Paranoia: What is it?

Paranoia is a form of delusional thinking, where a person believes they are being persecuted or threatened when they are not. It is a symptom of several mental health disorders and can be successfully treated with medication and therapy.

What is paranoia?

Paranoia is a state of mind in which a person believes they are being persecuted or threatened, despite a lack of evidence. Paranoid thoughts are a form of delusional thinking, which is a belief in something that isn’t real.

Paranoia isn’t a diagnosis in itself, but it is a symptom of several mental health problems, including paranoid personality disorder, paranoid schizophrenia, and bipolar disorder, among others.

Paranoia symptoms

The main sign of paranoia is the delusions themselves. You may believe:^[1]

• People are talking about you behind your back, trying to damage your reputation, or are excluding you.
• You are being watched or followed.
• The things people say to you are intended as insults.
• You are being watched or followed.
• Your life is in danger.
• Someone is planning to take your money or your belongings.
• The government or some other power is monitoring you.
• Your thoughts are being controlled by someone or something.

As a result, a person with paranoia may display additional behaviors such as:^[2]

• Taking offense easily and being defensive.
• Being mistrustful of others and finding it hard to maintain relationships.
• Appearing aggressive or hostile towards other people.

What causes paranoia?

Research has identified several possible factors that can increase the risk of experiencing paranoia.^[1]

• People who have experienced childhood trauma and other difficult circumstances can become mistrustful, which can develop into paranoia
• Social isolation
• Sleep deprivation
• Certain drugs, such as cannabis, cocaine, LSD, and alcohol
• Genetics – there is some evidence that paranoia runs in families
• Some illnesses, such as dementia and Parkinson’s, include paranoia as a symptom
• Mental health problems, including paranoid personality disorder, paranoid schizophrenia, and bipolar disorder, among others

Mental health conditions linked to paranoia

Paranoia is a symptom of a number of mental health problems that are listed in the Diagnostic and Statistical Manual of Mental Disorders ^[3], which is used by mental health professionals in the US to diagnose mental health problems.

Paranoid personality disorder

Paranoid personality disorder has paranoia as a key symptom. This personality disorder is believed to affect between 2.3% and 4.4% of the population ^[3]. It is a personality disorder characterized by persistent mistrust of others, usually beginning in early adulthood. People with paranoid personality disorder are hypervigilant to signs that someone can’t be trusted, and, as a result, struggle to develop and maintain close relationships.

Delusional disorder

Delusional disorder may be diagnosed if a person experiences delusions – beliefs that aren’t real – for more than a month^[3]. These delusions can include beliefs that they are unusually important or talented, or that someone is in love with them. It can also include paranoid delusions, such as their partner is being unfaithful or that someone is trying to harm them.

Schizophrenia

Schizophrenia is a serious mental health condition that includes symptoms such as delusions, hallucinations, disorganized thinking and speech, and strange behavior ^[3]. Delusions often take the form of paranoid thoughts and beliefs, so much so that ‘paranoid schizophrenia’ is sometimes used to describe the condition in someone who frequently experiences paranoia.

Borderline personality disorder

Borderline personality disorder (BPD) is a mental illness characterized by an intense fear of abandonment, problems with self-image, and impulsive behavior ^[3]. People with BPD can experience paranoia when they are particularly stressed.

Bipolar disorder

Bipolar disorder used to be called manic depressive disorder and is a kind of mood disorder characterized by periods of both mania and depression.^[3] During mania, someone with bipolar disorder may experience delusions, which can take the form of paranoid thoughts and beliefs.

How to treat paranoia

As paranoia can be a symptom of a mental health problem, it is often treated within the context of a person’s diagnosis. The two main treatments are medication and therapy.

Medication

Medication will likely depend on what other symptoms are present but various types can help with paranoia. For example, people with schizophrenia, delusional disorder, or bipolar disorder may be prescribed an antipsychotic or mood stabilizer, which can help to lessen paranoid thoughts ^[1].

Therapy

The most common therapy for paranoia is cognitive behavioral therapy (CBT)^[1], which explores how we think and feel. CBT can be used to examine paranoid thoughts and beliefs and look at different ways of interpreting how people behave and treat us.

Other forms of therapy may include psychodynamic therapy, interpersonal therapy, or family therapy.^[1]

How to manage paranoia

There are several self-help techniques available to support people experiencing paranoia. It is typically recommended that these techniques are used alongside medication and/or therapy.^[1]

• Improve your general wellbeing. Generally improving our physical and mental health can help alleviate the symptoms of mental health problems like paranoia. Take steps to eat healthily, get some exercise, and form good sleep habits.
• Practice relaxation. Paranoia can worsen with stress, so trying to manage stress by practicing mindfulness or other relaxation techniques can help to reduce the risk of paranoid thoughts.
• Build a support network. Reach out to friends and family members you trust and confide in them about what you are experiencing. They will be able to help you question your thoughts and beliefs to test whether they may be rooted in paranoia.

It can be difficult to know if your thoughts are paranoid or not. To test whether a thought is paranoid, you can consider:^[1]

• Whether anyone else shares your view
• Whether there is any actual evidence for or against your beliefs
• Whether your belief is likely to be true

Keeping a journal of your thoughts as well as details of your stress levels, sleep patterns, and eating and exercise habits can help you identify when paranoid thoughts appear and whether they are triggered by things like stress or sleep deprivation.

Paranoia vs Anxiety: What’s the Difference?

Paranoia and anxiety are different but linked. Paranoid thoughts and anxious thoughts are similar in that they both stem from perceived threats. However, paranoia is rooted in delusional thinking surrounding a mistrust of and suspicion about others and their motives, while anxiety is usually a more general set of worries about events, activities, or circumstances.^[3]