Paranoia

Paranoia may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Mental and emotional symptoms such as paranoia may be a sign of a complicated mental illness.

Paranoia may accompany other symptoms related to schizophrenia including:

• Beliefs that are not grounded in reality (delusions)

• Difficulty concentrating

• Difficulty sleeping

• Disorganization

• Sensations that are not real (hallucinations)

• Social isolation

• Unresponsiveness to other people and the environment (catatonia)

• Withdrawal or depression

Paranoia may occur on its own or be a symptom of paranoid personality disorder or obsessive-compulsive disorder. Other symptoms that may occur along with paranoia include:

• Anxiety

• Detachment

• Harbor grudges

• Hostility

• Hypersensitivity to perceived slights

• Inability to perform daily tasks

• Recurrent thoughts (obsession)

• Repeated actions you cannot control (compulsions)

In some cases, paranoia may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

• Being a danger to yourself or others, including threatening, irrational or suicidal behavior

• Inability to care for yourself

• Seeing or hearing things that are not there (hallucinations)

The exact cause of paranoia is not known. It may be related to a chemical imbalance in the brain, heredity, stress, or a traumatic life event. In some cases, it may be due to injury or infection of the brain. Usually, paranoia is a symptom of a mental illness.

Paranoia may be caused by a variety of mental disorders including:

• Agoraphobia

• Obsessive-compulsive disorder

• Paranoid personality disorder

• Schizophrenia

Paranoia can also be caused by a variety of events or other conditions including:

• Drug abuse

• Head injury or infection

• Heredity

• Social repression

• Stress

• Traumatic life event

People with mental disorders that have paranoia as a symptom usually do not realize there is a problem. For people with paranoid personality disorder, their way of thinking is normal to them. People with paranoid schizophrenia often lack awareness of having any mental health problems. Because of this, getting help for people with paranoia typically depends on a friend or family member intervening.

If you recognize signs of paranoia in yourself, see your doctor or find a mental health provider as soon as possible. Left untreated, paranoid disorders can worsen and cause problems with relationships and responsibilities.

If you think someone you care about is suffering from paranoia, try talking with them first. Express your concerns in a nonconfrontational way. Offer support and help finding a qualified mental health provider. It is possible the person may deny any problems and decline your assistance. Continue to provide encouragement and support.

Call 911 or go to your nearest emergency room for paranoia when:

• A friend or loved one is unable to care for themselves with food, clothing or shelter.

• A friend or loved one poses a danger to themselves or others.

• A friend or loved one has expressed suicidal thoughts or has attempted suicide.

In general, diagnosing the cause of paranoia involves ruling out physical problems that mimic paranoia. To do this, doctors may perform an exam and order blood tests and imaging exams. This can help eliminate possibilities such as neurological diseases, endocrine problems, and drugs and alcohol.

If doctors can rule out medical problems, a psychiatric evaluation is necessary. A mental health provider will conduct an interview and administer a questionnaire. Family and friends may also provide input with permission.

Doctors will compare their observations and information from the patient to a set of criteria from the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). The DSM-5 is a publication from the American Psychiatric Association. Each mental disorder has its own set of criteria in the DSM-5. However, they can have similar symptoms that overlap. It takes a qualified mental health provider to accurately apply the criteria to specific situations.

To diagnose your condition, your doctor or qualified mental health provider will ask you several questions related to your paranoia including:

• How long have you felt your paranoia? Or, when did you first notice your loved one’s paranoia?

• Are there specific events that trigger your, your loved one’s, paranoia?

• Have family members or friends been concerned about your state of mind or behavior?

• Is there a family history of mental illness?

• Do you, or your loved one, have any other symptoms?

• Have you, or your loved one, had a recent injury or infection?

• Have you, or your loved one, had a recent lifestyle change or difficult life event?

• Have you, or your loved one, talked about self-harm or suicide?

• What medications are you, or your loved one, taking?

The main treatment approach to paranoia depends on the underlying disorder. Both medications and psychotherapy can manage paranoia.

In paranoid personality disorders, psychotherapy is usually the main treatment. It can help you understand your thoughts and behaviors and learn to change them. Medications can be useful for relieving symptoms that may occur along with paranoia. This includes antidepressants, anti-anxiety medicines, mood stabilizers, and antipsychotics.

For paranoia related to schizophrenia, medications are the main treatment. Lifelong use of these medicines is necessary to control the disorder. Psychotherapy is useful for learning to cope with the disorder, maintaining medication therapy, and improving social interaction.

In some cases, severe paranoia may require involuntary hospitalization. Laws regarding this emergency step vary from state to state. In general, it is only appropriate when someone cannot care for themselves or poses an immediate danger to themselves or others. Once stabilized, the person may be a candidate for outpatient care, a day hospital program, or a residential program.

There are several self-care strategies you can use if you suffer with paranoia including:

• Avoid alcohol, nicotine and drugs, which can interfere with treatment

• Get regular activity, which can help counteract many negative mental symptoms

• Go to your appointments, including both medical and psychiatric visits

• Join a support group, which can help with coping and staying dedicated to treatment

• Learn about your condition, which can motivate you to continue treatment

• Practice relaxation techniques, such as meditation or yoga

• Take your medications

• Use social services, which can connect you with housing, transportation, and other necessities

Paranoia is often difficult to treat due to the suspicion of healthcare workers. Because people with paranoia do not seek treatment, it is likely that any problem underlying the paranoia will be allowed to continue. Because paranoia can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage.

Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your healthcare professional design specifically for you to reduce the risk of potential complications including:

• Absenteeism from work or school

• Adverse effects of treatment

• Development of an anxiety disorder

• Development of another mental disorder

• Inability to perform daily tasks

• Loss of employment

• Loss of relationships

• Social isolation