Paranoia as a Symptom in Bipolar Disorder

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Paranoia can be a symptom of bipolar disorder. It also frequently occurs in other mental health conditions, such as schizophrenia. Paranoia's definition can range from describing a relatively mild feeling of discomfort to an intense, extremely distressing pattern of thinking that indicates a person's mental wellbeing 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, the experience of paranoia can be persistent, extremely unpleasant, and even dangerous. Paranoid delusions can also be a sign of bipolar psychosis.

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.

Clinical Paranoia

A psychiatrist would use a clinical diagnosis of paranoia to describe a disordered way of thinking or an anxious state that can lead to a delusion. For example, a person who believes the FBI is tracking them through the fillings in his or her teeth is exhibiting clinically paranoid behavior.

True paranoia is characterized by unreasonable and/or exaggerated mistrust and suspicion of others. These feelings are not based in fact and may progress to persecutory delusions; strong beliefs that are untrue, unreal, or unlikely.

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

While the symptoms have some crossover and may coexist, paranoid ideation in borderline personality disorder is not the same as paranoid delusions. A person experiencing paranoid ideation feels that others intend to harass or persecute them. Delusion paranoia is rooted in false beliefs with no basis in reality as opposed to perceptions of harassment.

Paranoia in Bipolar Disorder

If you have bipolar disorder, you may experience clinical paranoia during a manic episode. It can also be a sign of psychosis, a condition in which you lose contact with reality. You're more likely to experience bipolar psychosis if your episodes of depression and mania are severe.

Psychosis is relatively rare, affecting approximately 3% of the U.S. population. Aside from bipolar disorder, it also occurs in other mental health conditions such as schizophrenia.

Symptoms of psychosis can include:

  • Disorganized speech and thought patterns
  • Delusions (false/paranoid beliefs about situations or people)
  • Hallucinations (hearing, seeing, or feeling things that aren't real)
  • Disordered thinking (thoughts jumping between unrelated topics).

The exact cause of paranoia isn't clear. Research has suggested that for someone with mental illness who is predisposed to paranoia and ideas or delusions of reference, certain triggers in their life or environment could play a role in the onset of these symptoms.

Potential paranoia triggers include:

  • Insomnia
  • Social isolation
  • Starting, stopping, or switching medications
  • Using and/or withdrawing from substances including alcohol and illicit drugs
  • Exposure to certain types of poisons and chemicals (pesticides, gasoline, paint)
  • 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)
  • Certain medical conditions that affect the brain such as Alzheimer's disease, Parkinson's disease, epilepsy, stroke, brain tumors, and Huntington's disease
  • Having a genetic predisposition for paranoia, a family history of mental illness, or experiencing trauma and/or abuse in childhood or young adulthood

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. For example, research has shown that older adults may experience paranoia after losing their hearing.

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).

Getting Help

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, delusional thinking and other symptoms related to paranoia may be a sign that your mental health needs to be managed in a different way.

If your symptoms are getting worse or not responding to treatment, it could indicate that an episode of psychosis is imminent. 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 treatment.

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.

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