Paranoia is the feeling that you’re being threatened in some way, such as people watching you or acting against you, even though there’s no proof that it’s true. It happens to a lot of people at some point. Even if you know that your concerns aren’t based in reality, they can be troubling if they happen too often.
Clinical paranoia is more severe. It’s a rare mental health condition in which you believe that others are unfair, lying, or actively trying to harm you even when there’s no proof. You don’t think you’re paranoid at all because you are very sure that it’s true.
Paranoia vs. justified suspicion
Unlike paranoid suspicions, you have evidence for justified suspicions, which can help keep you safe. For example, if there's been a series of burglaries in your area, being extra careful about security is a justified suspicion. These types of suspicions help protect you from real threats and are based in reality.
Types of Paranoia
There are four kinds of paranoia:
- Mistrust. This is when you find it hard to trust others and their intentions towards you, even though you can’t find any or enough evidence to prove your suspicions.
- Interpersonal sensitivity. You judge other people’s nonverbal language negatively and assign negative meanings to their comments.
- Ideas of reference. These are false beliefs that random or unrelated events are directly connected to you and can involve paranoia.
- Persecutory. You think someone or something is mistreating, stalking, or trying to harm you or someone close to you. You might repeatedly complain to legal authorities. Health care providers classify this type of paranoia as a delusion.
Anxiety vs. Paranoid Thoughts
A paranoid thought is a type of anxious thought. Anxiety can cause paranoia, affecting what you’re paranoid about and how long the feeling lasts. But paranoid thoughts can also make you anxious.
It’s normal to be anxious sometimes, especially if you’re going through a tough situation, such as losing a job or ending a relationship. When in large groups of people, you may worry that others will judge what you say or how you dress or behave. You might walk into a party by yourself and think, “Everyone is wondering why I’m alone.”
Some call this paranoid, but we all have thoughts like this from time to time. Just because you’re worried that people might be talking about you doesn’t mean you have a mental illness. Clinical paranoia happens when you’re 100% convinced of it, even when facts prove it isn’t true.
If you worry that your thoughts are paranoid, you probably have some anxiety rather than paranoia. If your anxiety isn’t linked to anything obvious and it never seems to get better or go away, you may need to talk to a doctor about it. Feelings of anxiety and panic that last a long time or get in the way of your daily life might be signs of an anxiety disorder. Symptoms of paranoia may be more severe.
Paranoia Symptoms
The symptoms of paranoia can include:
- Being defensive, hostile, and aggressive
- Being easily offended
- Believing you're always right and having trouble relaxing or letting your guard down
- Not being able to compromise, forgive, or accept criticism
- Not being able to trust or confide in other people
- Reading hidden meanings into people’s normal behaviors
- Assuming people are saying negative things about you behind your back
- Feeling like people are exploiting you
- Holding grudges for a long time
- Believing that people are after you, even strangers
- Assigning negative meaning to other people’s comments
- Having faith in unproven conspiracy theories
- Thinking that the world is always a threatening place
What Causes Paranoia?
There's no apparent cause of paranoia, but researchers think certain things may play a role, including:
Too little sleep
A single restless night probably won’t cause paranoid thoughts. But if you often go without sleep, it can start to take a toll. You might not think as clearly, and you’re more likely to clash with others or have misunderstandings with them. It may start to look like people are working against you when they’re just acting like they always do. If you go without sleep for long enough, you could even start to see and hear things that aren’t there (your doctor will call them hallucinations).
Adults should aim for 7-9 hours of sleep a night to stay alert and mentally healthy.
Stress
When the tension increases in your life, you could start to feel more suspicious of others. And the stress doesn’t have to be something negative like illness or job loss. Even a happy occasion, such as a wedding, can create a kind of stress that brings out paranoid thoughts along with the joy.
To help ease the tension, you can:
- Take time to relax and try to forget about what’s stressing you out.
- Spend time with friends.
- Find something to smile and laugh about.
- Get plenty of exercise.
- Meditate to clear your mind.
Paranoid personality disorder
One condition, paranoid personality disorder, can make it hard to trust others. It can cause negative thoughts about others that aren’t true, like “They don’t like me,” “They’re making fun of me,” or even “They’re plotting against me.” In some cases, no amount of evidence will convince you otherwise. This can lead to true clinical paranoia. Though you might not believe every unrealistic thought that enters your mind, you believe some of them.
