All About Paranoia: Definition, Health Effects, and How to Cope

Paranoid thoughts, including thoughts that others are talking about you behind your back or are trying to make you look bad, can happen to everyone at some point in life. But paranoia is different.

Paranoia involves constant and intense distrust of others or beliefs that others are “out to get you,” even though there's little to no evidence for these beliefs, according to Mind, a mental health charity in the United Kingdom.

Various factors can lead someone to experience paranoia, including mental health conditions, dementia, trauma, medications, or substance use. It can be very distressing to those who experience it and, depending on the severity, can significantly interfere with their lives and relationships if left unaddressed.

Read on to learn more about paranoia, its potential impact on daily life, and how you can help someone experiencing it.

Paranoia is a pattern of thinking that can cause an individual to have intense and distressing thoughts and suspicions that someone or something wishes to harm them or is out to get them in some way, when there's little to no evidence that these thoughts are true.

“It typically involves irrational or excessive fear, mistrust, or a belief that others are plotting against you,” says Ryan Sultan, MD, a clinical and teaching psychiatrist at Columbia University in New York City. These thoughts can range from mild to severe, causing distrust or discomfort to extreme fear of a looming threat.

Common types of thoughts people with paranoia may have, according to Mind, include:

• I'm being watched by people or organizations.
• I'm at risk of physical harm.
• I'm receiving threatening hints or double meanings from others.
• People are trying to steal my money or belongings.
• My thoughts or actions are being controlled by someone or something.
• The government is targeting me.

Paranoia itself is not a clinical diagnosis, Dr. Sultan says. Rather, paranoia is a symptom or feature that can be associated with certain mental health conditions or issues.

Specifically, paranoia can be a component of disorders such as paranoid personality disorder (a mental health condition involving a long-term pattern of suspicion or distrust of others without evidence), as well as schizophrenia or delusional disorder, says Caroline Fenkel, LCSW, the chief clinical officer at Charlie Health, a mental health care program for teens and young adults.

In an everyday setting, you may hear paranoia used to describe someone who is being overly cautious or suspicious about something, but Sultan and Fenkel caution against using the term in this way. “[It] can be problematic because it might downplay what people with clinical paranoia go through and add to the stigma,” says Fenkel.

As noted earlier, paranoid thoughts can happen to anyone, but they generally come and go without a noticeable impact on a person’s life. Paranoia refers to the consistent experience of paranoid thoughts and symptoms, often resulting in significant distress and impact on a person's daily life.

The signs and symptoms of paranoia, according to Mental Health America, include:

• Intense distrust or suspicion that isn't grounded in rational thoughts
• Feelings of fear, anger, and betrayal
• Hypervigilance (always on the lookout for threats)
• Trouble forgiving others
• Defensiveness about imagined criticisms
• Constant worry about the hidden motives of others
• Fear of getting tricked or taken advantage of
• Difficulty relaxing
• Argumentativeness

Experts don’t yet know the exact cause of paranoia, per Mental Health America. It’s likely a combination of genetic and environmental factors, including childhood trauma or neglect, a family history of mental health conditions associated with paranoia, trauma in adulthood, and substance use, says Leslie Dobson, PsyD, a clinical and forensic psychologist in Long Beach, California.

Paranoia can also be a response to extreme stress or underlying mental health conditions such as post-traumatic stress disorder (PTSD), says Sultan. “People with PTSD may have paranoid thoughts related to past traumatic experiences,” he explains.

Paranoia is a common component of schizophrenia, a condition that research shows can run in families, Dr. Dobson adds.

Some studies of twins, such as one published in the Indian Journal of Psychiatry, show a likelihood that identical twins will both be diagnosed with schizophrenia if one twin is diagnosed with the condition. “It may be something in their family or in their history, and so if they endure trauma or abuse [or use] illicit substances, it can actually lead the predisposed individual to have more mental health symptoms,” she explains.

In addition, older adults can experience paranoia as a result of memory loss. For instance, among people with Alzheimer’s disease, losing memories of people and objects can contribute to untrue beliefs or paranoia, according to the Alzheimer’s Association.

Someone with paranoia is likely to be diagnosed with another mental health issue or health condition in which paranoia is a symptom or component. For example, someone with schizophrenia, bipolar disorder, or PTSD may experience paranoia.

