Paranoia refers to intense fears and discomfort about one’s sense of safety in the world. Paranoia coincides with numerous mental health conditions, but it tends to be most prevalent in psychotic disorders, including schizophrenia.1 When someone has symptoms of paranoia, they can present as suspicious, distrustful, and hypervigilant. They may also become defensive if confronted.
What Is Paranoia?
Paranoia is a distortion of reality and mental perception of one’s environment. This results in someone believing they are threatened by a particular kind of outside force. Occasional or mild paranoia can exist on its own, particularly after real experiences of betrayal or trauma. However, persistent paranoia is often a symptom of other mental health conditions.
Below are some examples of paranoia:
- A person fearing the government is watching or tracking them
- A person believing there is a murder plot against them
- A person assuming that others are talking behind their back
- A person believing their partner is being unfaithful
- A person believing they are inherently superior to others
Anxiety Vs. Paranoia
Although symptoms may overlap, there are distinct differences between anxiety and paranoia. Someone with paranoia presents with chronic delusions related to a threat, conspiracy, or an evil sense of harm to self or others. Someone with an anxiety disorder might have some of these fear-based thoughts, but they do not inherently lead to such profound mistrust. Anxiety symptoms also tend to correlate with more self-doubt and feelings of insecurity, and those symptoms may not be inherently present with paranoia.
Symptoms of Paranoia
Symptoms of paranoia can manifest at any point in someone’s life. They can ebb and flow over time, and stress often exacerbates their intensity. Symptoms can also vary based on the presenting mental health condition.
Symptoms of paranoia may include:2
- Mistrust of others
- Increased isolation
- Reluctance to share personal information
- Finding hidden meanings in benign situations
- Having difficulty relaxing
- Stubbornness and hostility
Causes of Paranoia
Researchers haven’t pinpointed one specific culprit for paranoia. Instead, they have identified various environmental and genetic factors that may increase one’s likelihood of experiencing paranoia.
Possible causes of paranoia include:3
Having a history of trauma can make someone more susceptible to paranoia. Childhood trauma, in particular, fundamentally impacts the brain and can disrupt one’s sense of safety. If they have been hurt or threatened in the past, they might naturally fear history repeating itself in some form. People with post-traumatic stress disorder (PTSD) experience hypervigilance and avoidance behaviors as a result of their trauma.
Paranoia can be a symptom of schizophrenia. Schizophrenia is characterized by the presence of both positive symptoms (hallucinations and delusions) and negative ones (catatonia, anhedonia, and flat affect). Many people with schizophrenia experience heightened mistrust of the world.
Paranoia can be a symptom of bipolar disorder, and it can occur in either depressed or manic episodes. Paranoia can also be part of the psychotic features of bipolar disorder. In this case, the person develops delusions that can be grandiose or persecutory.
Paranoid Personality Disorder
Paranoia is the key symptom of paranoid personality disorder. This condition is chronic and characterized by profound mistrust of others coupled with the assumption that people will harm them. People with paranoid personality disorder struggle to form healthy relationships and consistently doubt someone’s sense of safety or loyalty.
Stress can aggravate all mental health symptoms, including paranoia. While it’s unlikely that any type of stress causes paranoia, toxic stress can weaken one’s emotional resolve and leave them more vulnerable to the effects of paranoid thoughts.
Lack of Sleep
Research shows that sleep deprivation is correlated with increased paranoia.4 Poor quality sleep is also associated with poorer mental health. People with insomnia or other sleep disturbances may be at a heightened risk for paranoia.
Certain drugs, such as cocaine, hallucinogens, Adderall, methamphetamine, marijuana, and alcohol can coincide with paranoia. Furthermore, substance abuse often worsens other mental health conditions, which might exacerbate the problem.
Peer or Familial Influence
Peer influence can make someone more prone to mirroring paranoid thought patterns. Some research shows that people who feel powerless look to conspiracy theories for a sense of comfort. Within certain communities, they may find kinship over shared mistrust.5
Paranoia may coincide with specific conditions, including Alzheimer’s disease, dementia, Parkinson’s disease, strokes, HIV/AIDS, and Huntington’s disease. Some research shows that hearing loss may also be a risk factor for paranoia.6
How Is Paranoia Diagnosed?
