What Are Paranoid Delusions?

Paranoid delusions, also known as persecutory delusions, are fears, anxieties, and suspicions centered on perceived victimization or unwarranted feelings of being threatened by external forces such as individuals or government authorities.

What Is a Delusion?

Delusion is a false belief that a person insists is true despite evidence to the contrary. It’s crucial to understand that cultural beliefs or oppressions are not classified as delusions. 

Unlike paranoia, paranoid delusions become so fixed that nothing can convince someone what they think or believe is not true. Paranoid delusions are not classified as a distinct mental health disorder, rather, they are often a symptom of other mental health conditions such as schizophrenia, paranoid personality disorder, and delusional disorder.

A man peeking outdoors through the blinds of a darkened room

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What Are Paranoid Delusions?

Paranoid delusions are unfounded feelings that someone or some group is out to mistreat, harm, and sabotage you or someone close to you. You may feel as though someone is plotting against you and seeks to destroy your life when there is no evidence of your claim. Irritability, anger, and low moods are characteristics of someone suffering from delusions.

A person with these delusions also believes in their perceived threats so much that no one, even those closest to them, can convince them that they are not real. It is not uncommon for them to report their untrue or highly exaggerated claims to professional authorities.


Symptoms that might accompany paranoid delusions include:

  • Intense and irrational feelings of mistrust or suspicion
  • Hypervigilance
  • Difficulty with forgiveness
  • Defensiveness in response to imagined criticism 
  • Preoccupations with hidden motives
  • Fears of being deceived or taken advantage of
  • Inability to relax
  • Argumentative behavior 

These symptoms often mean that people with paranoid delusions have problems with forming and maintaining interpersonal relationships.

Examples of Paranoid Delusions

People with paranoid delusions believe they are in danger due to external threats from specific people such as their spouse or parent, authorities such as the police or teachers, or groups such as a board or human resources department. 

They may say things like:

  • "They are out to ruin my reputation."
  • "They put tracking technologies in my medications." 
  • "I know my employer put a camera in my home." 
  • "If I leave the house, they will burn it down."
  • "The government released a virus to kill me." 

Note that there is always a subject acting as the threatening agent, whether it is an unspecified “they,” an authority figure like the government, or a specific person like a parental figure. 

Some people with paranoid delusions may avoid telling anyone about their beliefs due to sweeping suspicions that they cannot trust anyone. 

Causes and Risk Factors

There is no single cause for paranoid delusions. Many people experience them as part of an episode of a mental illness such as a psychotic or mood disorder.

Risk factors for paranoid thoughts include:

  • Life experiences: You are more likely to experience paranoid thoughts when you are in vulnerable, isolated, or stressful situations. 
  • Adverse childhood experiences (ACES): These may lead you to believe that the world is unsafe and people are not to be trusted. 
  • External environment: Some research suggests that paranoid thoughts are more common in communities where you feel isolated from the people around you rather than connected to them. Media reports of crime, terrorism, and violence may also play a role in triggering paranoid feelings.
  • Mental health: Experiencing anxiety, depression, or low self-esteem, along with the expectation that others are criticizing you, may make you more likely to experience paranoid thoughts and become more upset by them. 
  • Physical illness: Paranoia is sometimes a symptom of physical illnesses such as Huntington's disease, Parkinson's disease, strokes, Alzheimer's disease, and other forms of dementia. Hearing loss can also trigger paranoid thoughts in some people.
  • Lack of sleep: Lack of sleep can trigger feelings of insecurity and even unsettling feelings and hallucinations. 
  • Effects of recreational drugs and alcohol: Some drugs may trigger paranoia, such as cocaine, cannabis, alcohol, ecstasy, LSD, and amphetamines. 
  • Exposures to toxic substances: Certain steroids taken by athletes and some insecticides, fuel, and paint are also associated with paranoia. 
  • Genetics: Research suggests that certain (still unknown) genes may affect a person's susceptibility to paranoia. 


Since paranoid delusions are associated with other mental health conditions, it is there where clinicians often focus their diagnostics. Under the diagnostic criteria listed in the DSM-5, paranoid delusions that do not fit under a defined psychotic or other mental health disorder may be formally labelled as either "unspecified schizophrenia spectrum and Other psychotic disorder" or "other specified schizophrenia spectrum and other psychotic disorder."

