Paranoia Treatment

Paranoia is characterized by irrational and excessive feelings of persecution, mistrust, jealousy, threat, or self-importance. When a person is paranoid, they feel completely overwhelmed by their suspicions, despite any evidence that rationalizes these feelings.

For example, they might be afraid they are being poisoned, that their partner is cheating on them, or that someone is watching them, even though they do not have any proof that these things are actually happening.

Paranoia exists on a continuum—from everyday mild paranoia that is experienced without a diagnosable mental health condition to drug-induced or psychotic paranoia. Anyone from teens to older adults can experience paranoia.

The treatment for paranoia usually includes a combination of prescription medications and psychotherapy, but the specifics will depend on your needs, including any co-occurring mental health conditions that you have.

Signs of Paranoia

Paranoia does not look the same in every person who experiences it. People can be paranoid about different things, which determines the situations in which they may act paranoid.

Many people who are paranoid are able to work, attend school, and may even appear mentally well at first glance. However, people who are in close relationships with a person who is paranoid will often notice behavior changes—at times, because they are the subject of a person’s paranoia.

There are several signs and symptoms of paranoia, and a person may have some or all of them.

A person who is paranoid might experience:

• Preoccupation or obsession with the hidden motives of others, which are often identified as persecutory to the individual
• Feelings of mistrust and suspicion toward others
• Argumentativeness, irritability, and sometimes violence or aggression
• Poor relationships with others leading to increased isolation
• Lack of insight into the irrationality of their beliefs
• Holding grudges or not forgiving others for their perceived digressions
• Non-bizarre delusions
• Remembering events differently from how they actually occurred
• Defensiveness
• Hypervigilance, anxiety, and an inability to relax
• An increased frequency of pursuing legal action for the belief that their rights have been violated
• A consistent belief that their partners are being unfaithful
• Continued ability to engage in work or school despite their paranoid behaviors

Associated Conditions

Paranoia is often associated with paranoid personality disorder, a mental health condition that is outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, paranoid personality disorder is relatively rare.

Paranoia itself is much more common and can be a symptom of multiple psychiatric conditions, including:

• Paranoid personality disorder (PPD): A Cluster A personality disorder, PPD is estimated to affect 1.21% to 4.4% of adults in the United States. Symptoms include pervasive and unfounded distrust and suspicion (paranoia) that interferes with daily life and functioning. The onset of PPD might be linked to childhood trauma and social stress, in addition to environmental and genetic factors.
• Delusional disorder: A delusion is a fixed false belief. People with delusional disorder experience ongoing paranoia for one month or more that is not otherwise physiologically explainable. Delusions can be of jealousy or persecution, or fall into other categories. The person may feel that they are being conspired against and go to extreme lengths, including calling the police or isolating themselves.
• Schizophrenia: Schizophrenia is a mental health condition that is characterized by hallucinations, delusions, and disorganization. In previous versions of the DSM-5, paranoid schizophrenia was a subtype of this condition, however paranoia is now considered a positive symptom of schizophrenia (which means that it occurs in addition to typical mental function, as opposed to negative symptoms which take away from typical mental function). Some people with schizophrenia have paranoid delusions.
• Bipolar disorder: Some people with bipolar disorder experience paranoia, which is usually associated with delusions, hallucinations, or disorganization causing a loss of touch with reality. It is most common in the manic phase of bipolar disorder, although it can also be experienced during the depressive phase.
• Dementia: Dementia is an umbrella term for neurodegenerative conditions that affect memory and behavior, including Alzheimer’s disease and vascular dementia. People with dementia may have paranoid feelings related to the changes in their brain that are caused by the condition. The feelings might be linked to their memory loss, as people may become suspicious of others as a way to make sense of misremembering and misinterpreting events.

Paranoia Treatment

Paranoia can damage relationships, social functioning, and mental well-being. There are several approaches to treating paranoia and helping people experiencing it manage the symptom and cope more effectively with it in their day-to-day lives.

Lifestyle Tips

Some lifestyle changes may help reduce feelings of paranoia. Mindfulness exercises, as well as yoga, yoga Nidra, tai chi, or meditation, may help you switch your thoughts to the “here and now” rather than focusing on past events or the intentions of others.

Improving your sleep quality and quantity is shown to improve paranoid symptoms. A large randomized controlled trial found that treating insomnia was effective at reducing paranoia and hallucinations among participants.

For people who use substances, including alcohol, quitting or cutting back may also help control symptoms of paranoia, as substances can be a trigger.

Therapy

People with paranoia are often referred for psychotherapy. There are many types of psychotherapy, but cognitive behavioral therapy (CBT) has been shown to be effective at treating the pervasive symptoms of paranoia.

CBT can be done individually, but in the context of paranoia, research shows it is also effective in group settings. One randomized controlled trial of a group CBT program among prison inmates found that treatment was effective at lowering scores of paranoia.

