Paranoia Symptoms, Causes, and Treatments

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Paranoia is the feeling that you are under threat in some way, such as people are watching or out to get you, even if there is no evidence that this is true. Although it is not uncommon to have these thoughts and feelings from time to time, it can sometimes reflect a mental illness.

Understanding what is paranoia can help you decide how to cope with or get treatment for it.

Symptoms of Paranoia

Paranoia can take many different forms, including:

  • Ideas of reference: Believing that messages of special personal significance are being transmitted to you through innocuous or irrelevant things such as the TV, newspapers, mailings, mass emails, or the internet
  • Overestimating your role: Believing you have a special role or significance in the world that is unrecognized, unacknowledged, or is being thwarted by others
  • Overthinking interactions: Thinking there is a special meaning in the way people look at you, their tone of voice, or other aspects of their behavior that do not actually have any special meaning in reality
  • Suspicion: Questioning other peoples' motives or actions (out loud or in your mind), wondering why people are doing what you observe them doing, or what you believe they are doing, but have not observed
  • Trust issues: Unrealistic or exaggerated distrust of strangers, acquaintances, or loved ones

These are just examples of how paranoia can be experienced.

What Causes Paranoia?

Paranoid feelings are a normal part of the human experience and are particularly common among people who are vulnerable or at times of extreme stress.

For example, when you're walking alone late at night, you might believe you are being followed or watched, even if you are not; if you're under a lot of stress, you might think people are deliberately undermining you; or when you haven't had enough sleep, you might develop unrealistic paranoid ideas, simply because you are tired and your brain is not performing at its best.

These paranoid feelings generally are not a cause for concern and will go away once the situation is over.

When paranoia is outside of the range of normal human experiences, it can become problematic. The two most common causes of problematic paranoia are mental health conditions and drug use.

Mental Health Conditions

Paranoia can be a feature of many mental health diagnoses, including depression and bipolar disorder, but it is most commonly associated with psychotic disorders, such as schizophrenia. Paranoia is also the defining characteristic of paranoid personality disorder and the paranoid type of delusional disorder.

Generally, the more severe the mental illness, the less awareness or insight the person has that she is actually experiencing the symptom of paranoia, rather than a genuine threat from other people or the world.

Substance Use

Paranoia is associated with both intoxication and withdrawal effects of several drugs, including marijuana, alcohol, cocaine, meth, LSD, and bath salts.

The more intoxicated the person is, the more likely he may be to believe that others are against him. While a mildly intoxicated marijuana user may laugh at himself for having paranoid feelings, someone who is high on meth, or withdrawing from alcohol, may be so convinced others are against him that he becomes violent, in what he perceives as self-defense.

Treatments for Paranoia

Because paranoia can be a serious symptom of mental illness, it is important to see a doctor as soon as possible if you have experienced significant paranoid feelings—particularly if they have gone on for several days and you are starting to believe that others actually are against you.

Remember: it is natural for people who are feeling paranoid to fear to talk to those in authority, including doctors, so try to keep it at the forefront of your mind that your doctor's only interest is helping you to feel better.

Your doctor will be able to assess your mental and physical health and advise you on the cause of your paranoia. If you have been using drugs, it may include a period of detox. You might not like this idea but remember: drug use can trigger dormant mental health problems, so if you continue to use drugs while you're having paranoid feelings, it could lead to serious consequences.

Treatment for paranoia is often successful and will depend on the underlying cause of your symptoms.

Pharmaceutical treatments or prescription medications for paranoia are very effective in treating the condition when it is caused by depression, bipolar disorder, and psychotic disorders, but only a physician can determine the right medication for you. CBT may also be helpful for paranoia.

3 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. Richey LN, Walsh AL. Paranoia. John Hopkins Psychiatry Guide. Updated February 6, 2020.

  2. McLean Hospital. Harvard Medical School. Bipolar Disorder and Schizophrenia Treatment. 2020.

  3. Quello SB, Brady KT, Sonne SC. Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect. 2005;3(1):13-21. doi:10.1151/spp053113

Additional Reading

By Elizabeth Hartney, BSc, MSc, MA, PhD
Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada.