Is Everyone Out to Get Me? Paranoia in Social Interactions

In this episode, Under the Cortex hosts Michal Hajdúk from Comenius University Bratislava, Sohee Park from Vanderbilt University, and Amy Pinkham from The University of Texas, Dallas to discuss their new paper in Clinical Psychological Science titled “Paranoia: From Passive Social-Threat Perception to Misattunement in Social Interaction.” The conversation with APS’s Özge G. Fischer-Baum starts with what paranoia is in a clinical context and how it differs from the use of paranoia in an everyday context. They also discuss proposed improvements for how to clinically test the social impacts of paranoia. 

Send us your thoughts and questions at [email protected].

Unedited transcript

[00:00:09.470] – APS’s Özge G. Fischer Baum

Navigating life with suspicion can feel like an emotionally taxing experience. The persistent worry that there may be individuals who are out to harm you can leave you feeling isolated and drained. Living with paranoia is a clinical condition that has been the subject of psychological research for decades. This is under the cortex. I am Özge Gürcanlı Fischer Baum with the Association for Psychological Science. To understand the complexities of living with paranoia, I’m joined by Michal Hajdúk from Comenius University, Bratislava, Sohee Park from Vanderbilt University, and Amy Pinkham from the University of Texas at Dallas. They recently published an article in APS’s journal, Clinical Psychological Science. Today, we are going to discuss the interactional nature of paranoia, which is a fresh perspective in the field. Michal, Sohee, and Amy, thank you for joining me today. Welcome to Under the Cortex.

[00:01:14.240] – Sohee Park

Thank you.

[00:01:14.980] – Amy Pinkham

Thank you. You’re happy to be here.

[00:01:17.120] – APS’s Özge G. Fischer Baum

Great. I want to start right away. I want to hear about your personal interest in this topic a little bit. What got you interested in studying paranoia?

[00:01:29.330] – Michal Hajdúk

It’s quite a long time ago when I was a PhD student, and I remember I was interested in social cognition in schizophrenia. Then I read, I think, two or three articles written by Daniel Freeman, who is a professor of psychology now at Oxford University. I thought, Okay, this is something interesting. It’s related to my topic. After that, I realized that my topic of my PhD studies on this topic are really closely connected.

[00:01:54.510] – APS’s Özge G. Fischer Baum

What about you, Sohee?

[00:01:57.020] – Sohee Park

I think it goes back to my broad interest in social perception and cognition in how we might understand another person’s thoughts and feelings and so on. And we do this by generating our own theories and hypothesis about other people’s internal states. So most of the time we do this really quickly and automatically and accurately, because much of our everyday interactions are mundane and predictable, right? And we know the formula. But when there’s a certain change or uncertainty and anxiety, then the brain has to work much harder generate more complex theory. So these theories will generate other people’s minds sometimes, and it leads to wrong conclusions. I thought that was really interesting how people form hypothesis about other people’s intentions and feelings, and there’s a parallel to those. Basically, it’s an interest in social cognition.

[00:02:50.370] – APS’s Özge G. Fischer Baum

Yeah, your paper is great. We are going to talk more about it. But before that, Amy, how did you first start studying paranoia?

[00:03:00.660] – Amy Pinkham

So my story is quite similar. I’m also interested in social cognition and had been studying the way that we process social information and how this can be impaired in individuals who have schizophrenia. And as I was doing that, I just became very interested in how some people with schizophrenia could be paranoid, and some people were not at all. How sometimes people who were paranoid were paranoid about very specific things, whereas others had much broader paranoid thoughts. And then somehow, even though people were paranoid, they felt comfortable telling me all about the things that they were paranoid about. And there were a lot of questions that came up to me when I was thinking about all of this in terms of just, how does this work? And what makes some people paranoid and some people not? And what makes some individual exempt from those paranoid thoughts versus not? And it became, to me, very interesting as a phenomenon in its own right, and not necessarily something that was linked specifically to schizophrenia or to mental illness, but that I could also see in all the people that I ran into on a daily basis, diagnosed or not.

[00:04:12.670] – Amy Pinkham

Everybody has some level of suspicion sometimes. It became a great question is, when does that become problematic and when does it become paranoid, and when does it start to cross these lines? I feel like there’s just a lot that we don’t quite know yet.

[00:04:28.420] – APS’s Özge G. Fischer Baum

Right. That’s a very important point We all get suspicious at times, but when is it important? When is it interrupting our life? Which brings me to my next question. How would you say the clinical definition of paranoia differs from how it is colloquially used?