Other psychiatric disorders
Schizophrenia, another serious disorder, can make it hard to tell what’s real and what’s imagined. Most of the time, you simply don’t know when your thoughts have become paranoid. Friends, loved ones, or medical professionals often have to point it out and try to help you get treatment.
Borderline personality disorder, in which you have rapid emotional swings where you can worship someone one moment and hate them the next, can also cause paranoid thoughts and even clinical paranoia in some people.
Just because you feel paranoid or worry about what others think about you from time to time doesn’t mean you have a psychiatric disorder. The fact that you know your thoughts don’t make sense could be a sign of good mental health. But if these paranoid feelings happen all the time or start to get in the way of your home or work life, you might want to talk to your doctor or a mental health care provider.
Drug use
Drugs such as marijuana, hallucinogens (LSD, psychotropic mushrooms), and stimulants (cocaine, methamphetamine) have chemicals that make some people paranoid for short periods. Once the chemicals leave your system, the paranoia goes away, too. Days or weeks of intense alcohol abuse also can cause short-term paranoia, and over the long term, it can lead to ongoing paranoia and even hallucinations.
If paranoid thoughts are making you anxious or if you have minor symptoms of depression, drugs can make them much worse. In some people, they can trigger a psychiatric disorder with true clinical paranoia as a symptom.
Alcohol can also worsen paranoia. Plus, it makes us less inhibited, which makes it harder to control these feelings.
Memory loss
Alzheimer’s disease and other forms of dementia, which are more likely as you age, can change your brain in ways that make you more suspicious of others. You might notice that a loved one with dementia starts to hide things such as jewelry or money or becomes convinced that people have bad intentions toward them. This is part of the disease. Their doctor might be able to help you manage these symptoms.
Other causes
Other possible reasons for paranoia include:
- Bullying, abuse, or other difficult life experiences
- Low self-esteem
- Depression
- Anxiety
- Focusing on media about crime, terrorism, and violence
Paranoia and Dementia
It's common to have delusions (strongly held false beliefs) when you have dementia, and they can often feel like paranoia. Delusions in dementia usually fall into two types. You might believe that someone is trying to harm you, while other times, you may misidentify something or someone.
Common delusions include:
- Theft. If you can’t find a piece of clothing, you might think someone has stolen it. This worry can also make you hide things in unusual places, leading to more items going “missing.”
- Harm from loved ones. You might believe, for example, that a friend who brings you food is trying to poison you or that your partner is being unfaithful.
- Misidentifying your home. You might think your home is somewhere you’ve never lived. If you believe your home is where you used to live, it’s often due to “time-shifting.”
When someone with dementia has delusions, their beliefs feel very real to them. It's natural for you to feel upset and want to tell them it’s not true, but convincing them otherwise is often impossible and can cause more distress. Here are better ways to support someone with delusions:
Encourage discussion. Let your loved one talk through their thoughts. It might help you understand the reason behind their delusion. For instance, if they don’t believe their home is theirs, it might be due to recent changes in furnishings or the presence of unfamiliar people, such as professional caregivers.
Acknowledge their feelings. Recognize their distress and how they must be feeling. Dismissing their concerns or trying to distract them without first acknowledging their feelings can worsen the situation and cause them to lose trust. If they think a caregiver has stolen something, listen to them and acknowledge their feelings. Suggest looking for the missing items together and gently propose another activity, which might distract them from their delusion.
Offer a different explanation. Gently suggest another possible explanation for what may have happened. Present this as an additional possibility rather than opposing their view.
Reassure them. Make sure they know that you're taking their concerns seriously.
Avoid further distress. If the delusion is ongoing and causing significant problems, try to find ways to avoid more distress. For example, if they believe their friend is bringing poisoned food, consider local meal delivery options or microwave meals they can prepare themselves.
Paranoia Diagnosis
Figuring out what's causing someone to be paranoid is tricky. This is because distrusting people more than usual can be a sign of many different mental health problems, and some people with dementia also have it. Another challenge is that people who are paranoid might be scared to go to the doctor or hospital because they worry they might get hurt.
To diagnose paranoia, doctors may:
- Ask about your medical history
- Do a physical checkup
- Talk to you about your symptoms
- Perform mental health tests
Paranoia Treatment
If you feel that you’re losing touch with reality, a doctor or mental health professional is the best place to start. Because you can still tell that your thoughts aren’t reasonable, there are things you can do to help.