It can be challenging to obtain an accurate diagnosis of paranoia. People with paranoia may be suspicious or wary of healthcare professionals, which limits them from seeking help. Other times, symptoms present as comorbid with other physical or mental health conditions.
Depending on the presenting symptoms, a qualified doctor or mental health professional will evaluate the full continuum and symptoms and may use various psychiatric scales like the paranoia Worries Questionnaire (PWQ) or Bird Checklist of Adolescent Paranoia (B-CAP) to rule out specific diagnoses.
Treatment for Paranoia
Paranoia can erode one’s mental and physical health and cause significant rifts within interpersonal relationships. That said, collaborative treatment can make a difference in reducing or eliminating certain symptoms. Treatment is often multifaceted and may include a combination of talk therapy, medication, and lifestyle changes. The length of treatment largely varies based on the individual’s situation.
Therapy for Paranoia
Therapy can be effective in helping a person understand, recognize, and work through their paranoia. It’s often the first-line mental health treatment. When considering whether you need therapy for paranoia, it’s crucial that you find a therapist who you feel is competent and supportive. It’s normal to be skeptical or distrustful at first. But the right provider will not judge these feelings, and they will strive to provide a safe environment for you.
Therapy options for paranoia include:
- Cognitive-behavioral therapy (CBT): CBT can help people understand the relationship between their thoughts, feelings, and behavioral responses. By challenging negative or distorted thoughts, you typically feel better and react in healthier ways.
- Group therapy: Group therapy provides peer support and can help people better understand their behavior within the context of social relationships.
- Family therapy: Family therapy can be helpful if a child or adolescent struggles with paranoia. Family members can learn how to support and appropriately intervene with the child.
- Experiential therapy: Experiential therapy is often beneficial for people who struggle with traditional talk therapy. Experiential therapy may include activities like music, art, dance, and psychodrama.
Medications for Paranoia
Some doctors or psychiatrists may prescribe psychiatric medication for people experiencing paranoia. Antipsychotic medications can help reduce the intensity of paranoid thoughts, and they are often prescribed for people with schizophrenia, delusional disorder, bipolar disorder, or other psychotic disorders. Depression medication or anxiety medication may also be prescribed in the presence of comorbid diagnoses.
How to Cope With or Prevent Paranoia
You may not be able to stop paranoia completely, but you can take steps to manage symptoms when they arise. You can also consistently engage in healthy coping mechanisms to reduce stress, which may reduce certain symptoms from emerging.
Below are ways to help you cope with or prevent paranoia:
- Get enough sleep: Prioritize regular, high-quality sleep. Stick to a consistent schedule and practice mindfulness exercises if you struggle to fall or stay asleep.
- Maintain a healthy diet: Make sure to eat regularly and choose nutritious foods that give you energy.
- Refrain from substance use: Many substances intensify paranoid symptoms. If you’re in recovery, stick to your relapse prevention plan.
- Set media limits: If certain news outlets or media sources make you feel paranoid, set boundaries around them. Consider taking a break altogether.
- Engage in meaningful activities: Try to spend your free time engaging in passions that make you feel good about yourself. While these can act as a distraction, they also help make life feel more fulfilling.
- Practice cognitive restructuring: Try to remind yourself that there are often alternative perspectives to every situation. The next time you feel sure about something, try to consider how someone else might perceive the situation.
- Avoid isolating: Paranoia often festers when you’re alone. As much as possible, aim to stay connected to positive peer support.
- Take medication as prescribed: If you’re prescribed medication for paranoia or other mental health symptoms, don’t reduce your intake or stop taking it altogether before consulting with your doctor.
Living with paranoia can range from feeling somewhat frustrating to downright debilitating. However, the right treatment will help you manage your symptoms. If you are experiencing paranoia, commit to seeking help. Even if you feel nervous, the right therapist can make all the difference.