Paranoid Ideation

A Common Symptom of Borderline Personality Disorder

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Paranoid ideation, or paranoia is defined by systematized delusions of persecution or grandeur. It can also refer to beliefs of general suspicion regarding the motives or intent of others.​

Paranoid ideation is not the same thing as the delusional paranoia that can occur during psychosis. Delusional paranoia is based on false thoughts and beliefs rather than the perception of harassment.

For example, if you are experiencing delusional paranoia, you might believe that the government has bugged your house and car in order to keep tabs on you. If you are experiencing paranoid ideation, you might see two people in the hallway talking and believe they are talking about you.

If you have borderline personality disorder (BPD), it's likely that you have experienced paranoid ideation. It is one of the possible criteria for diagnosis according to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

It's also important to note that stress may make these paranoid thoughts and beliefs worse.


In order to be diagnosed with borderline personality disorder, you must be evaluated by a qualified mental health professional. While there is no definitive test for the disorder, here are some of the common signs and symptoms:

  • Risky, impulsive behavior, such as going on shopping sprees, using illicit drugs, or engaging in unprotected sex with multiple strangers.
  • Perpetual feelings of being bored and/or empty.
  • Intense love-hate relationships with others.
  • Extreme efforts to avoid real or perceived rejection or abandonment by others.
  • Anger issues, such as becoming extremely angry in inappropriate situations, exploding in rage, or being unable to control your anger, followed by feeling guilty or ashamed.
  • A perception of yourself that doesn't match up with what others think and changes often. This affects your thoughts, behaviors, opinions, relationships, and moods.
  • A feeling of disconnection with your body and/or your mind and paranoid thoughts that are made worse by stress.
  • Times of extreme emotion that last from a few hours to a few days and involve depression, anxiety, or irritability.
  • Suicidal behavior and/or behavior that's harmful to yourself.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.


Treatment is important if you're dealing with BPD. Your treatment plan will likely involve a combination of medications and psychotherapy.

Common psychotherapies used to treat BPD are dialectical behavioral therapy (DBT), psychodynamic therapy, and cognitive-behavioral therapy (CBT). A combination of different medications may be used to help treat your symptoms as well. Typical medications include antipsychotics, antidepressants, and mood stabilizers.

Related Conditions

If you have BPD, you may have another condition as well. Those conditions that commonly occur along with BPD include:

  • Depression
  • Bipolar disorder
  • Anxiety disorders
  • Substance use disorders


No one knows what causes BPD. It's believed that environmental factors, genetics, and abnormalities of the brain may all be involved. Specifically, people with a history of child abuse or neglect or other childhood trauma are more likely to have BPD. Also, if you have a parent or sibling with BPD, you are more likely to develop it yourself.

Additionally, there may be abnormalities in the brain that can lead to developing BPD. This is particularly true of areas of the brain that control emotions and judgment.

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Article Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Paranoia. Merriam-Webster. 2020.

  2. Borderline personality disorder. National Alliance on Mental Illness. Reviewed December 2017.

  3. Bassir nia A, Eveleth MC, Gabbay JM, Hassan YJ, Zhang B, Perez-Rodriguez MM. Past, present, and future of genetic research in borderline personality disorder. Curr Opin Psychol. 2018;21:60-68. doi:10.1016/j.copsyc.2017.09.002

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