic diagnosis, with the absence of marked alterations in functioning or strangeness. The subtypes are erotomanic, megalomaniac, of jealousy, of persecution and somatic. Furthermore, we find paranoia personality disorders, characterized by an overwhelming suspicion and mistrust towards others, whose intentions are interpreted as malicious. The continuum between personality and delusion remains controversial and recent neurocognitive research shines light on cognitive bias associated to strong anxious components.