[00:04:47.980] – Michal Hajdúk

We usually use one definition which is quite old. It’s like unfounded belief that other people want to cause us some harm. But I think it’s a very nice definition to some extent. But since then, there was a lot of different studies that pointed different aspects of paranoia. I think clinical settings consider paranoia as usually something more severe, like persecutory delusions. But as Amy mentioned, in general population, it means something different. We know it’s nothing like one single paranoia. It’s multidimensional contract which consists of different things like social evaluative concerns, suspiciousness, and maybe on the top of pyramid are persecutory ideation and delusions. I think people, when they use paranoia in everyday life, they more refer to the suspiciousness than persecutory delusions or persecutory ideas. It’s something different, but closely related. We know that people are socially anxious, and people who can be socially anxious, they’re more prone to being paranoid, for example.

[00:05:52.580] – APS’s Özge G. Fischer Baum

Yeah, let’s talk about that a little bit. How would you say are the most common misconceptions about paranoia? You mentioned one, you said people usually think it is only about being suspicious. What are the other misconceptions out there?

[00:06:09.420] – Amy Pinkham

I think one is this idea that paranoid has to be related to a mental illness, right? That if someone is paranoid, that means that they are mentally ill. One of the things that we’ve learned over the past several decades in terms of research on paranoia is that it really seems to exist on a continuum. So there are people who are otherwise completely psychologically healthy who can be more paranoid than maybe a general member of the population. And then that can go all the way from these mild, socially evaluative thoughts all the way to things that are true persecutory delusions, where you believe that one specific person or organization or whatever is trying to harm you, kill you. It can get very extreme. But it’s really not just something that only happens to people who have a diagnosis. And so it’s It’s hard for us to figure out where it crosses over from something that’s normative into something that becomes problematic and potentially clinically relevant. And I guess the other thing is that it’s not specific to schizophrenia. Several different diagnosis can have paranoid thoughts included as part of that experience. And so we see significant paranoia in bipolar disorder, in many of the anxiety disorders, sometimes even in depression.

[00:07:27.700] – Amy Pinkham

So it’s not, I think, as narrow as people used to think about it.

[00:07:32.510] – Sohee Park

Yeah, Amy and Michal both made really valid points about common misconception. Another one might be the misconception paranoia is a permanent feature of a person that’s residing in a person. That’s not true Even when clinical levels of paranoia are observed at time one, it doesn’t mean it will be observed at time two. So paranoid ideation fluctuates and it is treatable. So I think that’s an important point to make. Yeah.

[00:08:00.040] – APS’s Özge G. Fischer Baum

Let’s talk about that a little bit more, too. So how then has psychology typically studied and conceptualized clinical paranoia?

[00:08:09.310] – Sohee Park

In psychology, people, in general, have typically studied paranoia In a cognitive framework, it’s usually concept in terms of attribution errors, for example, incorrectly attributing negative intentions to other people in order to try to understand what has happened or is happening. So it might involve something like jumping to conclusions, faulty attributions, and so on. But it’s much more nuanced than just faulty cognition. It involves, as it was mentioned before, a lot of anxiety, fear, uncertainty, and safety behaviors. So we have to gain some control of anxiety and worry for any treatments to be successful and reducing paranoia ideation. But I would say in general, the field has focused a lot on more, mostly on cognitive aspects of paranoia.

[00:08:59.990] – Michal Hajdúk

I think it’s very important to distinguish between restate paranoia and trade paranoia because you can see that being paranoid in some occasions can be quite adaptive. In other occasions, if it’s too much paranoia in that situation, it’s not very adaptive. But We know that some people have a score very high on trait paranoia, and they cannot adapt to the changing environment. We need to understand that people can really defer how they perceive the situation. For example, if you are with somebody who are familiar with, we can expect that these people are less paranoid in that situation. But if you need to meet somebody who is new to you, so you can experience much more anxiety, and these feelings can really trigger your paranoid thoughts. This is one of the main argument of our article that we need to understand how paranoia can dynamically change from time frame. It can change as any study, for example, during several days, but it can also change within the day. We see a lot of fluctuation in paranoia and in patients with schizophrenia, also with other disorders. This is, I think, crucial for understanding what trigger paranoia based on different types of situation.

[00:10:07.180] – APS’s Özge G. Fischer Baum

It definitely has a survival value. If I am walking back at night to my home with my key in my hands, there’s a value of me being paranoid, looking back if somebody is following me. But if I bring the same thoughts in the morning when I’m going to the gym, it’s a different type of conception. Yeah, definitely. Your paper provides a fresh perspective. The key purpose of your paper is that there is something missing from the current treatment of paranoia. What would you say those missing elements are and why do they matter?

