What Is Paranoia?

Male executive listening to his colleagues' conversation in an office
ONOKY - Eric Herchaft / Getty Images
In This Article

What Is Paranoia?

Paranoia is a pattern of thinking that leads to irrational mistrust and suspicion of other people. It can range from mild feelings of discomfort to an intense, extremely distressing pattern of thinking that indicates a person's mental well-being is at serious risk.

You might say you feel paranoid if you are nervous or uneasy about a situation or person. Many people occasionally have a passing suspicion that a specific person seems "out to get them" and when casually conversing, may use the term "paranoid" to describe these concerns.

However, for people with mental illnesses such as bipolar disorder, schizophrenia, and paranoid personality disorder, the experience of paranoia can be persistent, extremely unpleasant, and even dangerous.

Symptoms

While most people experience some paranoid thoughts from time to time, paranoia is a more persistent state of constant, irrational, and unfounded distrust. It may include:

  • Feeling like a victim
  • Feeling misunderstood
  • Feeling persecuted
  • Isolation
  • Mistrust of others
  • Persistent anxiety and stress related to paranoid beliefs
  • Poor relationships with others due to distrust

Diagnosis

Your doctor will take your medical history, perform a physical exam, and may order lab tests to rule out any medical conditions that might be causing your symptoms. If no underlying medical causes are detected, you might be referred to a psychiatrist for further evaluation.

Your psychiatrist will ask questions and may administer psychological assessments to help them better understand your symptoms and mental status.

Examples of Paranoid Thoughts

Paranoia manifests differently for everyone, but common themes include:

  • You think someone might steal from, hurt, or kill you.
  • You feel like everyone is staring at you and/or talking about you.
  • You think people are deliberately trying to exclude you or make you feel bad.
  • You believe the government, an organization, or an individual is spying on or following you.
  • You interpret certain facial gestures among others (strangers or friends) as some sort of inside joke that's all about you.
  • You think people are laughing at you or whispering about you behind your back (can be accompanied by hallucinations).

Causes

The exact cause of paranoia isn't clear. Research suggests that certain mental illnesses predispose someone to paranoia. Certain triggers in their life or environment could play a role in the onset of these symptoms.

Potential contributions include:

  • Certain medical conditions that affect the brain such as Alzheimer's disease, Parkinson's disease, epilepsy, stroke, brain tumors, and Huntington's disease
  • Exposure to certain types of toxins and chemicals (e.g., pesticides)
  • Having a genetic predisposition for paranoia, a family history of mental illness, or experiencing trauma and/or abuse in childhood or young adulthood
  • Insomnia
  • Social isolation
  • Starting, stopping, or switching medications
  • Stress, trauma, or a major life change (such as losing a job, the sudden death of a loved one, being the victim of a crime, or having a major health crisis)
  • Using and/or withdrawing from substances including alcohol or drugs

Older adults may also be more likely to experience delusional or paranoid thinking as a result of age-related changes to hearing, sight, and other senses.

Conditions Where Paranoia May Present

Paranoia is a symptom that can be part of a number of conditions, including:

  • Bipolar disorder
  • Brain diseases or tumors
  • Epilepsy
  • Delusional (paranoid) disorder
  • Dementia
  • Paranoid personality disorder
  • Schizophrenia
  • Stroke

Paranoia can also be related to:

  • Brain toxicity caused by certain toxins or poisons
  • Certain prescription medications
  • Infections that can affect the brain such as human immunodeficiency virus (HIV)
  • Substance intoxication and withdrawal

Paranoid Ideation in BPD

Paranoia can emerge in borderline personality disorder (BPD). However, in contrast to many other conditions where it can present as fixed, in BPD it is usually transient and stress-related.

Paranoia in Bipolar Disorder

If you have bipolar disorder, you may experience paranoid delusions during a manic or depressive episode. Being diagnosed with bipolar disorder doesn't mean you will definitely experience paranoia, but it's still important to know the signs as well as what to do if you experience delusional thinking.

Paranoia and Psychotic Disorders

Paranoia can be a symptom or a sign of a psychotic disorder, such as schizophrenia or schizoaffective disorder. Paranoia or paranoid delusions are fixed false beliefs and are considered one type of psychotic symptom. Other symptoms of psychosis include:

  • Disorganized speech
  • Disordered thinking (thoughts jumping between unrelated topics)
  • Hallucinations (hearing, seeing, or feeling things that aren't real)

Clinical Paranoia

Paranoia is not a clinical diagnosis. it is either a sign or a symptom of a possible underlying psychiatric diagnosis.

Treatment

Treatment for paranoia depends on the severity of the symptoms as well as the underlying cause. Your doctor or psychiatrist may recommend medication, psychotherapy, or a combination of the two.

Medication

Antipsychotic medication may be prescribed, particularly if you have an underlying psychiatric condition such as schizophrenia or bipolar disorder. Other medications that might be used to treat your symptoms include antidepressants, mood stabilizers, and anti-anxiety drugs.

Psychotherapy

Psychotherapy can help people with paranoia develop better coping and communication skills. There can be efforts to help someone with paranoia "reality test" aspects of their beliefs. In addition, through therapy, people who are experiencing paranoia can potentially learn to develop a greater trust for others, find ways to manage and express their emotions in more adaptive ways, and improve their self-esteem and confidence.

Coping

If you're experiencing paranoia, it's crucial that you discuss these feelings with your doctor or psychiatrist. If you've already been diagnosed with bipolar disorder or another mental health condition, the emergence of paranoid delusional thinking may be a sign that your treatment or medications need to change.

It's important that you let your mental health care team know if you are having these symptoms so they can help keep you safe and ensure you get the right kind of care.

A Word From Verywell

Not only are symptoms of paranoia distressing, but they can seriously disrupt your activities at home, work, or school as well as negatively impact your social life and relationships.

Finding the most effective means to manage your symptoms may take time, but don't lose hope. There are resources and support that can help you learn to better cope with paranoid thinking and other aspects of living with bipolar disorder or another mental illness.

If you or a loved one are struggling with paranoia, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

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

Was this page helpful?
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 and Delusional Disorders. Mental Health America.

  2. Crespi B, Read S, Salminen I, Hurd P. A genetic locus for paranoia. Biol Lett. 2018;14(1). doi:10.1098/rsbl.2017.0694

  3. Crespi B, Read S, Salminen I, Hurd P. A genetic locus for paranoia. Biology Letters. 2019;14(1). doi:10.1098/rsbl.2017.0694

  4. Linszen MM, Brouwer RM, Heringa SM, Sommer IE. Increased risk of psychosis in patients with hearing impairment: Review and meta-analyses. Neurosci Biobehav Rev. 2016;62:1-20. doi:10.1016/j.neubiorev.2015.12.012

  5. Bipolar Disorder: Signs and Symptoms. National Institute of Mental Health. Updated April 2016.

  6. Bipolar Disorder. National Institute of Mental Health.

  7. Psychosis. U.S. National Library of Medicine. Updated March 26, 2018.