What Is Paranoia?

Paranoid woman peeking out window

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In This Article

Paranoia is a persistent and irrational distrust of others or a sense of persecution. It can occur in some mental conditions including bipolar disorder, schizophrenia, and paranoid personality disorder.

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 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.


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

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


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 with ask questions and 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).


The exact cause of paranoia isn't clear. Research suggests 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.


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

Some types of paranoia that people may experience include:

Paranoid Ideation

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. 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.

Symptom of Psychosis

Paranoia can also be a sign of psychosis, a condition in which you lose contact with reality. 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)

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.


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.


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


Psychotherapy can help people with paranoia develop better coping and communication skills. Through therapy, people who are experiencing paranoia can 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.


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.

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.

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Article Sources
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