Levels of paranoia are higher in autism: systematic review

Paranoia, defined as the unfounded or exaggerated idea that something or someone is deliberately trying to psychologically, physically or financially harm you, is not an uncommon transient sentiment among the general population at one time or another. On a more pathological level, paranoid schizophrenia perhaps represents the archetypal label where paranoia assumes an altogether more persistent and 'life-changing' effect; also potentially escalating into more extreme behaviour/s.

The idea that levels of paranoia might also be elevated as and when a diagnosis of autism spectrum disorder (ASD) is received is discussed in a recent review paper by Debbie Spain and colleagues [1]. Looking at the available peer-reviewed literature on the topic, researchers reported that those with ASD "were consistently found to have higher levels of paranoia compared to non-clinical controls, and lower levels than individuals with current psychotic experiences manifesting in the context of schizophrenia." They further speculated that: "core ASD characteristics and associated neurocognitive impairments also serve to precipitate and perpetuate paranoia."

Accepting that cultural views of paranoia or paranoid behaviour are not generally all that 'positive' and how this may have potentially the same impact on autism as it has had on the perception of schizophrenia, the Spain paper is an important addition to the research literature. I say this not solely because of how issues such as perseveration and rumination potentially linked to the perpetuation of paranoia are not uncommon in cases of autism [2] but also because of the still evolving story around how autism and schizophrenia might, on occasion [3], overlap (see here). The idea that social anxiety and depression might be something else important to the clinical regions of paranoid thought [4] also ties in with evidence on the over-representation of these labels/behaviours alongside some autism (see here).

Appropriate clinical screening is, once more, implied as and when any suspicions about the presence of chronic paranoid thinking occur when autism is diagnosed; not least because of the potential for progression into the clinical realms of schizophrenia (with caveats) and related labels. That paranoia combined with ruminative thinking and/or worry [5] for example, can in some circumstances be absolutely disabling for a person is also a good reason why intervention should be very, very seriously considered...

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[1] Spain D. et al. Conceptualising paranoia in ASD: A systematic review and development of a theoretical framework. Research in Autism Spectrum Disorders. 2016; 25: 97-111.

[2] Pugliese CE. et al. The role of anger rumination and autism spectrum disorder-linked perseveration in the experience of aggression in the general population. Autism. 2015 Aug;19(6):704-12.

[3] Woodbury-Smith MR. et al. Autism spectrum disorders, schizophrenia and diagnostic confusion. Journal of Psychiatry & Neuroscience : JPN. 2010;35(5):360.

[4] Carroll A. Are you looking at me? Understanding and managing paranoid personality disorder. Advances in Psychiatric Treatment. 2009; 15: 40-48.

[5] Startup H. et al. Worry processes in patients with persecutory delusions. Br J Clin Psychol. 2016 Mar 20.

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Spain, D., Sin, J., & Freeman, D. (2016). Conceptualising paranoia in ASD: A systematic review and development of a theoretical framework Research in Autism Spectrum Disorders, 25, 97-111 DOI: 10.1016/j.rasd.2016.02.002