First, eating a healthy, balanced diet, exercising, and getting plenty of sleep is crucial. All these things are part of a mental balance that can help keep paranoid thoughts at bay.
After that, it can actually help to talk to yourself about paranoid thoughts. This only works when you can still tell your thoughts are unreasonable. Keep it realistic. Instead of thinking to yourself, “I’m crazy” or “I’m paranoid,” try something like: “I’m worried about something highly unlikely to be true.”
Even if you don’t have a mental illness, if your paranoid or irrational thoughts get in the way of doing things you want to do, talk to a social worker, psychologist, or psychiatrist. Talk therapy or some medication could help you feel better.
Often, people who feel paranoid don’t get treatment because they don’t realize their thoughts are unrealistic. If you’re worried about a friend or family member, talk to a health professional or use a resource such as the National Alliance on Mental Illness (www.nami.org, 800-950-NAMI) or the Substance Abuse and Mental Health Services Administration (www.samhsa.gov/find-treatment, 800-662-HELP).
Paranoia Complications
Long-term, serious paranoia can lead to other health problems, such as:
- Trouble sustaining relationships
- Job loss
- Isolation
- Anxiety and depression
It's important to get help if you have ongoing paranoia or if someone you know has the condition.
Living With Paranoia
If you live with paranoia, try these self-care techniques:
- Keep a diary. Track your paranoid thoughts — when they happen, how strongly you believe them, and how you feel. This can help identify triggers and patterns.
- Question and challenge thoughts. Ask if your worries are realistic, based on evidence, or exaggerated. Consider what you’d say to a friend with similar concerns.
- Gradually test fears. Start small, like stepping outside your home, and build up to larger challenges to see if your fears are justified.
- Talk about your thoughts. Share with trusted friends or join peer support groups to ease isolation and stress.
- Practice mindfulness and relaxation. Focus on the present moment to reduce paranoia. Techniques such as meditation or breathing exercises can help.
- Ensure sound sleep. Aim for quality sleep since lack of it can worsen paranoid thoughts.
- Get professional help. Consider cognitive behavioral therapy (CBT) or other therapies to challenge and change paranoid thoughts.
- Explore creative therapies. Use arts and creative activities to express feelings and gain new perspectives on your thoughts.
- Take medication. Your doctor may prescribe antipsychotic drugs if you have a condition such as schizophrenia that causes paranoid thoughts.
How to Support Someone With Paranoia
If someone you care about lives with paranoia, here are some ways to support them:
Try to understand their beliefs. Recognize that their paranoid thoughts may come from real anxiety or past experiences. Acknowledge their feelings, even if you disagree with their beliefs.
Validate their fears. Show empathy for their emotions by saying things like, “Things sound really scary for you right now,” without agreeing with their perception of the threat.
Offer support. Let your loved one know you're there for them. Providing comfort and distraction can help them break the cycle of paranoia.
Encourage them to get help. Reassure your loved one that it's okay to ask for help and that support is available.
Respect their independence. Avoid taking control or making decisions for them. Respect their wishes and independence.
Plan for crises. Agree on a plan for getting help during a mental health crisis.
Take care of yourself. Supporting someone with paranoia can be tough. Make sure you look after your well-being by getting support from friends, a therapist, or peer support groups.
When to Call a Doctor
If your paranoia is getting more severe and affecting your life, you must visit a doctor or mental health professional. People with serious paranoia may seem hesitant to seek help because of suspicion and a lack of trust. If your loved one has signs of paranoia, gently encourage them to get help or consult a doctor about what to do.
Takeaways
Paranoia is when you feel like people are threatening or watching you without proof. It’s normal to have these feelings now and then, but if they happen a lot, it could be a sign of a mental health issue. Unlike justified suspicion, which is based on real evidence (such as being careful after a series of local burglaries), paranoia lacks a rational basis.
Paranoia can happen for many reasons, such as stress, drug use, personality disorders, or dementia. Treatment often involves therapy and medication. Taking care of yourself by tracking your thoughts, questioning fears, and seeking support can help, but if paranoia affects your daily life, it’s important to get professional help.
Paranoia FAQs
What is the difference between being paranoid and delusional?
Paranoia involves intense feelings of anxiety or fear, often related to threats or conspiracy. It can happen with different mental health conditions but is most common in psychotic disorders. Paranoid thoughts can turn into delusions if the irrational beliefs become so fixed that nothing can change them.
