Paranoia vs. Anxiety: How to Spot the Difference

What is Paranoia?

Paranoia is intense suspicion that a person is being targeted by others who wish to harm them in some way.¹ A person may have mild paranoid thoughts on one end of that spectrum, or they may be distraught by precursory delusions at the other end of that spectrum, which can cause distress and functioning problems, and is a potential criterion in schizophrenia spectrum and other psychotic disorders.¹

Paranoid symptoms can also be seen across different diagnoses such as hallucinogen intoxication and other substance use disorders, paranoid personality disorder, and personality change due to medical condition.² While paranoia can be a prominent symptom, it is not a diagnosis in and of itself.³

Common traits and thoughts related to paranoia include:

• Persecutory delusions
• Suspiciousness of others
• Distrust in others
• Isolating from others
• The belief that others will harm you
• Beliefs that others are plotting against you

Note that one of the major aspects of paranoia is that it is based on the inaccurate or exaggerated estimation of others’ actual harmful intent toward the person.⁴

What is Anxiety?

Anyone may experience feelings of anxiety across any point in their life, the feeling is usually one of worry in anticipation that something in the future may go badly.²

There are also several diagnoses where anxiety symptoms are centered, and there are multiple types of anxiety disorders that are accompanied by other symptoms as well.

Anxiety-related traits and thoughts include:

• Excessive worry about the future
• Nervousness
• Tension
• Physical symptoms like nausea or sweating when worried about the future
• Attention on anticipating danger
• Fear of unknowns and uncertainty in future⁵

Differences Between Paranoia & Anxiety

When looking at paranoia on a spectrum from mild paranoid ideation to paranoia traits in diagnoses within Psychosis related disorders, the latter part of the spectrum has criteria such as delusions which can be linked to paranoia. Whereas when looking at anxiety on a spectrum, within the multiple anxiety disorder diagnoses, delusions aren’t a criterion linked to anxiety. ²

Similarities Between Anxiety & Paranoia

The shared point of paranoia and anxiety is that they both deal with a type of worry.⁶ In one instance, the person is worrying about potential negative things happening in the future (anxiety), and the other instance the person is worrying about others harming them in the future (paranoia). For some individuals, both anxiety and paranoia can also bring about distress and problems functioning, and that is a time when it is especially valuable to get in contact with a healthcare provider.

Can Paranoia & Anxiety Be Co-Occurring?

A person can definitely experience both feelings of anxiety, and paranoia-influenced thoughts. Studies show that it is quite likely for people with high paranoia to also experience anxiety, but people with anxiety are not as likely to experience paranoia.⁶ For example, when a study looked at individuals with comorbid schizophrenia and anxiety disorders, over 63% of participants had paranoid delusions.⁷

How Are Anxiety & Paranoia Diagnosed?

As mentioned before, neither anxiety nor paranoia are diagnoses within and of themselves, but they can be parts of other diagnoses, which a provider can help you best sort out. Sometimes a person only experiences traits or symptoms of a disorder but does not fit the diagnosis completely, and that is not unusual. Overall though, a provider will usually make a diagnosis after a psychological evaluation which can include verbal questions on symptoms, mental health history, assessments, and sometimes lab tests if necessary. A person can go to their primary healthcare provider, which might refer them to a mental health provider, or they can go to a mental health provider directly.

Anxiety

There are multiple anxiety disorders, and they are usually diagnosed with a clinical interview where a provider considers all of your symptoms and history. Then, they compare these symptoms to the diagnostic criteria in the most recent edition of the Diagnostic and Statistical Manual (DSM-5TR), the reference most often used to diagnose mental health conditions.

There are also many anxiety assessments that may help with diagnosing conditions, such as The Beck Anxiety Inventory, and new emerging measures from the DSM-5TR like the PROMIS Anxiety for Emotional Distress and Anxiety, or other more disorder-specific tests depending on what your provider might think is necessary for diagnosis.⁸

Paranoia

Somewhat similar to seeing a provider for anxiety symptoms, when coming to a provider with paranoid-type thoughts, the provider will likely ask you about your symptoms, take your history, look at your medical records, and might also choose to have you do some labs if they think it is necessary to help with the diagnosis or ruling other diagnoses out.

