Paranoia

Paranoia is the feeling of being watched, persecuted, threatened, or put in danger without evidence that it’s the case. Someone who is in a paranoid state may believe in conspiracies, experience irrational fears and suspicions, or think that others are “out to get them.”

If it persists, paranoia may develop into a delusion—a false, persistent belief. Paranoia and delusions are features of several different mental health conditions, especially psychotic disorders. 

Learn more about paranoia, including signs and symptoms, types, causes, diagnosis, treatment, and when to see a healthcare provider.

Symptoms of Paranoia

Paranoia usually involves intense feelings of anxiety, fear, betrayal, and/or suspicion. People who are experiencing paranoia often refuse to accept that they are not being persecuted or threatened, even when they are presented with solid evidence that their fears are unfounded. 

Here are some possible signs and symptoms of paranoia:

• Hypervigilance
• Defensiveness
• Hostility
• Anxiety
• Sensitivity to perceived criticism
• Extreme mistrust and suspicion
• Argumentativeness
• Difficulty with forgiveness
• Believing that others are gossiping about you or conspiring against you
• Believing that others are attempting to steal from, lie to, poison, betray, sabotage, physically harm, or even kill you
• Thinking that others are speaking in coded meanings 
• Thinking that a person, government, or organization is spying on or tracking you
• Thinking that your thoughts or actions are being monitored or controlled

Someone who is in a paranoid state may have trouble getting along with others because of their fears of betrayal. They may also become isolated and withdrawn in an attempt to protect themselves from harm.

Causes of Paranoia

Paranoia is not always a sign of an underlying medical condition. Nearly everyone has paranoid thoughts at some point, especially during times of stress. People who have experienced poverty, racism, abuse, trauma, and other kinds of chronic inequality or oppression are more at risk of developing paranoid thoughts. 

When paranoia is intense and persistent, however, it may be a feature of a medical condition, whether mental, physical, or both.

Mental Health Conditions

Paranoia is particularly common among people with psychotic disorders—mental health conditions that involve abnormal thinking and cause people to lose touch with reality.

The following mental health disorders are often associated with paranoia:

• Bipolar disorder: Bipolar disorder is a mood disorder that causes extreme shifts in mood. Some people with bipolar disorder experience symptoms of psychosis (breaking from reality). This may include paranoid delusions, hallucinations (hearing or seeing things that others can’t), or both.
• Schizophrenia: Schizophrenia is a psychotic disorder that causes disturbances and disorganization in speech, emotions, thinking, movement, perceptions of reality, and social interaction. Paranoid delusions, especially involving fears about persecution, are common in people with schizophrenia.
• Delusional disorder: People with delusional disorder have delusions that persist across time, but they don’t experience other symptoms of psychosis (such as hallucinations). These false beliefs usually involve paranoia about conspiracies and other perceived threats. They may be bizarre (highly unlikely to happen) or non-bizarre (technically possible), but they are always detached from reality. 
• Paranoid personality disorder (PPD): Paranoid personality disorder is a non-psychotic mental health condition that involves extreme, long-term mistrust and suspicion of other people. People with paranoid personality disorder may isolate themselves or struggle in work or school environments due to their suspicions.

Physical Conditions

In some cases, paranoia has a physical cause. Paranoia may be a sign of certain neurological conditions and forms of cognitive decline, such as:

• Dementia: Paranoia is often present in the later stages of dementia and conditions that cause dementia, such as Alzheimer’s disease, Huntington’s disease, and Parkinson’s disease. People with Alzheimer’s disease often experience paranoia as a result of ongoing memory loss. For example, if they lose their possessions, they might start to think that someone is stealing from them. 
• Traumatic brain injury (TBI): Brain injuries can sometimes cause changes in personality, memory, and mood, as well as schizophrenia-like psychotic symptoms. People with TBIs may experience paranoia, delusions, and hallucinations shortly after their injury or many months or years later.

Recreational drug or alcohol use, addiction, and withdrawal can also sometimes lead to drug-induced paranoia. For example, people who use cannabis, hallucinogens, or amphetamines may experience paranoid thoughts as a side effect.

Are There Tests to Diagnose the Cause of Paranoia?

Because paranoia may be a sign of a mental illness or physical condition, it’s important to seek help. A psychiatrist or psychologist can use the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) to determine whether you have delusional disorder, schizophrenia, bipolar disorder, or any other mental health condition. 

Your primary care provider (PCP) may also refer you to another specialist, such as a neurologist. They can use a physical exam, an assessment of your medical history, and/or imaging tests to rule out a brain injury and other possible underlying conditions.

How to Treat Paranoia

Treatment for paranoia typically involves medication, psychotherapy, or a combination of both. Cognitive behavioral therapy (CBT) can help you identify your irrational fears and suspicions, change your negative thinking patterns, and alter your behavior to reduce their impact. 

Your psychiatrist may prescribe antipsychotic medications to treat paranoia, especially if you have schizophrenia or bipolar disorder. Some antipsychotic medications that have shown promise in treating symptoms of paranoia include Risperdal (risperidone), Zyprexa (olanzapine), and Invega (paliperidone palmitate).

When to See a Healthcare Provider

If you think you may be experiencing paranoia, help is available. Reach out to your healthcare provider if:

• You are preoccupied with thoughts of being harmed, monitored, or betrayed.
• Your thoughts are interfering with your daily life or relationships.
• Your thoughts persist even after you find evidence that they are not true. 
• Your suspicions, fears, or beliefs upset or worry you.
• You know that your fears are unlikely to come true, but you can’t get rid of them.
• Your loved ones often have to reassure you that your suspicions are unfounded.

Summary

Paranoia is a feeling of intense fear and anxiety about being watched, threatened, or betrayed. It may involve unfounded fears about infidelity, harm, persecution, or surveillance. 

Paranoia may be a symptom of a mental health condition, such as bipolar disorder, schizophrenia, paranoid personality disorder (PPD), or delusional disorder.

Neurological conditions, such as traumatic brain injuries (TBIs), dementia, Parkinson’s disease, and Huntington’s disease, can sometimes lead to paranoia. It may also be triggered by stress, isolation, trauma, or drug use. 

Effective treatments for paranoia include psychotherapy such as cognitive behavioral therapy (CBT) and antipsychotic medication.

A Word From Verywell

If you experience paranoia, it may be difficult to trust others and believe that they have your best interests in mind. You might even find it challenging to trust healthcare providers. However, because paranoia may be a sign of a serious medical condition—such as a brain injury or mental illness—it’s important to seek help.