Paranoia is classified as a pattern of irrational thinking that causes unfounded suspicion and mistrust of other people. While it is normal for all of us to experience paranoia at some point in our lives, when this pattern of thinking becomes constant and intense, it can lead to extreme distress, an inability to function day-to-day, and serious mental health issues.
Paranoia may include feeling persecuted, misunderstood, isolated, and distrustful. These feelings can lead to the breakdown of relationships and persistent anxiety, stress, or depression.
Paranoia manifests differently from person to person; however, common themes include:
- Fear that someone will try to hurt or kill you
- Feeling like everyone is talking about you, staring at you, or laughing at you
- Feeling isolated due to deliberate exclusion
- Believing you are being spied on or followed by the government or an organization.
- Any of these themes may be accompanied by hallucinations
Paranoid thoughts, also known as delusions, are most frequently centered on other people, their opinions of you, or what they might do or think. As low-level paranoia is a common human experience and an interpretation of genuine social behaviors, it can be difficult to determine whether or not a suspicious thought is a delusion. Suspicious thoughts are likely symptoms of paranoia if:
- There is no evidence for the thought or there is evidence against the thought
- No one else shares, or agrees with, the thought
- The thought is still intense even after reassurance from trusted others
Causes of Paranoia
The absolute cause of paranoia is not clear; however, research suggests that particular triggers, past trauma, environment, and certain mental illnesses are potential factors in the onset of paranoia-based symptoms.
Potential contributions include:
- Brain diseases/conditions such as Alzheimer’s, dementia, Huntington’s, stroke, epilepsy, or tumors
- Brain toxicity (caused by toxins or poisons)
- Prescription medications
- Substance intoxication and withdrawal
- Having a genetic predisposition for paranoia
- Experiencing trauma and/or abuse
- Social isolation
- Stress/ a major life change (such as sudden death of a loved one, losing a job, divorce, being the victim of a crime, or ill health)
- Mental health conditions including bipolar disorder, schizophrenia, paranoid personality disorder, and delusional disorder
Paranoia and Mental Health
Paranoia is not a diagnosis in itself but instead is a symptom of various mental health disorders. Mild paranoia, which affects most of us at some point in our lives, is known as non-clinical paranoia. These thoughts will vary over time, be rated to certain environments or situations, and not be overwhelming or distressing, These can be rationally thought through.
However, the other end of the spectrum is clinical paranoia or persecutory delusions which can be severe, even dangerous, and require therapeutic treatment.
Delusional disorder is a rare disorder that tends to present in middle to later life and is slightly more common in women. It is a type of serious mental illness, a “psychosis,” in which someone has trouble recognizing reality and distinguishing what is real from what is imagined.
There are several recognized sub-types of Delusional Disorder:
- Erotomanic: Patients believe that another person, often someone who is important or famous, is in love with them. This belief can lead to stalking behaviors, as they will try to make contact or pursue a relationship with the person.
- Grandiose: Patients with this delusion may believe they have a special ability or remarkable talent, have made an important discovery, or have a relationship with someone important, such as a celebrity or the Pope. It could also be more generalized, where the person has an exaggerated sense of worth, knowledge, or power.
- Jealous: Patients with this delusion believe that their partner, spouse, or lover is unfaithful. It may be supported by some evidence. However, it is either exaggerated, falsified, or misinterpreted.
- Persecutory: People with this type of delusional disorder believe that they (or someone close to them) are being plotted against, threatened, or mistreated or that someone is spying on them or planning to harm them. The person will often make repeated accusations and complaints to legal authorities. They may also react aggressively because of their perceived need for self-defense or retaliation.
- Somatic: The patient believes that they have an illness, medical issue, physical defect, or bodily dysfunction. Such individuals may believe that they are experiencing physical sensations or bodily dysfunctions, such as foul odors or insects crawling on or under the skin, or that they are suffering from a general medical condition or defect.
