What is Paranoia?

Paranoia is often a symptom of a psychotic disorder. In the UK, psychotic disorders disproportionately affect Black males, with 3.2% affected, as opposed to 0.3% of White males. However, a study undertaken in 2018 demonstrated that different forms of paranoia affect somewhere between 2% to 30% of the population.

What is paranoia?

Paranoia is a symptom of mental health conditions, in which the individual suffers from unreasonable suspicion and mistrust of others. They often feel that they are the subject of outward threats. It rarely stands alone as a mental health condition, as commonly it is a symptom of other psychotic conditions.

Paranoia often persists, despite the individual being presented with rational information or opposing evidence to the suspicion. Paranoid thoughts may even transpire into delusional thoughts, where the individual begins to hear or visualise things.

Whilst mild paranoid thoughts are something that many people experience at some point in their life, the symptoms in someone with paranoia must be consistent and more extreme than what might be considered to be normal.

What can cause paranoia?

Paranoia can be caused by a deterioration in mental and emotional functions that employ the use of reasoning, and is often a symptom of psychotic conditions, such as schizophrenia. It is not entirely known why these mental and emotional functions deteriorate, but it is widely thought that it is linked to past trauma, repressed emotions, genetics and life experiences. It can also be triggered by substance abuse.

Past trauma and life experiences:

Circumstances, events and experiences during childhood may evoke beliefs and feelings of suspicion within the world, and lead someone to become untrusting. Many cases of paranoia can be linked back to episodes of child abuse and bullying. Life experiences as an adult can trigger paranoia as well. Paranoia may be more likely to occur in someone who has been the victim of a crime, where mistrust develops into paranoid thoughts.

Environment:

Paranoia may occur when a person is constantly exposed to instances of crime or bad news, for example, someone may believe that they are at risk of something because it has been widely reported on the news, and go to extreme measures to protect themselves from harm. Paranoia may also be heightened for those in cities and busy areas.

Substance abuse:

Paranoia is not usually caused by substance abuse itself, but it can trigger underlying paranoid thoughts and behaviours. Hallucinogenic drugs, such as LSD and cannabis, are particularly triggering, but other drugs such as cocaine, amphetamines and alcohol can all have temporary effects of paranoia.

Other substances which aren’t considered to be drugs are also linked to paranoia, such as paint, glue, gas and steroids. Importantly, the use of any of these substances may interfere with the efficacy of any medication that is administered to a patient suffering from paranoia.

Genetics:

Scientists are unsure exactly how paranoia may be linked to genes, but psychotic disorders that involve symptoms of paranoia, such as schizophrenia, are more likely to occur in individuals with a family history.

Health conditions:

Paranoia can be a symptom of mental and physical health conditions, such as psychosis, schizophrenia, personality disorders, anxiety and depression, as well as degenerative diseases such as dementia. You can read more about the side effects of psychosis by visiting our knowledge base.

Poor sleep:

Consistently poor sleep can cause paranoia, as sleep affects a person’s clarity of mind, creating tension and intense analysis of people’s normal behaviours. Lack of sleep in worst-case scenarios can cause hallucinations, where the individual may begin to confuse things that haven’t happened with reality.

Stress:

Stress can induce many thoughts and feelings, including paranoid thoughts, which cause mistrust of the people around you.

What are the signs and symptoms of paranoia?

Symptoms of paranoia are often presented with symptoms of other mental health conditions.

Some symptoms of paranoia include:

• Defensive behaviour, which can sometimes become aggressive or violent.
• Difficulty relaxing.
• The view that you are always correct.
• Taking offence easily.
• Mistrust in people.
• Inability to confide in people.
• Analysing people’s words and actions to find hidden meanings.
• Not being able to forgive others.
• Not being able to take criticism on board.

Statements which might be common to people with paranoia are:

• ‘No one likes me’.
• ‘Everybody is staring at me’.
• ‘Everybody is making fun of me’.
• ‘X has something against me’.
• ‘They’re trying to make me fail’.
• ‘X is obsessed with me’.
• ‘X is following me’.

What are the types of paranoia?

Paranoid Personality Disorder

Paranoid Personality Disorder (PPD) is a mental health condition characterised by mistrust which is so extreme that it affects routines, thoughts and behaviour. Someone with PPD may feel extremely suspicious of others and is continually analysing the behaviours of others to catch them out for signs of deception.

Even if they are provided with evidence to the contrary, they will still persist in doubting how much they can trust other people. Their behaviour may become controlling and aggressive, which can make relationships with others difficult, tense and imbalanced.

They may accuse loved ones frequently of things that they haven’t done. PPD affects all areas of life, from their professional life to their personal life.

As this type of disorder centres largely around mistrust of others, sufferers will often respond in a hostile manner towards suggestions of treatment, and are usually convinced that they are fine and do not need help. They may even believe that the suggestions of treatment reaffirm their thoughts that people do not have their best interests at heart.

Delusional Disorder

Delusional disorder is an extreme type of psychotic disorder, where the individual cannot distinguish between reality and imagination. Delusions are immovable convictions of things that are not true or real but could be real.

For example, people with delusional disorder might be convinced that they are being watched, followed, or that someone is trying to harm them, and even that someone is deeply in love with them. The situations, whilst they may not be true, are not situations that could never occur. However, in their case, they are not true.

