Mind Help

Paranoia

Paranoia refers to suspicious thoughts, worries or a strong feeling of threat. A paranoid person may feel threatened by a person or an organization and may hold false beliefs without having any proof for it. In extreme cases, paranoid thoughts can affect a person’s ability to function normally in daily life.

What Is Paranoia?

Paranoia is a thought process or an instinctive feeling that may lead to irrational beliefs or delusion. Influenced by stress, anxiety and fear, paranoid thinking can result in unreasonable suspicion and even mistrust of family, friends and peers. Paranoid individuals may hold persecutory beliefs and develop conspiracy theories about a perceived threat towards their life. They may have a strong sense of harm and believe that people are focused on observing or hurting them. A person with this condition may make false accusations about someone and may socially isolate themselves due to a general distrust of others. Paranoid thoughts are usually an indicator of a personality disorder or a mental health condition. It is also associated with psychosis, dementia and substance abuse. However, it is usually different from intense anxiety or phobias.

“Paranoia involves two key components: a person having unfounded ideas that harm will occur to them, and the idea that the harm is intended by others,” explains a 2017 study 1 . Paranoid thoughts tend to have three primary traits:

  • Unfounded or exaggerated thoughts and beliefs
  • Intense fear about something terrible that can happen
  • A strong belief that the person is being singled out and targeted by others

MindJournal describes paranoia as “a mental state characterized by an individual’s correct observation from an incorrect or mistaken premise, leading to the development of a logically constructed, systematized and persistent series of persecutory delusions, like being maligned, poisoned or conspired against.” A paranoid state can lead to several complications if it occurs frequently or persists for a long time. Clinical paranoia is a more intense form where the person doesn’t believe that they are paranoid as they strongly believe their thoughts are right even if there is no proof.

Research shows that around 5-50% of the general population tend to have paranoid thoughts. According to a British survey, 21% of respondents believed that others were trying to hurt them, while another New York based study found that 11 percent of people thought they were being spied upon or followed. David Penn, a professor of psychology at the University of North Carolina says “People walk around with odd thoughts all the time. The question is if that translates into real behavior.”

History Of Paranoia

According to the International Network for the History of Neuropsychopharmacology (INHN ), the term paranoia is derived from the Greek word “para noeo”, with “para” meaning derangement or departure from the normal, and “noeo” meaning thinking. In Ancient Greece, the term was used to describe a crazy or insane person. The term was first documented in Greek plays and was used by prominent philosophers like Aristotle, Plato and Hippocrates.

Later in the 1800s, the term was used by Johann Christian Heinroth to describe a disorder of intellect with preserved emotions and volition. Paranoid thoughts were first mentioned in DSM-III-R of the American Psychiatric Association to explain the overlapping diagnostic criteria of delusional (paranoid) disorder. Moreover, the ICD-10 of the World Health organization, mentioned the thought disorder in association with delusional disorder in 1992. A 2016 study 2 explains “Paranoia (from the Greek παρά and νοια) made for greater clarity in psychiatric terminology, and denoted a broad category, including both acute and chronic delusional states which were considered to be distinct from mania and melancholia, and usually not to lead to mental deterioration.”

Understanding Paranoid Thoughts

Paranoia is primarily a thought disorder characterized by fearful feelings and severe intense anxiety, suspicion, mistrust and is associated with thoughts of conspiracy, threat or persecution. One 2015 scientific analysis states that it “is a projection of the patient’s internal disturbance, which, as a consequence, is believed to be the result of the hostility of others, such as neighbours, secret agents or foreign powers,” etc. Paranoid thoughts may occur in various mental disorders, such as:

  • Paranoid personality disorder
  • Delusional (paranoid) disorder
  • Paranoid schizophrenia

According to the Encyclopedia of Mental Health 3 (Second Edition), 2016, paranoid people often believe that certain people or groups are targeting them for intentional harm. Cognitive-perceptual biases of intentionality, referentiality and mistrust define this thought disorder. Individuals with this condition often respond with fear, hostility or guardedness to the perceived threats and vulnerabilities.It is believed that childhood abuse and heredity may play a crucial role in the formation of the condition. Some experts also believe that it may be a defensive mechanism, however that is debatable.

Although most people tend to be a bit paranoid at times, severe forms of such thoughts can become delusions. Mental Health America (MHA) explains “Paranoia can become delusions, when irrational thoughts and beliefs become so fixed that nothing (including contrary evidence) can convince a person that what they think or feel is not true.” Delusions of persecution are closely associated with paranoid schizophrenia. The Encyclopedia of Stress 4 (Second Edition), 2007, states that contemporary psychological approaches claim that social cognition plays a crucial role. It also emphasizes that persecutory ideas are linked with mechanisms which may explain memorable experiences in an individual’s life that can make their sense of self-preservation stronger.

