Paranoia

What is paranoia?

Paranoia is a way of thinking that involves feelings of distrust and suspicion about others without a good reason. It often involves thoughts that others are out to get you or are looking to harm you in some way. You can also have paranoid thoughts about threats to other people, your culture or society.

Paranoia varies in severity and can be temporary or long-lasting. It’s the most common symptom of psychosis — over 70% of people with psychosis have paranoia. But you can have mild paranoid concerns without having psychosis. In fact, mild paranoia is quite common in the general population.

Paranoia can be a type of delusion — an unshakeable belief in something untrue. Not all delusions are about feelings of being harmed or threats. For example, you might have a delusion that another person, often someone important or famous, is in love with you. This isn’t paranoia.

Types of paranoia

Paranoid thoughts tend to cluster into four subtypes:

• Mistrust: You’re overly suspicious of others’ intentions and find it difficult to trust others, even though there isn’t any or much evidence to justify these feelings.
• Interpersonal sensitivity: You tend to interpret others’ nonverbal language negatively. You assign negative meanings to other people’s remarks.
• Ideas of reference: These are false beliefs that random or irrelevant events directly relate to you. They can involve paranoia.
• Persecutory: You believe someone, or something, is mistreating, spying on or attempting to harm you (or someone close to you). You may make repeated complaints to legal authorities. Healthcare providers consider this type of paranoia a delusion.

In general, the severity of paranoia depends on how much:

• You believe the paranoid thoughts.
• You think about paranoid thoughts.
• The paranoid thoughts cause you distress.
• The paranoid thoughts interfere with your everyday life.

Many people experience mild paranoia at some point in their lives. This is nonclinical paranoia. It’s temporary and isn’t overwhelming or distressing. You can rationally think through this type of paranoia.

Severe paranoia is rare. Healthcare providers consider persecutory delusions to be severe paranoia.

What are the signs of paranoia?

Paranoia can look like many different things, including:

• Finding it difficult to trust others.
• Obsessing over the loyalty or trustworthiness of loved ones.
• Being overly suspicious of others’ intentions.
• Assuming people are saying negative things about you “behind your back.”
• Feeling like you’re being exploited.
• Persistently holding grudges.
• Thinking that people — even strangers — are out to get you.
• Difficulty coping with any kind of criticism.
• Assigning negative meanings to other people’s remarks.
• Being reactive or always on the defensive.
• Being hostile, aggressive and argumentative.
• Believing in unfounded conspiracy theories.
• Considering the world to be a place of constant threat.

What causes paranoia?

Researchers don’t know the exact cause of paranoia. But they think certain factors may contribute to it, including:

• Childhood trauma, especially bullying, and victimization.
• Environmental factors, like low socioeconomic status and social isolation.
• Intense or chronic stress.

Paranoia is a common part of psychosis, which is a state of being disconnected from reality. People with psychosis may have false beliefs about or experience things that aren’t real. Psychosis isn’t a condition. It’s a term that describes a collection of symptoms.

Moderate to severe paranoia can be a symptom of certain mental health conditions, including:

• Paranoid personality disorder (PPD): PPD is a mental health condition marked by a long-term pattern of distrust and suspicion of others without adequate reason to be suspicious. You often think that others are trying to demean, harm or threaten you.
• Delusional disorder: Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions. A delusion is an unshakable belief in something untrue. The belief isn’t a part of your culture or subculture, and almost everyone else knows this belief to be false.
• Schizophrenia: Schizophrenia is a mental health condition that severely affects how you think, feel and behave. It often involves paranoia.

Is paranoia a form of schizophrenia?

You may have heard the term “paranoid schizophrenia.” This is an outdated name for a subtype of schizophrenia. Experts no longer use or recognize this term. Instead, experts recognize schizophrenia as a specific disease, which is part of a spectrum of related conditions that involve psychosis.

Paranoia is often a part of schizophrenia. But you can have paranoid thoughts without having schizophrenia.

Is paranoia a form of anxiety?

No, anxiety and paranoia are different. Anxiety causes fear, worry and a constant feeling of being overwhelmed. It’s characterized by excessive, frequent and unrealistic worry about everyday things, like job responsibilities, health or chores.

Anxiety is generalized worrying. Paranoia is more specific. It involves feelings of distrust and suspicion of others without enough evidence to support your concerns.

Another difference is that anxiety can be a diagnosable mental health condition, like generalized anxiety disorder or another anxiety disorder. Paranoia isn’t a specific mental health condition, but it can be a feature of one.

How is paranoia treated?

If you have mild to moderate paranoia without an underlying mental health condition, psychotherapy (talk therapy) may help. With the guidance of a mental health professional (like a psychologist), you can identify and change unhealthy emotions, thoughts and behaviors.

If you have an underlying mental health condition that’s causing paranoia, treatment varies based on the condition and its severity. It typically involves a combination of psychotherapy and medications, like anxiolytics and/or antipsychotic medications.

If you have severe paranoia and other severe symptoms of psychosis (like hallucinations), you may need to stay in a hospital until your symptoms stabilize.

What are the possible complications or risks of not treating paranoia?

If paranoia becomes long-lasting or more severe, it can cause significant distress and lead to issues like:

• Difficulty maintaining relationships.
• Job loss.
• Isolation.
• Anxiety and depression.

Because of this, it’s important to seek help if you or someone you know has persistent paranoia.

When should I see a healthcare provider about paranoia?

If paranoia is overwhelming your thoughts or negatively affecting your life, it’s important to see a healthcare provider or mental health professional.

People with severe paranoia may not want to see a healthcare provider due to feelings of mistrust and suspicion. If a loved one has paranoia, try to gently encourage them to seek medical help or ask your provider about how you can help them.