Harvard Health Publishing says that if the person allows it, the following can be useful in the diagnostic process of paranoid delusions related to delusional disorder:

  • Conversations with supportive family or friends
  • A general medical evaluation
  • Diagnostic tests such as an electroencephalogram, magnetic resonance imaging, or computed tomography scans when a neurological cause is suspected.


It can be particularly difficult to treat a person with paranoid delusion, as there can often be irritability, emotional guardedness, and even hostility. The person suffering from the delusion may be suspicious of the intentions of mental health clinicians and may not even recognizing that they are experiencing an illness.

Progress is typically slow, but recovery and reconnection is possible.

With sustained treatment, a person with paranoid delusions can enter remission. Specific treatments will depend on several factors, including the perceived cause of delusions and the receptiveness of the person to accepting that they need help. Their ongoing willingness to stay the course of any given treatment plan is also a considerable factor.

Treatment options for paranoid delusions typically take a combination approach, and may include typical or atypical antipsychotic medications that can help reduce symptoms by blocking abnormal messages to the brain.

Cognitive behavioral therapy can be used to help the person challenge and ultimately change conscious thought patterns related to their paranoia. 

In some cases, supervised drug or alcohol detox, hospitalization, or in-patient treatment may be necessary to reduce the risk of harm to the person and others if their paranoid delusions are related to a substance use disorder.

It is ideal to contact a professional at the first sign of a delusion. If you suspect you or someone you know has paranoid delusions, and there are any concerns for someone's safety, call 911 for assistance. 

Supporting a Loved One

Supporting a loved one with paranoid delusions can be challenging. The risk of caregiver burnout is high due to the often chronic nature of such patterns of thinking. 

The following ideas from the National Alliance on Mental Health and come directly from someone who has experienced psychosis-associated delusions:

  • Avoid disputing or reinforcing the delusions. It has the opposite effect, and the person may indeed cling even harder to their delusions.
  • Validate but redirect underlying fears. This can be useful for people with less severe symptoms, and can help them see alternate options to their beliefs without suggesting that the person is wrong. The formula could be something like this: “I see what you’re getting at (regarding the unfounded suspicion). I tend to think of it like this… (providing a reasonable explanation without insisting on its truth).”
  • Understand this is an ongoing recovery process without any quick fixes. 

Also, consider the following ways you can support someone with paranoid delusions:

  • Consider if their beliefs may be justified
  • Consider if there is a basis for their beliefs
  • Talk openly
  • Don’t dismiss fears
  • Focus on the person’s feelings
  • Support them to seek professional help
  • Respect their wishes
  • Know where to get emergency help 

You should not have to support a loved one with paranoid delusions on your own. These delusions won't go away with love and kindness alone. The person you love requires professional help.

If you are feeling overwhelmed or are at risk of burnout, reach out for help as soon as possible.

A Word From Verywell

Recovering from paranoid delusions is possible. Leaving paranoid delusions untreated can potentially have a seriously detrimental impact not only on the person experiencing the delusion but also on their loved ones, co-workers, and community. 

It can be difficult to determine whether you need help when these thoughts are occurring. If you can, it can be particularly helpful to step back and challenge your own beliefs. Keeping a diary of paranoid thoughts, sleeping patterns, prescription medications, and recreational or illicit drug use can be an invaluable way to see patterns that otherwise may go unnoticed.

Talking to others, sharing your thoughts, and asking for help can make all the difference. You do not have to suffer from your own thoughts. With the right help, you can get your life back and learn to manage thought processes in a healthy way.

5 Sources
Verywell Health 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. MedlinePlus. Psychotic Disorders.

  2. Mental Health America. Paranoia and Delusional Disorders.

  3. Lamster F, Nittel C, Rief W, Mehl S, Lincoln T. The impact of loneliness on paranoia: An experimental approach. J Behav Ther Exp Psychiatry. 2017 Mar;54:51-57. doi: 10.1016/j.jbtep.2016.06.005

  4. Harvard Health Publishing. Delusional Disorder.

  5. Runkle, K. National Alliance on Mental Health. Psychosis: Responding to a Loved One in the Face of Uncertainty.

By Michelle Pugle
Michelle Pugle, BA, MA, is an expert health writer with nearly a decade of contributing accurate and accessible health news and information to authority websites and print magazines. Her work focuses on lifestyle management, chronic illness, and mental health. Michelle is the author of Ana, Mia & Me: A Memoir From an Anorexic Teen Mind.