One 2006 study explains “Their perception of the world as a threatening place drives them to be highly alert to any evidence suggesting that they are being victimized. A constant search for proof of their victimization often leads them to misinterpret others’ comments and behaviors.” They often tend to be extremely confident about their ideas and knowledge, tend to be hypersensitive to criticism, and have trouble maintaining healthy personal and social relationships. The study adds “People who are paranoid are locked into a rigid and maladaptive pattern of thought, feeling, and behavior based on the conviction that others are out to get them.”

According to the National Health Service (NHS 5 ), UK, paranoid thoughts can often be triggered by the following:

  • Traumatic life experiences and adverse events, like a breakup or bullying
  • Excessive stress caused by the external environment
  • Alcohol and substance abuse
  • Abuse, neglect, abandonment or mistreatment during childhood leading to general mistrust
  • Poor health or medical conditions
  • Sleep deprivation or persistent poor quality sleep
  • Anxiety and depression

Is It Paranoia Or Justified Suspicion?

Suspicious thoughts don’t necessarily translate into paranoid thoughts. When there is external evidence to support a person’s suspicious beliefs and behavior, then it may be justified suspicion. This is often known as prudent paranoia and is “a form of constructive suspicion regarding the intentions and actions of people and organizations,” explains Harvard Business Review. Suspicious thoughts that are justified can indicate high emotional intelligence. “Emotional intelligence, after all, consists in large part of paying attention to what’s happening in the environment and responding to it,” adds Harvard researchers. However, if someone strongly holds on to their suspicion and mistrust even in the lack of evidence or presence of evidence proving the contrary, then it can be a paranoid thought. Justified suspicions can enable someone to be aware and cautious while paranoia can make them unnecessarily stressed, anxious and afraid of things that are not real. However, it can often be challenging to figure out whether your suspicions are justified or not, especially when your friends and family do not believe you.

Paranoid thoughts are primarily focused on what other people may think or do. As evidence can vary from personal experience to the words of a witness, different perspectives can be gained from the same evidence. This is why it is crucial to seek medical help when symptoms of paranoid thoughts become too severe. Ideas and thoughts tend to be paranoid when:

  • Only the person shares these paranoid, suspicious thoughts
  • Loved ones believe that their thoughts are not justified
  • There is no solid evidence to back up their thoughts and ideas
  • Evidence proving otherwise is available
  • The person is unlikely to have enemies or be targeted by others
  • They still strongly believe in their thought even after being reassured by others
  • These thoughts are motivated by uncertain feelings & ambiguous events

Paranoia Vs Anxiety

A paranoid state is a form of anxious feeling or thought. Paranoid thoughts may lead to anxiety while anxiety may also cause such thoughts. Anxiety often determines what a person becomes paranoid about and the longevity of these thoughts and ideas. Most of us tend to feel anxiety almost on a daily basis as we overcome one challenge after the other. Feelings of anxiety can become severe when someone is experiencing stressful situations, like unemployment, financial problems, divorce or a breakup. Anxiety can often make a person believe that others are judging them for their failures or their lack of something. This can be a milder form of being paranoid which most of us experience at times. However, this is not a sign of a mental condition.

Clinical paranoia occurs when an individual is convinced of threat, persecution or conspiracy, even when the evidence points to the contrary. For most people, paranoid thoughts are nothing more than anxiety. However, if this anxious feeling is not caused by a specific event or experience and if such feelings persist for a long time, then it is best to consult a mental health expert as it may be a thought disorder. However, it should be noted that the symptoms of paranoia are often more intense than panic or anxiety. Moreover, these symptoms may last longer and affect the person’s ability to function in daily life.

Symptoms Of Paranoia

All of us tend to have paranoid thoughts sometimes in our lives. However, the condition can be severe in some individuals. Although the experience of paranoia may vary from person to person, there are some common symptoms associated with this pattern of distorted thinking, such as:

  • Mistrust of others, even loved ones
  • Feeling constantly stressed and anxious due to paranoid thoughts
  • Feeling misunderstood, confused and disbelieved
  • Feeling abused and persecuted
  • Being doubtful or suspicious of others
  • Feeling victimized even in the absence of a real threat
  • Feeling detached or hostile
  • Social withdrawal and isolation
  • Strained social and personal relationships due to mistrust

The severity of symptoms may vary depending on the sufferer and may adversely affect their daily functioning and quality of life.

Read More About Symptoms Of Paranoia Here.

Types Of Paranoia

Paranoia can be a unique and different experience for each person. However, for a sufferer, some of the most common types of paranoia and paranoid thoughts may include thinking:

  • They are being talked about behind their back
  • Being watched, online or in real life, by people or organisations with malicious intent
  • Others are attempting to tarnish their social reputation or exclude them
  • They are at a serious risk of being physically harmed or assassinated
  • They are being secretly threatened with double meanings words or hints
  • Others are plotting against them or deliberately trying make them feel bad and upset
  • Others are attempting to con, steal or take their money and possessions
  • Others constantly interfere their thoughts and actions to manipulate them
  • An organization or the government is trying mind control on them

A paranoid person may experience such thoughts consistently or occasionally when triggered.