[00:10:43.620] – Michal Hajdúk

I think the main point of our article is that people who are paranoia are not passive. They are not only receiving information from their surroundings and from the context. So they are very active in social interaction. And what we really that we need to take account that when we are in social interaction, we are not alone, and we need to also understand the role of our social partner. And this is something which can be quite difficult to measure or to study because we usually use approach which is very decontext-wise. For example, we can use images of faces, and we can ask people to rate how trustworthy they are. But in a real life, we do not have time for this, and we need to dynamically adapt to changes in the situation. We know that other factors, for example, in schizophrenia, people who have cognitive impairment, can have difficulties with adjusting the situation. It’s about interplay between positive symptoms or paranoia and other problems people can have. I think what is noble and important is really to understand the paranoia from both perspectives, to be maybe target of paranoia and being somebody who is paranoid because from a phenomenological level, it’s totally different experience.

[00:11:59.720] – Michal Hajdúk

Sense.

[00:12:01.280] – APS’s Özge G. Fischer Baum

Right. And your paper brings this interactional aspect to studying paranoia. That’s why it brings a fresh perspective. Let me ask you a little bit about the details of the possibility of studying paranoia. How might someone socially test paranoia in a controlled experimental setting?

[00:12:23.440] – Michal Hajdúk

I think it’s very tough. What we propose that we need to utilize new methods and measures which are based on second-person neuroscience. It’s approach which really try to model dynamic interactions. It’s not only about looking at the pictures, but we try to understand the social interaction itself. There are options how to study. I think the way how you can study is quite simple. You put two people into interaction and then you are measuring things from heart rate, skin conductance level, to perception of that interaction. Also, we can measure psychopathology before the interaction. You can put everything together Now we have quite a lot of options to quantify how people align during that interaction. We can, for example, if they smile at the same time, if they look into the eyes together, and if you have EEG, you can measure if they synchronize on their own level. So there are quite a few options.

[00:13:20.080] – APS’s Özge G. Fischer Baum

Sohee, do you have things to add?

[00:13:22.830] – Sohee Park

Yeah, I think there’s new ways of looking at it. For example, in the past, we have used that to eye-tracking patterns and eye gaze information to see whether if there’s a conjoint attention and social attention, this whole range of tasks that have been developed over the years. What’s really exciting is the use of immersive virtual reality now. You can simulate or generate social environment in VR, and you can enter that situation. You can manipulate the social context to increase levels of uncertainty or anxiety. And you can study the impact of this change in environment on paranoia-related behavior and self-report measures. So for example, Katrina Stegmai and Bern, University of Bern has looked at interpersonal distance regulation in relation to paranoia. So you can look at your comfort level for interpersonal distance. How comfortable do you feel when a person is standing at this distance versus further distance? Dan Freeman at Oxford, he has developed a really fascinating paradigm using immersive VR to study and develop treatment for paranoia. So they create London underground VR game. So you enter this underground and then you have to interact with people in there. And they found that people are high on anxiety and negative self-image, more likely to jump to paranoid thoughts and so on.

[00:14:58.660] – Sohee Park

So they found But what’s interesting, from such studies, they found that persecutory delusions are really common across general public. So after such paranoia induction scenario, you can measure levels of paranoia to see who might be most susceptible to these manipulations. You can also use experimental measures to measure paranoia. For example, you can measure interpersonal distance. You can measure how synchronized you might be with another person. So you can use a lot of methods. And of course, you can look at self and health report measures. So I think it’s been a very interesting golden age of paranoia research, and there’s a lot to be done. And I just wanted to actually mention that Michal and Amy have founded this group called International Consortium of Paranoia Research. They’re directing a very large scale international study, I think first time ever, to look at the state of paranoia across really a very large group of multiple nations across different nations. So I I think there’s just experiment paradigms using technology, but also much larger scale international studies going on as well.

[00:16:09.370] – APS’s Özge G. Fischer Baum

Yeah, I have so many questions. So you talked about alignment in this social context, and you also talked about the importance of synchrony. What do you mean by synchrony in the context of paranoia and social interactions?

