It’s not uncommon for people to experience slight bouts of paranoia from time to time. But for people with mental illnesses such as bipolar disorder, schizophrenia, and paranoid personality disorder, the experience of paranoia can be persistent and extremely unpleasant—even dangerous.
Signs and Symptoms of Paranoia
How do you know if you or someone you love might have paranoia? Here are some signs to watch for:
Becoming defensive due to criticism that is imagined versus real Being argumentative Difficulty forgiving others Hypervigilance Fear of being taken advantage of or deceived Inability to relax Mistrust of others Preoccupation with the notion that others have hidden motives
Diagnosis
Paranoia isn’t actually a diagnosis in and of itself. Instead, it is often a symptom of (or diagnostic criteria for) another underlying health issue that is either physical or mental in nature.
Believing the government, an organization, or an individual is spying on or following you Feeling like everyone is staring at and/or talking about you Interpreting certain facial gestures in others as some sort of inside joke that’s all about you, whether the other person is a stranger or friend Thinking people are deliberately trying to exclude you or make you feel bad Thinking people are laughing at you or whispering about you behind your back (can be accompanied by hallucinations) Thinking someone might steal from, hurt, or kill you
Getting to the root cause of paranoia generally begins with a healthcare provider collecting medical history information. They may also perform a physical exam and order lab tests to rule out any medical conditions that might be causing this symptom. Alzheimer’s disease, dementia, Parkinson’s, epilepsy, stroke, and brain cancer can all affect cognitive function. Testing to see if any of these exist can help a practitioner determine whether paranoia is a result of one of them or something else. If no underlying medical cause is detected, someone with paranoia might be referred to a psychiatrist. A psychiatrist will ask questions about the person’s thoughts and experiences. They may also do a psychological evaluation to help better understand the individual’s symptoms and mental status.
Causes of Paranoia
The exact cause of paranoia isn’t clear. But some of the factors associated with paranoid thoughts or feelings include:
Aging: Older adults may be more likely to experience delusional or paranoid thinking as a result of age-related changes to hearing, sight, and other senses. Certain medications, or stopping their use: Amphetamines can have many adverse effects, of which paranoia is one. But sometimes paranoia occurs after stopping a medication. Adderall (dextroamphetamine-amphetamine) is a drug used to treat attention-deficit hyperactivity disorder, but stopping it suddenly can result in paranoid delusions. Genetics: Some research suggests that there may be a genetic component to paranoia. Having certain life experiences: Experiencing trauma and/or abuse in childhood or as a young adult, social isolation, or exposure to 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) can all contribute to feelings of paranoia. Exposure to certain toxins or poisons: One study of 2,232 adolescents in the United Kingdom found that exposure to higher levels of outdoor air pollution accounted for 60% of their psychotic experiences, some of which included paranoid thoughts. Infections that can affect the brain: People with human immunodeficiency virus (HIV) can develop a secondary condition, sometimes referred to as “HIV mania,” which includes psychotic symptoms such as paranoia and auditory or visual hallucinations. Sleep deprivation: Going long periods of time without sleep can create a host of negative effects. A review of sleep deprivation studies found that the longer participants were awake, the more likely they were to experience symptoms of delusion and paranoia. Substance intoxication and withdrawal: Psychosis symptoms are common with substance abuse, and the development of these symptoms is more likely in cases of severe use and addiction.
Paranoia and Mental Health Conditions
Paranoia can be a symptom of a physical health condition such as a brain disease or a stroke. Paranoia is also sometimes present with certain mental health conditions, particularly those involving psychosis.
Borderline Personality Disorder
Paranoia can emerge in people with borderline personality disorder (BPD). In contrast to many other conditions where paranoia is a fixed or continuous symptom, BPD-related paranoia is usually more transient and occurs when stress levels are higher.
Bipolar Disorder
If you have bipolar disorder, you may experience paranoid delusions during a manic or depressive episode. 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.
Psychotic Disorders
Paranoia can be a symptom or sign of a psychotic disorder, such as schizophrenia or schizoaffective disorder. Paranoia or paranoid delusions are just one type of psychotic symptom. Other symptoms of psychosis include:
Disorganized speech Disordered thinking (thoughts jumping between unrelated topics) Hallucinations (hearing, seeing, or feeling things that aren’t real)
Treatment of Paranoia
Treatment for paranoia depends on the severity of the symptoms as well as the underlying cause. Your healthcare provider or mental health provider may recommend medication, psychotherapy, or—most frequently—a combination of the two.
Medication
Antipsychotic medication may be prescribed, particularly if you have an underlying psychiatric condition such as schizophrenia or bipolar disorder. Other medications that might be used to treat your symptoms include antidepressants, mood stabilizers, and anti-anxiety drugs.
Psychotherapy
Psychotherapy can help people with paranoia develop better coping and communication skills. It can also sometimes help the person “reality test” aspects of their beliefs. Through therapy, people who are experiencing paranoia can also potentially learn to develop greater trust in others, find ways to manage and express their emotions in more adaptive ways, and improve their self-esteem and confidence.
Digital Treatments
Researchers are also beginning to explore the use of digital treatment options for people with paranoia. Among those being considered are:
Mobile appsSocial networkingVirtual realityWeb-based therapies
SlowMo is a newer option that offers digitally delivered face-to-face therapy sessions. It was created to help reduce paranoia in people with psychosis. A 2021 study involving 361 participants showed benefits after using SlowMo, though more research is needed to understand its effects.
Coping With Paranoia
If you’re experiencing paranoia, it’s crucial that you discuss these feelings with your healthcare provider or psychiatrist. If you’ve already been diagnosed with another mental health condition, the emergence of paranoid delusional thinking may be a sign that your treatment or medications need to change. Let your mental health care team know if you are having these symptoms so they can help keep you safe and ensure that you get the right kind of care.
A Word From Verywell
Not only are symptoms of paranoia distressing, but they can seriously disrupt your activities at home, work, or school and 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 manage paranoid thinking and other aspects of living with bipolar disorder or another mental illness. For more mental health resources, see our National Helpline Database.