Paranoia is diagnosed by mental health professionals based on a clinical assessment, according to Sultan. A doctor will ask a series of questions to get an idea of the person’s history, symptoms, and behaviors.

“As clinicians, we look for a theme of distrust or thinking that more harm is due to the person than actual evidence or reality allows,” adds Dobson.

The treatment for paranoia depends on the underlying condition it’s linked to and the severity of the paranoia. Treatment may include psychotherapy, medication, and support, says Sultan.

A combination of individual therapy, group support or therapy, and medication usually works best, says Dobson, who has specialized in treating schizophrenia and psychosis for 20 years.

Medication

Antipsychotic medications may be prescribed to people who have schizophrenia or bipolar disorder, for instance, and are experiencing paranoia. “They help the individual stay in reality in a genuine manner, and then they are more receptive and responsive to psychotherapy,” says Dobson.

Others who may experience paranoia, such as people with PTSD, may be prescribed antidepressants or anti-anxiety medications to help lessen their symptoms, according to Mayo Clinic.

Psychotherapy

Psychotherapy (aka “talk therapy”) can help people experiencing paranoia build trust and learn to manage their paranoid thoughts. Cognitive behavioral therapy (CBT) is commonly used to help with paranoia, both Fenkel and Sultan note. “CBT can help individuals manage irrational thoughts and develop healthier thinking patterns,” says Sultan.

Through CBT, therapists can work with patients to help them learn how to recognize paranoid thought patterns, what causes them, how to better understand their thoughts and the behaviors and the motivations of others, and how to change their own thoughts or behaviors.

“In therapy, we strive to build a trusting relationship, and then we start to question the paranoid thoughts and help the individual see reality,” says Dobson.

Lifestyle and Behavioral Changes

In addition to therapy and medication, certain lifestyle changes may help remove or lessen contributing factors to paranoia.

For example, using substances such as cannabis can exacerbate paranoid thoughts, according to Dobson. If substance use is worsening these thoughts, avoiding these substances can help relieve symptoms. A doctor will likely recommend professional treatment for substance use if the person can’t stop on their own.

She also recommends maintaining a healthy, consistent lifestyle in ways such as eating a nutritious diet, exercising regularly, and cultivating a strong support system to help keep symptoms stable.

Complementary and Integrative Therapies

Although medication and psychotherapy are typically the most commonly used treatments, other potential treatment options, such as virtual reality interventions, are emerging. A systematic review of eight studies showed that virtual reality treatments may improve symptoms of paranoia, increase patients’ social participation with others, and decrease suspiciousness and stress.

Paranoia can get worse over time if it’s not treated. It may lead some individuals to isolate from social situations or feel threatened and angry, according to Dobson.

In severe cases, paranoia can be dangerous to the person experiencing it and those around them. Research suggests that, among people with schizophrenia, for instance, paranoia may be linked to aggression.

“Many people with extreme paranoia engage in fantasies about harming others,” says Dobson. "They may commit violent crimes because they perceive themselves as already harmed or they are going to be harmed."

It can be challenging to support someone with paranoia, but there are things you can do to help. Sultan and Dobson recommend you:

• Encourage them to seek professional help.
• Be consistent, honest, authentic, and direct when communicating with them.
• Avoid arguing with them about irrational beliefs and instead listen with understanding and empathy for what they’re going through.
• Be patient and nonjudgmental.

An example of how to help, Dobson says, could be to say something like, “I know you feel upset because someone followed you, but it is more likely that the person was going into the store to get food, just like you. I’ve seen him get groceries there when you have not been there.”

Researchers still have a lot to uncover about paranoia, its causes, and potential treatment options. Statistics and research about paranoia are often tied to conditions in which paranoia is a potential symptom, such as schizophrenia or paranoid personality disorder.

For instance, research published in March 2016 in Schizophrenia Research: Cognition estimated that paranoia happens in almost 50 percent of people who seek initial help for schizophrenia — a condition that affects an estimated 1 in 300 people worldwide, according to the World Health Organization.

Approximately 0.5 to 4.5 percent of the U.S. population has paranoid personality disorder, a condition in which paranoia is the primary symptom, according to Cleveland Clinic.

It’s important to note that much of the research and statistics related to paranoia come from individuals who are in prisons or state hospital systems, says Dobson. “We have access to them due to the severity of their condition leading to incarceration or hospitalization,” she explains. “So, statistics are based on more extreme cases, rather than our daily life.”