What Is Paranoia? Symptoms, Causes And Treatments

Paranoia is the distressing feeling an individual might experience when they believe, without evidence (or very little evidence), that someone wishes to do them harm. Fueled by anxiety and fear, an episode of paranoia causes individuals to believe there are very real threats to their well-being, even when there is evidence to the contrary.

While anyone may experience a moment of paranoid thinking, when episodes are severe and persistent, they may signal a serious mental health condition such as schizophrenia or paranoid personality disorder, says Elaina DellaCava, M.D., a psychiatrist at Weill Cornell Medicine and New York Presbyterian Hospital in New York.

“Paranoia has a range of severity. For some people, low-level paranoia can occur when under stress, when sleep deprived or after a traumatic event,” says Dr. DellaCava. “It can occur in individuals living with dementia or who have had brain injuries, and can also occur in individuals who abuse recreational drugs or who are withdrawing from drug use.”

Common examples of paranoid thoughts might include believing the following:

• People talking about you behind your back
• You’re being tracked or spied on
• Others are working to diminish your image or character
• You’re in danger of being physically harmed
• You are under the government’s control

Non-Clinical Paranoia vs. Clinical Paranoia

Paranoia exists on a spectrum, from mild to severe. While many people may experience mild paranoid thoughts on occasion, others deal with more severe episodes with greater frequency. When one experiences paranoia at a more severe level, it may warrant a clinical diagnosis.

“We may all experience occasional bouts of paranoia, such as feeling watched or overly suspicious of others,” says Harold Hong, M.D., a psychiatrist in Raleigh, North Carolina. “However, when these feelings become persistent and impact daily functioning, it may be a sign of a mental health disorder.”

While Dr. Hong says it can be difficult to distinguish non-clinical paranoid thinking from a diagnosable disorder, there are a few important distinctions. The following are signs that you may need help from a mental health provider:

• Intense and irrational suspicions that are persistent over weeks or months
• Fixed beliefs that are inconsistent with reality and cannot be changed by evidence or logical reasoning
• A significant disruption in social, occupational, and/or other important areas of life functioning
• Experiencing significant emotional distress due to the paranoid thoughts and their consequences (e.g., negative impact on mood and behavior)

People with paranoia may feel like they are being watched, followed or threatened, explains Dr. Hong. Symptoms can vary between individuals depending on the underlying condition, he adds.

Some of the most common symptoms of paranoid thinking include the following:

• Intense and irrational feelings of mistrust and suspicion
• Hypervigilance
• Argumentativeness and defensiveness
• Social isolation
• Inability to see irrational beliefs for what they are

In some cases, paranoia may even advance into delusions, which can be described as fixed false beliefs, says Dr. DellaCava. “We may see a person with paranoia develop a belief that others are trying to poison them, lie to them or sabotage them in some way,” she adds. “They may believe that the government is spying on them, or that others are trying to monitor their thoughts or actions.”

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Mental Health America notes that research has not determined a singular, definitive cause of paranoia. Rather, it points to two potential contributing factors: Environmental and biological. A history of childhood neglect—in which a caregiver did not provide proper emotional, physical or supervisory care—may play a role. Other environmental factors, according to the U.K.-based mental health organization Mind, may include life experiences (such as being bullied or burglarized), or living in an urban environment or community where you feel isolated from people around you.

On the biological side, research suggests there’s a genetic link, and there may be evidence to support a link between a family history of schizophrenia or schizotypal personality disorder and paranoid thinking.

While anyone may experience moments of paranoid thinking, severe paranoia is a common symptom among individuals diagnosed with primary psychotic disorders. Mental health conditions associated with paranoia include the following:

Schizophrenia: A serious mental disorder defined in part by intense paranoia, as well as other symptoms such as hallucinations, illogical thinking and abnormal body movements.

Delusional disorder (persecutory type): A disorder characterized by a central belief that someone harbors malicious intent toward you.

Paranoid personality disorder: A personality disorder that results in a long-term pattern or mistrust and suspicion of others, but that does not include symptoms of psychosis, which is a condition that disrupts an individual’s perception of reality.

“Paranoia associated with psychosis can be bizarre or frightening, and typically impair someone’s functioning to a significant degree,” says Holly DuBois, M.D., a psychiatrist and the chief clinical officer at Mindstrong in Round Rock, Texas. “Paranoid personality disorder describes a maladaptive way of approaching relationships and the world, but doesn’t usually limit function to the same degree.”

Paranoid thoughts may be a sign of something more serious if your fears are so significant they disrupt your ability to function professionally or socially, says Dr. DuBois. “Furthermore, if the nature of the suspicious ideas themselves are particularly bizarre, e.g., foreign military is tracking my movements, these are beliefs so disconnected from reality that they warrant immediate treatment to alleviate suffering,” she adds.

When it comes to serious mental disorders, Dr. DuBois says paranoid delusions can be difficult to treat. This is partly because individuals with conditions like paranoid personality disorder may not recognize they have a problem, adds Dr. Hong. Even so, he says treatment for paranoia is two-pronged, involving medication and psychotherapy.

To treat paranoia, health care providers may use a combination of the following:

Psychotherapy: Cognitive behavioral therapy (CBT) is the standard treatment for paranoia. CBT focuses on identifying and changing negative thought patterns, says Dr. Hong. When treating paranoia, the goal of therapy is to help you examine the evidence behind your beliefs, and look for different interpretations.

Treatment may also include reality testing approaches, such as designing behavioral experiments with the patient that will help them to see that their suspicions or fears are not consistent with what is happening in their environment or their relationships. Recent research has found virtual reality-based CBT can be effective at improving symptoms of paranoia in participants with psychotic disorders^[1]Geraets C, Snippe E, van Beilen M, et al. Virtual reality based cognitive behavioral therapy for paranoia: Effects on mental states and the dynamics among them. Schizophrenia Research. 2020;222:227-234. .

Medication: Antipsychotics may be used to treat paranoia in people with paranoid schizophrenia, while antidepressants and minor tranquilizers may be prescribed to treat individuals with anxiety or depression who are experiencing paranoid thinking.

“Antipsychotic medications may reduce an individual’s focus on the delusions, but eliminating them entirely can take time,” says Dr. DuBois. “More mild paranoid ideas or orientations may respond to psychotherapy.”

Oftentimes, it’s family and friends who first notice signs and symptoms of paranoia, says Dr. DuBois, though she encourages anyone who is struggling to function because of their fears to seek professional help. Further, if you feel as though your fears might represent a break with reality, or you are avoiding people and places you’d ordinarily enjoy because you’re afraid for your safety, Dr. DellaCava advises seeking help.

“If someone is having thoughts of harming themself or others due to paranoia, this would be considered an emergency and [they] should be seen in an emergency room setting,” she adds.

If you or a loved one need mental health support, there are resources available to get you the help you need. In moments of crisis, The Substance Abuse and Mental Health Services Administration (SAMHSA) National Hotline offers free, confidential support available 24/7 Contact the hotline by calling 1-800-662-HELP (4357) or visiting the treatment locator online.