Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Mar 1;43(2):332-343.
doi: 10.1093/schbul/sbw161.

The Clinical Features of Paranoia in the 20th Century and Their Representation in Diagnostic Criteria From DSM-III Through DSM-5

Kenneth S Kendler  1   2   3
Affiliations
Review

The Clinical Features of Paranoia in the 20th Century and Their Representation in Diagnostic Criteria From DSM-III Through DSM-5

Kenneth S Kendler. Schizophr Bull. .

Abstract

This review traces, through psychiatric textbooks, the history of the Kraepelinian concept of paranoia in the 20th century and then relates the common reported symptoms and signs to the diagnostic criteria for paranoia/delusional disorder in DSM-III through DSM-5. Clinical descriptions of paranoia appearing in 10 textbooks, published 1899 to 1970, revealed 11 prominent symptoms and signs reported by 5 or more authors. Three symptoms (systematized delusions, minimal hallucinations, and prominent ideas of reference) and 2 signs (chronic course and minimal affective deterioration) were reported by 8 or 9 of the authors. Four textbook authors rejected the Kraepelinian concept of paranoia. A weak relationship was seen between the frequency with which the clinical features were reported and the likelihood of their inclusion in modern DSM manuals. Indeed, the diagnostic criteria for paranoia/delusional disorder shifted substantially from DSM-III to DSM-5. The modern operationalized criteria for paranoia/delusional disorder do not well reflect the symptoms and signs frequently reported by historical experts. In contrast to results of similar reviews for depression, schizophrenia and mania, the clinical construct of paranoia/delusional disorder has been somewhat unstable in Western Psychiatry since the turn of the 20th century as reflected in both textbooks and the DSM editions.

Keywords: DSM; Kraepelin; delusional disorder; history; paranoia; psychiatric nosology.

PubMed Disclaimer

References

    1. Kraepelin E. Psychiatrie: Ein Lehrbuch fur Studierende und Aerzte (6th Ed. 2 vols.). 6th ed. Leipzig, Germany: von Barth Verlag; 1899.
    1. Kraepelin E. Psychiatry, A Textbook for Students and Physicians (Translation of the 6th Edition of Psychiatrie-Translator Volume 2-Sabine Ayed). Translator Volume 2-Sabine Ayed, Translation of the 6th Edition of Psychiatrie ed. Canton, MA: Science History Publications; 1990.
    1. Schifferdecker M, Peters UH. The origin of the concept of paranoia. Psychiatr Clin North Am. 1995;18:231–249. - PubMed
    1. Percy Smith R. The Presidential Address, on Paranoia, delivered at the Sixty-third Annual Meeting of the Medico-Paychological Association, held in London on July 21st and 22nd, 1904. J Ment Sci. 1904;L:607–633.
    1. Dowbiggin I. Delusional diagnosis? The history of paranoia as a disease concept in the modern era. Hist Psychiatry. 2000;11:37–69. - PubMed

MeSH terms