- Mixed: An individual exhibits delusions that are characterized by more than one of the above types, but no one theme dominates.
Thought disorder is defined as a disorganized way of thinking. This can be expressed through abnormal expressions of language when speaking and writing. Thought disorder is one of the key symptoms of schizophrenia, but it can also occur alongside mania, bipolar disorder, and depression.
Although there are more than 20 sub-types of thought disorder, it is considered one of the most difficult mental illnesses to treat as the symptoms can be hard to define or may only occur occasionally such as when the person is tired or under stress.
Schizophrenia is a severe and chronic mental health disorder that affects how a person perceives reality and relates to others. This disorder can make daily life difficult, and a sufferer will likely have debilitating issues at work, school, or in relationships.
Schizophrenia presents through a disabling psychosis where the individual loses touch with reality. A person’s behavior, emotions, and personality can alter dramatically and suddenly as they find themselves confused, suffering intense delusions, and experiencing auditory, visual, or sensory hallucinations. These psychotic episodes are extremely distressing and can lead to dangerous behavior and even violence to themselves or others.
Paranoid Personality Disorder
Paranoid Personality Disorder (PPD) is exhibited by people who persistently perceive interpersonal threats without reasonable evidence or cause. People suffering from this disorder are often on high alert, constantly scanning their social environment for signs of threat.
Individuals with PPD frequently believe that people are plotting against them, persecuting them, attempting to harm them, or trying to demean them. This can result in the sufferer holding grudges or acting vindictively in response to perceived slights or acts of aggression.
This disorder is more common among women than men and usually begins by early adulthood.
Treatment for clinical paranoia can be challenging, especially if the delusion is longstanding. It is common for people to dismiss the possibility of a mental health disorder as the paranoid delusions appear real and justified. It is essential for the person to be supported by family and friends who can compassionately help them differentiate between reality and delusion.
- Treatment establishes a positive and effective physician-patient relationship, with support to address the complications the delusions may cause for the patient.
- Psychotherapy provides a safe environment for patients to explore their delusions while cultivating healthier and more functional behaviors.
- Hospitalization if the delusions trigger dangerous behavior.
- Antipsychotics can be helpful; however, not all delusions respond to medication.
- Ongoing education of family and friends along with support resources and family therapy.
 Boyd, Tom, and Andrew Gumley. “An Experiential Perspective on Persecutory Paranoia: A Grounded Theory Construction”. Psychology and Psychotherapy: Theory, Research and Practice, vol 80, no. 1, 2007, pp. 1-22. Wiley, https://doi.org/10.1348/147608306×100536. Accessed 24 Feb 2022.
 Hollander, E. et al. “Body Image in Mood and Psychotic Disorders”. Encyclopedia of Body Image and Human Appearance, 2012, pp. 233-237. Elsevier, doi:10.1016/b978-0-12-384925-0.00035-3. Accessed 19 Jan 2021.
 Sarzynska-Wawer, Justyna et al. “Detecting Formal Thought Disorder by Deep Contextualized Word Representations”. Psychiatry Research, vol 304, 2021, p. 114135. Elsevier BV, https://doi.org/10.1016/j.psychres.2021.114135. Accessed 24 Feb 2022.
 Moritz, Steffen et al. “Prolonged Rather than Hasty Decision-Making in Schizophrenia using the Box Task. Must we Rethink the Jumping to Conclusions Account of Paranoia?”. Schizophrenia Research, vol 222, 2020, pp. 202-208. Elsevier BV, https://doi.org/10.1016/j.schres.2020.05.056. Accessed 24 Feb 2022.
 Lewis, Katie C., and Jeremy M. Ridenour. “Paranoid Personality Disorder”. Encyclopedia Of Personality And Individual Differences, 2020, pp. 3413-3421. Springer International Publishing, https://doi.org/10.1007/978-3-319-24612-3_615. Accessed 24 Feb 2022.