Another randomized controlled trial of mindfulness-based cognitive therapy in groups of 10 to 15 people found that treatment significantly reduced feelings of paranoia, and improved feelings of social acceptance.

Group therapy may seem counter-intuitive for people who are experiencing a deep mistrust of others. However, group settings create a safe space for people to confront these feelings with others who have similar feelings and experiences.

What a Therapy Session Might Be Like

If you have paranoia, it is normal to feel distrustful of your therapist at first. In the beginning, you will focus on building trust and a therapeutic relationship with one another.

In your first therapy sessions, your therapist will listen to your concerns and may ask you a few questions. As you continue with therapy, your therapist might ask more probing questions to help you identify where your feelings are coming from and what’s triggered them.

You may feel more comfortable journaling about your paranoid symptoms to identify triggers rather than talking through them. Practicing relaxation and mindfulness techniques during sessions may also help you feel more at ease.

Medication

Typical and atypical antipsychotics can be prescribed to treat severe paranoia, particularly for people who have schizophrenia, bipolar disorder, or delusional disorder. There are several antipsychotics that might be prescribed to treat paranoia, including:

• Olanzapine
• Risperidone
• Paliperidone palmitate long-acting injection 

Paranoia About Doctors and Medications

Compliance with a medication regimen can be a challenge for people with paranoia. They may distrust their doctor or the medication itself, and in some cases, a person might believe that they are being poisoned by the medication that is prescribed to them for their symptoms.

Thorough education should be provided on the medication and the importance of adhering to a regimen as prescribed. Doctors should also practice therapeutic listening and relationship building with patients who are experiencing paranoia.

Living With Paranoia

If you have paranoia, you may feel a constant push-and-pull between your desire to restore relationships and your paranoid thoughts and distrust of others.

Your doctor or therapist may recommend specific lifestyle changes, psychotherapy, or medication regimens that have been individualized according to your needs. However, people who are paranoid may find it difficult to trust doctors, therapists, and even prescribed treatments.

You will first need to build trust with your physician or therapist—a process that might take some time. Making some lifestyle changes, like working on your sleep hygiene, practicing mindfulness, and limiting substance use, is an important first step to managing symptoms of paranoia.

You may find that your biggest obstacle is maintaining healthy relationships with others. Paranoid thoughts can distance you from friends, family, and your spouse or partner. It can also affect your workplace and school relationships. This distance can feel isolating and further impact your mental well-being.

Try to communicate your feelings to your loved ones in a simple way about your feelings. Focus on facts rather than assigning blame. You might find it easier to write them a letter rather than have a conversation in person. Remember that it’s just as important to listen to their point of view as it is sharing your own.

Summary

People can become paranoid about many things and for many different reasons. Sometimes, paranoia is a symptom of a mental health condition or substance use disorder.

There are ways to treat paranoia, such as through therapy and medications. However, treatment can be difficult because people who are paranoid might be distrustful of their doctors, therapists, and even the medications that have been prescribed to them.

A Word From Verywell

A person who is paranoid may continue to function at work or school, but they often have difficulty with close relationships if they feel suspicious about their family, friends, or partner. They might even be untrusting of their doctors and therapists, which can make treatment challenging.

While it can take time and patience, building trusting relationships with healthcare professionals is a crucial part of managing the condition.

Frequently Asked Questions 

Paranoia and anxiety are not the same. People with paranoia have unfounded suspicion or mistrust of others, whereas people with anxiety have a more generalized feeling of being in danger, which is not always attributed to a specific cause.

A person can experience both paranoia and anxiety. Paranoia can also lead to anxiety and vice versa.

Paranoia and anxiety can combine in post-traumatic stress disorder (PTSD). Hypervigilance is a symptom of PTSD, and it may manifest as a feeling of paranoia that is triggered by reminders of past traumatic events.

What are common paranoia triggers?

There are several known triggers of paranoia, including lifestyle factors like insomnia, lack of sleep, and poor sleep quality. The use of alcohol and other substances, as well as childhood trauma and socioeconomic factors, are also triggers.

Does paranoia start at a certain age?

Paranoia can occur at any age, from adolescents to older adults.

How can I support someone with paranoia? 

If you have a loved one experiencing paranoia, they might push you away. You may struggle to find ways to support them that they will accept.

Try to avoid being defensive or taking their accusations too personally. Communicate with simple, factual language and do not assign blame.

Your loved one might be resistant to treatment as a consequence of their paranoia. Encourage them to seek treatment—be it psychotherapy, medication, lifestyle changes, or a combination of these options that best meets their needs.

If they consider you a trusted ally, your loved one might also benefit from having your support when they go to doctor or therapy appointments.

Finally, participating in a support group, counseling, or therapy for yourself is also beneficial. Taking care of your own health will help you be there to support your loved one.