People with delusional disorders usually have delusions that fall into the following categories:

• Somatic. They are convinced that they have a health issue.
• Jealousy. They become extremely jealous of someone, usually a friend or a partner, and may believe that they are being betrayed by that person.
• Grandiose. They believe that they are extremely powerful or knowledgeable, or that they are important/superior to others.
• Erotomania: The individual might believe that someone loves them, and may not even know the person very well. Usually, it is someone in the public eye. Someone with delusional disorder may continually try to get in touch with them.
• Persecutory. They think that someone is trying to harm them, or someone that they know. They may even go as far as to report that they are being watched or stalked.

People with delusional disorder can function within society, though they may be obsessed with their delusion, which may interfere with other aspects of their life. They are not typically affected by paranoia with many things outside of their delusion. It is likely that their delusion may be a symptom of another existing psychotic disorder, rather than existing by itself.

Paranoid Schizophrenia

Paranoid schizophrenia is a form of schizophrenia that merges paranoia with delusions and can be extremely disruptive to leading a normal life. People with paranoid schizophrenia can often feel as though people are ‘out to get them’, including friends and family.

Thus, they may feel safer inside and alone. Schizophrenia, without paranoia, affects the way people think and act, and their perception of the world around them, causing them to become isolated from reality.

Symptoms of paranoid schizophrenia are slightly different to those of other forms of paranoia, as they combine with symptoms of schizophrenia. You can read more about schizophrenia by visiting our knowledge base.

Is paranoia a mental health problem?

The term paranoia has Greek origins, deriving from ‘para’, meaning ‘beside’, and ‘noos’, meaning ‘mind’. Historically, the term has been used colloquially to describe any type of delusion, but it has since been widely agreed that paranoia cannot be distinctly described as a mental health condition by itself.

It usually presents with markers for wider mental health conditions. If you present with symptoms of paranoia, your doctor will often look for wider symptoms of psychotic conditions, or health conditions such as dementia.

Is paranoia dangerous?

Paranoia has been depicted in the media to be dangerous, though the majority of people with paranoid thoughts do not present a threat to themselves or those around them. However, there are safety concerns in some cases, as people with more extreme paranoid thoughts can become defensive and react aggressively.

Sadly, one of the most damaging consequences of paranoia is isolation. Many people who suffer from paranoia tend to isolate themselves, due to their mistrust of others. Simultaneously, people may choose to avoid people with paranoia, due to fear and sometimes to discrimination. This can further the paranoid thoughts, and add to depression and anxiety disorders.

Can paranoia be diagnosed and treated?

Living with paranoia is extremely difficult. It can be very hard to build relationships, which significantly impacts the trust that an individual has for doctors and therapists. Thus, someone with paranoia may be unknown to mental health services, as diagnosis involves referrals to psychologists and psychiatrists.

There are various treatments available for illnesses that present paranoia as a symptom, none of which are guaranteed to work.

These may include:

Cognitive Behavioural Therapy

This is a tried and tested method for exploring how people interact with their thoughts and helps to address anxiety, which can make paranoia worse. Other forms of therapies may be useful, such as art therapies, which help people who are suffering from paranoia to process their feelings. You can read more about CBT by visiting our knowledge base.

Psychotherapy

Psychotherapy can be an extremely effective treatment, as it helps individuals to open up wounds from repressed traumatic experiences, which are known to be common factors in people who then later suffer from paranoia. It is often used alongside medications to see the best effects.

Medication

Medication is usually offered to people with paranoid schizophrenia. The medication will take the form of an antipsychotic drug which can lessen the severity of delusions and hallucinations, which lead to paranoid thoughts. In addition to this, doctors may prescribe antidepressants if the paranoia is a symptom of depression and anxiety.

Antipsychotic drugs that may be prescribed are:

• Pimozide. This may be prescribed for people who suffer from paranoid delusions.
• Risperidone. Andrew, who experienced symptoms of psychosis at 15 years old, tells his story of how risperidone helped him recover.
• Clozapine. A form of atypical antipsychotic, clozapine is prescribed when other antipsychotics have not given the desired effects.

Other drugs may include olanzapine and paliperidone. Antipsychotics treat psychosis generally and may have varying side effects, as there is no approved medication for treating paranoia directly.

It is important that anyone using antipsychotic medications should be monitored closely for side effects, and should cease immediately from taking any medications that worsen paranoia and anxiety or lead to thoughts of harm and suicide.

Mindfulness:

It may be helpful to implement changes to sleep routines, as improved sleep has been proven to aid in reducing the symptoms of paranoia. Additionally, practising exercises such as yoga and meditation can help to bring thoughts back to the present, and regain control of the mind.

What support is available for people with paranoia?

Whilst people with psychotic disorders, depression, anxiety and other mental health conditions are able to attain free therapy under the care of the NHS, waiting lists can be extremely long. There are other services available which may be of use to anyone experiencing paranoia.

• British Association for Counselling and Psychotherapy (BACP) is a service that helps people to find registered therapists and counsellors from their extensive directory.
• Rethink is a mental health charity that helps individuals to find support local to them, including support groups, therapy and online support. They also provide information about living with a mental illness and responding to unusual behaviours.