Analysis of Life Narratives of Patients with Paranoid Delusions: A Qualitative Study

Abstract

This study aimed to analyze the life narratives of patients with paranoid delusions and identify the core components of their lived experiences. This qualitative study employed narrative analysis with a thematic analysis approach. Data were collected through McAdams’ semi-structured interview guide from patients diagnosed with paranoid disorder at Razi Psychiatric Hospital in Tehran. Purposive sampling was used, and interviews continued until theoretical saturation was reached with eight participants. Data were transcribed and analyzed through open, axial, and selective coding using MAXQDA software. Analysis revealed several overarching dimensions in patients’ narratives. Family dynamics and interpersonal interactions played a central role in shaping threat-related schemas. Early-life trauma, inconsistent caregiving, and chronic exposure to conflict were strongly inferred as precursors of persistent mistrust. Identity-related conflicts, negative self-evaluation, and heightened interpersonal sensitivity emerged as stable psychological patterns. Dysfunctional coping strategies—including avoidance, suppression, and withdrawal—were shown to reinforce paranoid ideation. Moreover, maladaptive defense mechanisms such as projection and denial contributed to misinterpretation of social cues and the consolidation of delusional beliefs. Thematic synthesis revealed shared structures such as externalized negative attributions, hypervigilance to threat, fragile self-coherence, and systematic misreading of ordinary interpersonal signals. The findings indicate that paranoid delusions arise from an interplay of developmental, emotional, cognitive, and social factors, reflected clearly in patients’ life narratives. Understanding these dimensions provides a foundation for therapeutic interventions targeting trauma processing, schema reconstruction, emotion regulation, and the strengthening of secure interpersonal functioning.