Understanding Paranoia in Bipolar Disorder

Paranoia can be a symptom of bipolar disorder, as well as a symptom of other types of mental health conditions, such as schizophrenia. Depending on whom you ask, paranoia is a term that can have multiple definitions, some mild and some that are more intense. For instance, in common, everyday language, paranoia might mean feeling nervous about a person or a situation, or it might mean feeling convinced that somebody is out to get you. The term is often tossed around casually, but for some people with bipolar disorder, it may be a sign of psychosis.

The clinical diagnosis of paranoia requires a more specific explanation. Psychiatrists use the term to describe a disordered way of thinking or an anxious state that can lead to a delusion. For example, a person who believes that the FBI is tracking her every move through the fillings in her teeth is exhibiting clinically paranoid behavior.

The key to true paranoia is that you exhibit an unreasonable and/or exaggerated mistrust and suspicion of others. This suspicion is not based on fact and often grows into delusions, which are strong beliefs in things that are untrue, unreal, or unlikely. Paranoia is a symptom that can be part of a number of conditions, including:

• Bipolar disorder
• Paranoid personality disorder
• Schizophrenia
• Delusional disorder
• Brain toxicity that may be caused by drug or alcohol use or certain types of poisoning
• Brain diseases or tumors
• Certain prescription medications
• Dementia
• Epilepsy
• Stroke
• Infections that affect the brain, such as HIV

In bipolar disorder, clinical paranoia can be part of a manic episode or it may be a sign that you're experiencing psychosis, a condition in which you lose contact with reality. This is more likely to happen if you have severe episodes of depression and mania. About 3 percent of the U.S. population experiences psychosis.

Symptoms of psychosis can include:

• Delusions, which are false beliefs about the reality of situations or people. Paranoid delusions are common.
• Hallucinations, which involves hearing, seeing, or feeling things that aren't real.
• Disorganized speech and thought patterns.
• Disordered thinking, which means that your thoughts jump around between unrelated topics.

Though paranoia can be different for everyone, these are some specific ways that it might manifest in a mental health condition, including: 

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

If these scenarios describe anything that you're currently feeling, consider it a red flag and don't ignore it. It's important to discuss any feelings of paranoia with your psychiatrist and work toward methods to control them because symptoms like these are unpleasant and are potentially very disruptive to your everyday activities and responsibilities. Also, if you're indeed having psychotic symptoms, your mental health provider needs to be aware and adjust your treatment plan accordingly.