[00:16:30.440] – Amy Pinkham

So synchrony, just in general, refers to how closely two individuals align when they’re having a conversation or when they’re interacting, not just when they’re having a conversation. An example of two people being in synchrony would be if you start walking with someone and then you two fall into step together, that would be a good indication of synchrony. You both are mimicking each other’s behaviors and physical actions, and that helps promote feelings of closeness and understanding between the two people in the interaction. So the opposite side of that, asynchrony, would be when there is a lack of alignment between the two individuals. One of the things that we think could be really interesting to examine is whether or not individuals who are paranoid would show greater synchrony with other people who are also paranoid. So would they align more easily? Almost because they’re coming from a similar starting point. And then what impact impact would that then have on subsequent social interactions? And on the opposite end of that, if we have someone who is very paranoid and they’re interacting with someone who is not or who they just are not meshing well with, how then can that impact the interaction?

[00:17:45.280] – Amy Pinkham

And I think you can imagine an interaction where someone who is paranoid maybe starts to think, Okay, I don’t know this person I’m talking to. I don’t know if I can trust them. And so then they start acting differently in that interaction. The person that they’re interacting with responds to that and starts to also think this may not be going well. And then you just have this complete breakdown of that interaction that could end up making both people feel more negatively about what happened. And we think that that then could exacerbate these feelings of paranoia or contribute to the maintenance of paranoia. And so this is something that has been missing from the current research approaches. We have the person who’s paranoid and said, Okay, you are the one we’re interested in, and we want to know how you process social information and how you interpret things and how you act. But we realize it’s much more than that. It really is this interaction between that person and their environment, that person and other people. And there’s going to be feedback between all of that and loops between what’s happening on one side versus the other.

[00:18:50.550] – Amy Pinkham

That’s going to change the way the person is interacting and just behaving moving forward. We think we need to take all of that into account. Synchronic is one way that we might be able to quantify some of that connection between the two people.

[00:19:05.060] – Michal Hajdúk

You can measure different types of synchrony from physiological levels to neuronal level to behavioral level. We can see that maybe they can align on some level, but not on other level. I think our research program, which we propose, it’s very in line with our doc perspective. We need to use different levels of explanation from psychological level to neurobiological level, and it can help us to really differentiate mechanism behind paranoia.

[00:19:35.560] – APS’s Özge G. Fischer Baum

This was a very informative and wonderful conversation. I want to thank all of you. But before that, is there anything else that you would like to share with our listeners?

[00:19:49.350] – Michal Hajdúk

I have maybe one wish, and I hope that we will find studies who will test our hypothesis soon in articles because I think we outlined a lot of possible how to study it. I hope that people in the community, and I think it’s quite a large community of researchers who are interested in paranoia because it’s a very important topic, they will try it and we will see. Maybe we are wrong, but I hope not.

[00:20:14.210] – Amy Pinkham

I’ll Well, so he mentioned this earlier, but I just want to give one additional plug for our effort to organize Paranoia researchers and Paranoia research globally. We do have an organization called the International Consortium for Paranoia Research. We have a great website. And so if there are other researchers out there who are interested or just anyone in the community, we are open, we are transparent, but we would really like to promote research related to paranoia and make sure that we are trying to understand diverse and multiple perspectives, and that we’re moving forward with this research in a really open and inclusive way. As Sohe mentioned, I really do think we are at a golden age of trying to understand these things and being more insightful about them than we have been in the past. And so we want to keep that going, and we want to have as many people as possible join us in this effort. So that’s also there, and I’ll end on that.

[00:21:18.210] – Sohee Park

I think I’d like people to stay tuned for the outcome of the first international survey of paranoia, but maybe to end by saying that paranoia is about distrust, suspicion, social disconnection, and so on, right? So what society induces feelings of threat and disconnection such that members of the society would feel unsafe and suspicious? And what can we do to flip the script and maybe move towards a society built on trust, connection, and feelings of safety? So I think that’s important to bear in mind, especially as we seem to be lurching towards a world filled with this information and deep fakes and loss of connection and loneliness. So I think it’s basically… Yeah, I think it’s really important that we really study this together and try to find maybe some solution towards forming society that is more connected and more trustful.

[00:22:20.590] – APS’s Özge G. Fischer Baum

I want to say one thing for the researchers who are listening us out there. Your paper clearly really outlines a lot of points of possible research programs for the new researchers. Thank you for, first, creating this publication, and second, for joining me today. It was a wonderful conversation.

[00:22:46.440] – Sohee Park

Thank you. Thank you very much.

[00:22:49.370] – APS’s Özge G. Fischer Baum

This is Özge Gürcanlı Fischer Baum with APS, and I have been speaking to Michal Hajdúk from Comenius University, Bratislava, Sohee Park from Vanderbilt University, and Amy Pinkham from the University of Texas at Dallas. If you want to know more about this research, visit psychologicalscience.org.