What Are Paranoid Delusions?

Paranoid delusions, or persecutory delusions, are fears, anxieties, and suspicions that someone may feel even though they are not based in reality. Someone with paranoid delusions may think that they are being victimized or threatened by external forces such as individuals or government authorities.

Unlike paranoia, paranoid delusions become so fixed that nothing can convince the person that what they think or believe is not valid.

Paranoid delusions are not classified as a distinct mental health disorder; instead, they are often a symptom of other mental health conditions such as schizophrenia, paranoid personality disorder, or delusional disorder.

What Are Paranoid Delusions?

Paranoid delusions are unfounded feelings that someone or some group is out to mistreat, harm, and sabotage you or someone close to you.

You may feel like someone is plotting against you and seeking to destroy your life without evidence of your claim. Irritability, anger, and low moods are characteristics of someone suffering from delusions.

A person with these delusions also believes in their perceived threats so much that no one, even those closest to them, can convince them that they are not real.

It is not uncommon for them to report their untrue or highly exaggerated claims to professional authorities.

Symptoms

Symptoms that might accompany paranoid delusions include:

• Intense and irrational feelings of mistrust or suspicion
• Hypervigilance
• Difficulty with forgiveness
• Defensiveness in response to imagined criticism 
• Preoccupations with hidden motives
• Fears of being deceived or taken advantage of
• Inability to relax
• Argumentative behavior 

These symptoms often make it hard for people with paranoid delusions to form and maintain interpersonal relationships.

Examples of Paranoid Delusions

People with paranoid delusions believe they are in danger due to external threats from specific people such as their spouse or parent, authorities such as the police or teachers, or groups such as a board or human resources department. 

They may say things like:

• "They are out to ruin my reputation."
• "They put tracking technologies in my medications." 
• "I know my employer put a camera in my home." 
• "If I leave the house, they will burn it down."
• "The government released a virus to kill me." 

Note that a subject is always acting as the threatening agent, whether it is an unspecified “they,” an authority figure like the government, or a specific person like a parental figure. 

Some people with paranoid delusions may avoid telling anyone about their beliefs due to sweeping suspicions that they cannot trust anyone. 

Causes and Risk Factors

There is no single cause for paranoid delusions. Many people experience them as part of an episode of a mental illness such as a psychotic or mood disorder.

Risk factors for paranoid thoughts include:

• Life experiences: You are likelier to experience paranoid thoughts in vulnerable, isolated, or stressful situations. 
• Adverse childhood experiences (ACES): These may lead you to believe that the world is unsafe and people are not to be trusted. 
• External environment: Some research suggests that paranoid thoughts are more common in communities where you feel isolated rather than connected to the people around you. Media reports of crime, terrorism, and violence may also trigger paranoid feelings.
• Mental health: Experiencing anxiety, depression, or low self-esteem, along with the expectation that others are criticizing you, may make you more likely to experience paranoid thoughts and become more upset by them. 
• Physical illness: Paranoia is sometimes a symptom of physical illnesses such as Huntington's disease, Parkinson's disease, strokes, Alzheimer's, and other forms of dementia. Hearing loss can also trigger paranoid thoughts in some people.
• Lack of sleep: Lack of sleep can trigger feelings of insecurity and even unsettling feelings and hallucinations. 
• Effects of recreational drugs and alcohol: Some drugs may trigger paranoia, such as cocaine, cannabis, alcohol, ecstasy, LSD, and amphetamines. 
• Exposures to toxic substances: Certain steroids taken by athletes as well as some insecticides, fuel, and paint are also associated with paranoia. 
• Genetics: Research suggests that certain (still unknown) genes may affect a person's susceptibility to paranoia. 

Diagnosis

Paranoid delusions are typically associated with other mental health conditions,

Under the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard classification of mental disorders, paranoid delusions that do not fit under a defined psychotic or other mental health disorder may be formally labeled as "unspecified schizophrenia spectrum and other psychotic disorder" or "other specified schizophrenia spectrum and other psychotic disorder."

Diagnosis of paranoid delusions related to delusional disorder may include:

• Conversations with supportive family or friends
• A general medical evaluation
• Diagnostic tests including an electroencephalogram, magnetic resonance imaging, or computed tomography scans when a neurological cause is suspected

Treatment

It can be challenging to treat a person with paranoid delusions, as the person can often be irritable, emotionally guarded, and even hostile.

The person suffering from the delusion may be suspicious of the intentions of mental health clinicians and may not even recognize that they are experiencing an illness.

Progress is typically slow, but recovery and reconnection are possible.

With sustained treatment, a person with paranoid delusions can enter remission. Specific treatments will depend on several factors, including the perceived cause of delusions and the person's receptiveness to accepting that they need help.

Their ongoing willingness to stay the course of any given treatment plan is also a considerable factor.

Treatment options for paranoid delusions typically take a combination approach and may include typical or atypical antipsychotic medications that can help reduce symptoms by blocking abnormal messages to the brain.

Cognitive behavioral therapy can help the person challenge and ultimately change conscious thought patterns related to their paranoia. 

In some cases, supervised drug or alcohol detox, hospitalization, or in-patient treatment may be necessary to reduce the risk of harm to the person and others if their paranoid delusions are related to a substance use disorder.

Supporting a Loved One

Supporting a loved one with paranoid delusions can be challenging. The risk of caregiver burnout is high due to the often chronic nature of such thinking patterns. 

The following ideas from the National Alliance on Mental Health come directly from someone who has experienced psychosis-associated delusions:

• Avoid disputing or reinforcing the delusions. It has the opposite effect, and the person may cling even harder to their delusions.
• Validate but redirect underlying fears. This can be useful for people with less severe symptoms and help them see alternate options to their beliefs without suggesting that the person is wrong. The formula could be like this: “I see what you’re getting at (regarding the unfounded suspicion). I think of it like this… (providing a reasonable explanation without insisting on its truth).”
• Understand this is an ongoing recovery process without any quick fixes. 

Also, consider the following ways you can support someone with paranoid delusions:

• Consider if their beliefs may be justified.
• Consider if there is a basis for their beliefs.
• Talk openly.
• Don’t dismiss fears.
• Focus on the person’s feelings.
• Support them and suggest they seek professional help.
• Respect their wishes.
• Know where to get emergency help.

You should not have to support a loved one with paranoid delusions alone. These delusions won't go away with love and kindness alone. The person you love requires professional help.

If you feel overwhelmed or are at risk of burnout, reach out for help as soon as possible.

Summary

A paranoid delusion is a belief that someone or something is out to get you. A person with paranoid delusions may think the government is spying on them or that an employer intends to ruin their reputation, for example.

Paranoid delusions often accompany mental illnesses such as schizophrenia.

Treatment for paranoid delusions includes antipsychotic medications and cognitive behavior therapy. Support from friends and family can help a person with paranoid delusions get the help they need.