Bipolar Disorder Symptoms Mania and Hypomania What Is Paranoia? By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on April 28, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print ONOKY - Eric Herchaft / Getty Images Table of Contents View All Table of Contents Definition Symptoms Diagnosis Causes Related Mental Health Conditions Treatment Coping What Is Paranoia? Paranoia is a pattern of thinking that involves intense, irrational distrust and suspicion. It can range from mild feelings of discomfort, nervousness, or unease about a situation or person to intense, distressing thoughts that could put your mental well-being at risk. It's not uncommon for people to experience slight bouts of paranoia from time to time. But for people with mental illnesses such as bipolar disorder, schizophrenia, and paranoid personality disorder, the experience of paranoia can be persistent and extremely unpleasant—even dangerous. While most people have some paranoid thoughts on occasion, the term "paranoia" refers to a more persistent state of constant, irrational, and unfounded distrust. Signs and Symptoms of Paranoia How do you know if you or someone you love might have paranoia? Here are some signs to watch for: Becoming defensive due to criticism that is imagined versus real Being argumentative Difficulty forgiving others Hypervigilance Fear of being taken advantage of or deceived Inability to relax Mistrust of others Preoccupation with the notion that others have hidden motives Examples of Paranoid Thoughts Paranoia manifests differently for everyone, but common themes include: Believing the government, an organization, or an individual is spying on or following you Feeling like everyone is staring at and/or talking about you Interpreting certain facial gestures in others as some sort of inside joke that's all about you, whether the other person is a stranger or friend Thinking people are deliberately trying to exclude you or make you feel bad Thinking people are laughing at you or whispering about you behind your back (can be accompanied by hallucinations) Thinking someone might steal from, hurt, or kill you Diagnosis Paranoia isn't actually a diagnosis in and of itself. Instead, it is often a symptom of (or diagnostic criteria for) another underlying health issue that is either physical or mental in nature. Getting to the root cause of paranoia generally begins with a healthcare provider collecting medical history information. They may also perform a physical exam and order lab tests to rule out any medical conditions that might be causing this symptom. Alzheimer's disease, dementia, Parkinson's, epilepsy, stroke, and brain cancer can all affect cognitive function. Testing to see if any of these exist can help a practitioner determine whether paranoia is a result of one of them or something else. If no underlying medical cause is detected, someone with paranoia might be referred to a psychiatrist. A psychiatrist will ask questions about the person's thoughts and experiences. They may also do a psychological evaluation to help better understand the individual's symptoms and mental status. Causes of Paranoia The exact cause of paranoia isn't clear. But some of the factors associated with paranoid thoughts or feelings include: Aging: Older adults may be more likely to experience delusional or paranoid thinking as a result of age-related changes to hearing, sight, and other senses. Certain medications, or stopping their use: Amphetamines can have many adverse effects, of which paranoia is one. But sometimes paranoia occurs after stopping a medication. Adderall (dextroamphetamine-amphetamine) is a drug used to treat attention-deficit hyperactivity disorder, but stopping it suddenly can result in paranoid delusions. Genetics: Some research suggests that there may be a genetic component to paranoia. Having certain life experiences: Experiencing trauma and/or abuse in childhood or as a young adult, social isolation, or exposure to 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) can all contribute to feelings of paranoia. Exposure to certain toxins or poisons: One study of 2,232 adolescents in the United Kingdom found that exposure to higher levels of outdoor air pollution accounted for 60% of their psychotic experiences, some of which included paranoid thoughts. Infections that can affect the brain: People with human immunodeficiency virus (HIV) can develop a secondary condition, sometimes referred to as "HIV mania," which includes psychotic symptoms such as paranoia and auditory or visual hallucinations. Sleep deprivation: Going long periods of time without sleep can create a host of negative effects. A review of sleep deprivation studies found that the longer participants were awake, the more likely they were to experience symptoms of delusion and paranoia. Substance intoxication and withdrawal: Psychosis symptoms are common with substance abuse, and the development of these symptoms is more likely in cases of severe use and addiction. Paranoia and Mental Health Conditions Paranoia can be a symptom of a physical health condition such as a brain disease or a stroke. Paranoia is also sometimes present with certain mental health conditions, particularly those involving psychosis. Borderline Personality Disorder Paranoia can emerge in people with borderline personality disorder (BPD). In contrast to many other conditions where paranoia is a fixed or continuous symptom, BPD-related paranoia is usually more transient and occurs when stress levels are higher. Paranoid personality disorder is a distinct personality disorder (separate from BPD and other personality disorders). People with paranoid personality disorder have a chronic and pervasive distrust and suspicion of others. 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. Psychotic Disorders Paranoia can be a symptom or sign of a psychotic disorder, such as schizophrenia or schizoaffective disorder. Paranoia or paranoid delusions are just 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) Treatment of Paranoia Treatment for paranoia depends on the severity of the symptoms as well as the underlying cause. Your healthcare provider or mental health provider may recommend medication, psychotherapy, or—most frequently—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. It can also sometimes help the person "reality test" aspects of their beliefs. Through therapy, people who are experiencing paranoia can also potentially learn to develop greater trust in others, find ways to manage and express their emotions in more adaptive ways, and improve their self-esteem and confidence. Digital Treatments Researchers are also beginning to explore the use of digital treatment options for people with paranoia. Among those being considered are: Mobile appsSocial networkingVirtual realityWeb-based therapies SlowMo is a newer option that offers digitally delivered face-to-face therapy sessions. It was created to help reduce paranoia in people with psychosis. A 2021 study involving 361 participants showed benefits after using SlowMo, though more research is needed to understand its effects. Coping With Paranoia If you're experiencing paranoia, it's crucial that you discuss these feelings with your healthcare provider or psychiatrist. If you've already been diagnosed with another mental health condition, the emergence of paranoid delusional thinking may be a sign that your treatment or medications need to change. Let your mental health care team know if you are having these symptoms so they can help keep you safe and ensure that 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 and 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 manage 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. 21 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. Asenio-Aguerri L, Beato-Fernández L, Stavraki M, Rodríguez-Cano T, Bajo M, Díaz D. Paranoid thinking and wellbeing. The role of doubt in pharmacological and metacognitive therapies. Front Psychol. 2019;10:2099. doi:10.3389/fpsyg.2019.02099 Raihani N, Bell V. 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JAMA Psychiat. 2021;78(7):714-725. doi:10.1001/jamapsychiatry.2021.0326 By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.