Paranoid anxiety is a term used in object relations theory, particularity in discussions about the Paranoid-schizoid and depressive positions.
The term was frequently used by Melanie Klein, especially to refer to a pre-depressive and persecutory sense of anxiety characterised by the psychological splitting of objects.
Donald Meltzer saw paranoid anxiety as linked not only to a loss of trust in the goodness of objects, but also to a confusion between feeling and thought.
For the extreme forms of such anxiety, he coined the term ‘terror’, to convey something of the qualitatively different intensity of their nature.
Sigmund Freud considered that there was generally a small kernel of truth hidden in the exaggerated anxiety of the paranoid – what Hanns Sachs described as an amoeba about to become monster.
The anti-psychiatrist David Cooper argued indeed that “The therapist in working with people might far more often have to confirm the reality of paranoid fears than in any sense disconfirm or attempt to modify them”, but most family therapists would probably agree that this is an extreme and one-sided position.
Idealisation (as in the transference) can be used as a defence against deeper paranoid anxieties about the actual presence of a destructive, denigrating object.
Conversely, paranoid fears, especially when systematised, may themselves serve as a defence against a deeper, chaotic disintegration of the personality.
Persecutory Anxiety State (Panic Attack) and Persecutory Delusion
Paranoid anxiety may reach the level of a persecutory anxiety state (a form of panic attack), including various levels of persecutory delusions (the preferred term to paranoid delusions).
Heavy drinking is said to sometimes precipitate acute paranoid panic – the protagonist’s unconscious hostile impulses being projected onto all those around.
Hamm in Endgame by Samuel Beckett has been singled out as a character driven by paranoid anxiety.
Noboru in The Sailor Who Fell from Grace with the Sea by Yukio Mishima is shown to have persecutory anxiety.