Unraveling the roots of paranoid thinking: The role of childhood maltreatment, failures in mentalizing, and defense mechanisms

Paranoid thinking is characterized by an unwarranted mistrust and suspicion of others, often culminating in beliefs that others intend to cause harm. This type of thinking can vary from within normal limits to pathological extremes, where it manifests as intense fears of persecution, conspiracy, or betrayal that severely affect mental and relational functioning. In the psychoanalytic literature, paranoid thinking has been linked to experiences of parental humiliation, failures in reflective functioning, and primitive defense mechanisms such as projection and splitting. This study aimed to test a model of paranoid thinking where the relationship between childhood maltreatment and paranoid thinking is mediated by uncertainty about mental states and primitive defenses. A sample of 461 adults (142 males, 30.8%), aged 18 to 69 years, completed self-report measures on child maltreatment, failures in mentalizing, defense mechanisms, and paranoid thinking. A serial mediation analysis showed that child maltreatment positively predicted paranoid thinking, with this relationship being partially mediated by uncertainty about mental states and primitive defenses. The findings suggest that in treating individuals with paranoid thinking, clinicians should focus not only on working through traumatic memories but also on enhancing mentalizing abilities and promoting the use of more mature defense mechanisms.