Paranoia

Paranoia is a pattern of thinking that involves intense, irrational distrust and suspicion. It can range from mild discomfort, nervousness, or unease about a situation or person to intense, distressing thoughts that can put mental well-being at risk. Anyone can experience slight paranoia symptoms occasionally; however, in people who have mental illnesses such as bipolar disorder, schizophrenia, and paranoid personality disorder, the experience of paranoia can be persistent, extremely unpleasant, and even dangerous.

Signs and Symptoms of Paranoia

How do you know if you or someone you love might have paranoia? Here are some signs:

• Defensiveness of imagined criticism
• Argumentativeness
• Difficulty forgiving others
  
• Hypervigilance
• Fear of being taken advantage of or deceived
• Inability to relax
• Mistrust of others
• Belief that others have hidden motives

Diagnosis

Paranoia isn't a diagnosis in and of itself. Instead, it's typically regarded as a symptom of (or diagnostic criteria for) an underlying physical or mental health issue.

Getting to the root cause of paranoia generally begins with a healthcare provider collecting the person's medical history. They may also perform a physical exam and order lab tests to rule out medical conditions such as Alzheimer's disease, dementia, Parkinson's, epilepsy, stroke, and brain cancer that can affect cognition.

If there are no medical issues, the person will be referred to a psychologist, who will do a psychological evaluation to better understand their symptoms and mental status.

Causes of Paranoia

The cause of paranoia isn't clear, but contributing factors might include:

• Age-related changes to hearing, sight, and other senses
• Certain medications such as Adderall (dextroamphetamine-amphetamine) and other amphetamines
• Genetics
• Social isolation, trauma and/or abuse, and major life changes (such as a job loss, death of a loved one, crime incident, or health crisis)
• Exposure to certain toxins, such as in outdoor air pollution
• Infections that can affect the brain, such as human immunodeficiency virus (HIV)
• Sleep deprivation
• Substance abuse, intoxication, and withdrawal
  

Paranoia and Mental Health Conditions

Paranoia can signal a physical health condition such as brain disease or stroke. Paranoia also occurs with certain mental health conditions, particularly those involving psychosis.

Borderline Personality Disorder (BPD)

In contrast to many other conditions in which paranoia is a fixed or continuous symptom, BPD-related paranoia is usually transient and occurs when stress levels are high.

Bipolar Disorder

Paranoid delusions can occur during manic or depressive episodes in bipolar disorder.

Psychotic Disorders

Paranoia and paranoid delusions can occur with psychotic disorders such as schizophrenia and schizoaffective disorder. Other symptoms of psychosis include:

• Disorganized speech
• Disordered thinking (thoughts jumping between unrelated topics)
• Hallucinations (hearing, seeing, or feeling things that aren't real)

Treatment of Paranoia

Treatment for paranoia depends on symptom severity and the underlying cause. A healthcare provider may recommend medication, psychotherapy, or—most frequently—a combination of the two.

Medication

Antipsychotic medication may be prescribed, particularly with underlying psychiatric conditions such as schizophrenia and bipolar disorder. Other medications that might be used include antidepressants, mood stabilizers, and anti-anxiety drugs.

Psychotherapy

Psychotherapy can help people with paranoia improve their coping and communication skills. It can also help the person "reality-test" aspects of their beliefs.

Therapy also can help people who are experiencing paranoia develop greater trust in others, find adaptive ways to manage and express their emotions, and improve their self-esteem and confidence.

Digital Treatments

Technology has changed the way paranoia and other mental health issues are treated. The options thus far include mobile apps, web apps, virtual reality, SMS, and more. In a 2024 research review, 30-40% of people who have psychotic disorders said they'd used these tools.

In particular, SlowMo therapy has shown success in helping people with paranoia develop healthier thinking patterns and reduce worry. The approach combines digital and in-person therapy to show people how to slow down fast thinking, notice their thoughts, and take in new information. A 2021 study with 361 participants showed benefits after using SlowMo, though more research is needed to understand its effects.

Coping With Paranoia

It's crucial to discuss feelings of paranoia with a healthcare provider or psychiatrist. If you've already been diagnosed with another mental health condition, the emergence of paranoid delusional thinking may be a sign that your treatment or medications need to change.

The Takeaway

The distressing symptoms of paranoia can disrupt activities at home, work, and school and affect your social life and relationships. Finding the most effective treatment may take time, but don't lose hope. There are resources and support that can help you learn to manage paranoid thinking and other aspects of living with a mental illness.