The term was frequently used by Melanie Klein,[1][2] especially to refer to a pre-depressive and persecutory sense of anxiety characterised by the psychological splitting of objects.
[3] 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.
[5] Freud considered that there was generally a small kernel of truth hidden in the exaggerated anxiety of the paranoid[6] - what Hanns Sachs described as an amoeba about to become monster.
[9] Idealisation (as in the transference) can be used as a defence against deeper paranoid anxieties about the actual presence of a destructive, denigrating object.
Heavy drinking is said to sometimes precipitate acute paranoid panic[13] – the protagonist's unconscious hostile impulses being projected onto all those around.