What Is Paranoid Ideation?

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What Is Paranoid Ideation?

Paranoid ideation is a symptom that can occur in borderline personality disorder, post-traumatic stress disorder (PTSD), and psychotic disorders such as schizophrenia. It involves transient, stress-related paranoia. Paranoia is characterized by the experience of feeling threatened, persecuted, or conspired against. It can also loosely refer to beliefs of general suspicion regarding the motives or intentions of others.

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


Symptoms of paranoid thinking can differ in terms of duration and severity. Some people may have very brief, mild paranoid ideations. For other people, these thoughts can be more severe and persistent. Some common symptoms include:

  • Anxiety and stress
  • Difficulty with relationships
  • Distrust
  • Feeling exploited
  • Feeling isolated
  • Feeling like a victim
  • Feeling persecuted by others
  • Interpreting body language, words, and glances as hostile
  • Thinking that they are being watched or spied on

Paranoid ideation is not the same thing as delusional paranoia, which involves beliefs that are false and fixed. 

For example, if you are experiencing delusional paranoia, you might have an ongoing belief that the government has bugged your house and car in order to keep tabs on you. Paranoid ideation may occur transiently. For example, you might see two people in the hallway talking and briefly believe they are talking about you.


Paranoid ideation is one of the symptoms that might lead to the diagnosis of borderline personality disorder. 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, these are some of the common signs and symptoms:

  • Anger issues, such as becoming extremely angry in inappropriate situations, exploding in rage, or being unable to control your anger, perhaps followed by feeling guilty or ashamed
  • A perception of yourself that changes often and affects your thoughts, behaviors, opinions, relationships, and moods
  • Extreme efforts to avoid real or perceived rejection or abandonment by others
  • Feelings of disconnection with your body and/or your mind and paranoid thoughts that are brought on by stress
  • Intense and unstable love-hate relationships with others
  • Perpetual feelings of being bored and/or empty
  • Risky, impulsive behavior, such as going on shopping sprees, using illicit drugs, or engaging in risky sex
  • Suicidal behavior and/or behavior that's harmful to yourself
  • Times of extreme emotion that last from a few hours to a few days and involve depression, anxiety, or irritability

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 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.


No one knows what causes BPD or the paranoid ideation that may accompany the condition. It's believed that environmental factors, genetics, and abnormalities of the brain may all be involved.

  • Changes in the brain: 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.
  • Childhood trauma: Specifically, people with a history of child abuse, neglect, or other childhood trauma are more likely to have BPD.
  • Family history: If you have a parent or sibling with BPD, you are more likely to develop it yourself.
  • Interruptions in reasoning: People are more likely to have paranoid thoughts when their ability to reason and interpret the world around them is compromised.
  • Stress: Stressful and traumatic events often play a role in triggering paranoid ideation.


If you are having paranoid ideation due to BPD, it is important to find the appropriate treatment for your condition. Your treatment plan will likely involve a combination of medications and psychotherapy.


Paranoid ideation in BPD is usually triggered by stress. Finding ways to manage stress levels can be an effective way to cope with paranoid thoughts. Some strategies you might try include:

  • Deep breathing: This is a common stress management technique that involves taking slow, deep breaths. It can aid in relaxation and ease feelings of anxiety. This technique is particularly useful because it can be used anywhere at any time.
  • Meditation: This ancient technique has a wide range of health benefits, including easing stress and anxiety. There are a wide variety of meditative techniques, but mindfulness meditation, a strategy that involves focusing on the present, might be particularly helpful.
  • Progressive muscle relaxation (PMR): This technique involves tightening and then relaxing various muscle groups throughout the body. After some practice, people can use PMR to quickly induce feelings of relaxation.
  • Regular exercise: Physical exercise can be a great way to cope with feelings of stress. Research has also shown that exercise can help manage the body's reaction to anxiety. 
  • Visualization: This technique involves using mental imagery to help induce a more relaxed state of mind. When you find yourself experiencing paranoid or panicked thoughts, for example, you might focus on an image that helps you feel calm and grounded.
  • Yoga: This form of exercise can be a great way to combine physical activity with calming, meditative movements.
6 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. Merriam-Webster. Paranoia. 2020.

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

  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013.

  4. 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

  5. Freeman D, Evans N, Lister R. Gut feelings, deliberative thought, and paranoid ideation: A study of experiential and rational reasoningPsychiatry Res. 2012;197(1-2):119-122. doi:10.1016/j.psychres.2011.12.031

  6. National Institute on Mental Health. Anxiety disorders.

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.