Treatment for Anxiety & Paranoia

It is most important to note that if you are distressed, concerned, or uncomfortable with either your symptoms of anxiety or paranoia or both, consider reaching out to your physician or mental health care provider and sharing your concerns. Even if you are just curious about your symptoms, reach out for help and inquire about it. It is also important to share all your symptoms with a provider and be very transparent because you want to make sure that all your needs are being addressed, and if your provider discussed medication with you, make sure they are aware of all symptoms.

Treatment for Paranoia

Different treatments may be used for different types of disorders that have paranoia symptoms. Medication and talk therapy are two approaches that work well together when it comes to schizophrenia spectrum and other psychotic disorders.⁹ These are just three major approaches, but your provider might advise you try other evidence-based approaches too.

Treatment options for paranoia include:⁹

• Medications: This is where a psychiatrist will help the individual see if there are any specific types of pharmacological treatments that can help them with symptoms, as medications have been shown to help with the improvement of symptoms.
• Cognitive behavioral therapy (CBT): CBT for psychosis (CBTp) is recommended by the APA and can help with psychoeducation and improvement of functioning.
•  Assertive Community Treatment (ACT): Assertive Community Treatment is especially helpful for people with comorbid disorders and those who need a little extra help than just outpatient services offer, because it provides access to a team of people to help with medication management, case management, and other resources.

Treatment for Anxiety

Anxiety disorders can vary, and so can the treatments for them. Depending on your symptoms and their severity, your provider could suggest talk therapy or medications for anxiety. Here are some of the major approaches, but every individual is unique, so your provider might advise other evidence-based approaches as well that better fit for you.

Treatment options for anxiety disorders include:

• Cognitive behavioral therapy (CBT): CBT for anxiety is an evidence-based approach that helps a person recognize and adjust their thoughts and beliefs which in turn can help have a positive influence on their feelings and behaviors.
• Exposure and response prevention therapy (ERP): ERP is most helpful with anxiety disorders that have to do with phobias, and it works by helping the individual gently work on facing their phobia with the help of a therapist.
• Acceptance Commitment Therapy: ACT is a type of evidence-based approach works by helping the individual recognize and accept their anxious thoughts, and then helps them commit to making changes and living life in a way that more closely aligns with their values, as that is more what is in their control.
• Medications: This is an area where your psychiatrist will help you if you both feel it is a fit to try medication if it is best for you and the anxiety disorder you have. The FDA has approved many medications for anxiety disorders, such as SSRIs, SNRIs, etc.¹⁰ This is best reviewed with your psychiatrist but can be helpful in treatment for some individuals. Medication prescriptions are also accessible through online psychiatry options.

How to Cope With Paranoia or Anxiety

Paranoia and anxiety often share the concept of worry, and in that area mindfulness, journaling, social support, and self-care are shared coping skills that have been shown to help both. You should not have to go at it alone though, if your symptoms feel uncomfortable or concern you, reach out to a healthcare provider.

Healthy coping skills for dealing with paranoia or anxiety include:

• Social support: Social support from family, community, friends, etc. is noted as beneficial by the APA as a coping skill.¹¹ Getting help, support, and comfort from others may be able to help you in your journey to feeling better.
• Practicing mindfulness: In psychotherapy, mindfulness practice has been shown to help across many mental health diagnoses, and it does so by having the individual be more present in the moment, bringing about a calmer, clearer mind.^12,13,14 You may be able to find mindfulness apps, mindfulness classes, mindfulness books, etc. to help you with practicing it.
• Journaling: Although there still needs to be more research done on journaling for mental health benefits, it is low cost and easy to utilize, and very flexible as a person can use it to journal about gratitude, just let out their feelings onto paper, or track their symptoms and triggers for more insight.¹⁵
• Self-care: This is a coping skill for general well-being, which can have a positive effect on a person’s mental health.¹⁶ Self-care means taking care of yourself. Some things you can do regularly are: Exercise, get quality sleep, be hydrated, eat well, do activities that you enjoy, and anything else you think is important and safe for you to do in your routine for overall wellness.

Final Thoughts

Whether you’re experiencing anxiety or paranoia or both, there are professionals that can help you and set up a treatment plan with you. Finding a therapist you connect with is easier with an online therapist directory. Look for someone with the appropriate experience and training to meet your needs with paranoia. Be transparent and honest with your provider for the best treatment planning. You’re not alone, and things can improve.