Read More About Types Of Paranoia Here.

Comorbid Conditions

Paranoid thoughts are associated with a number of psychological disorders such as, schizophrenia and delusional disorder. It can also be observed in people with different medical conditions which affect brain function, such as multiple sclerosis and Alzheimer’s disease. Paranoia is widely associated with these following mental health conditions as well:

  • Phobias
  • Depression
  • Anxiety disorders
  • Dementia
  • Parkinson’s disease
  • Huntington’s disease,
  • Brain injury
  • Severe trauma
  • Excessive stress

Apart from these, alcohol and substance use disorder is also associated with paranoid thoughts. “Cannabis and amphetamine abuse often causes paranoid thoughts and may trigger an episode of psychosis. Other drugs such as alcohol, cocaine and ecstasy can also cause paranoia during intoxication or withdrawals,” explains Healthdirect Australia.

Causes Of Paranoia

The exact cause for paranoid behavior is not fully understood. However, it is believed that it may be caused by a combination of certain factors like mental conditions, personality disorder or drug abuse. “The cause of paranoia is a breakdown of various mental and emotional functions involving reasoning and assigned meanings. The reasons for these breakdowns are varied and uncertain,” adds Mental Health America (MHA). Certain symptoms are associated with denied, projected or repressed emotions. Paranoid thoughts can also be related to certain adverse events, experiences and relationships in the life of the person.

Here are some of the common factors that are believed to cause the onset of the thought disorder:

  • Genetic factors
  • Psychiatric disorders
  • Substance abuse
  • Chemical imbalances in the brain
  • Stress & anxiety
  • Abusive or traumatic experiences
  • Insomnia and sleep deprivation
  • Brain infection
  • Head injury
  • Cognitive biases

Moreover, there are also some common risk factors associated with the development of paranoia, including:

  • Low self-esteem
  • Memory loss
  • Social repression
  • Adverse childhood experiences
  • Reduced brain circulation due to high blood pressure
  • Impaired hearing
  • Social isolation

Read More About Causes Of Paranoia Here.

Diagnosis Of Paranoia

Paranoia can be often difficult to diagnose as the exact causes for the onset is unclear and it is common to a wide range of psychiatric disorders. Moreover, patients tend to have an extreme sense of distrust and hence they are reluctant to seek treatment. The person may be suspicious of doctors and hospitals and may falsely believe that treatment is meant to harm them. However, a patient may seek treatment when symptoms become too severe for the person to function normally in daily life and starts affecting their mental and physical health adversely. To perform an effective diagnosis, a doctor may:

  • Analyze medical and family history
  • Conduct a medical or physical examination
  • Conduct a personal interview to assess the severity of the symptoms
  • Conduct psychological assessments and tests

The doctor may also conduct certain laboratory tests to determine if the symptoms are caused by other psychiatric disorders, medical conditions, medications or alcohol and drug abuse. If paranoid thoughts are caused by a psychiatric condition, then a doctor may refer the patient to a mental health professional like a psychiatrist or a psychologist for effective diagnosis and treatment.

Treatment Of Paranoia

As paranoia can often be diagnosed as a part of some other psychiatric condition, seeking medical help can be necessary and helpful. A mental health professional can suggest certain psychotherapies and medications to help a paranoid person relieve distress, focus on their reality and improve the quality of their lives. This is why patients must consult a doctor if they experience paranoid thoughts and symptoms for several days. However, as paranoid individuals tend to believe that everyone is against them and are highly suspicious of the world, they may rarely seek treatment. Loved ones can often recognize someone suffering with paranoid personality traits and may encourage them to visit a therapist.

People with paranoia are naturally afraid and cautious about interacting with individuals in authority, like doctors. But, patients need to realize that doctors are there to help them get better. Although there is no specific treatment for this thought disorder, medical care can help the sufferer overcome the symptoms and live a more fruitful life. It should be noted that treatment primarily depends on the severity of the condition. A doctor will assess the patient to understand the cause of such paranoid thoughts and to identify and other underlying conditions.

Research 6 indicates that people suffering from paranoia and schizophrenia can benefit greatly when treatment and support is customized to address the specific issues of these mental health illnesses. Although there is no specific cure for paranoid thoughts, treatment can be directed at underlying causes and can help relieve the symptoms. Treatment can include the following strategies that aim to improve the patient’s mental health and quality of life:

1. Therapy

Different forms of psychotherapy 7 can be recommended by mental health professionals to improve the patient’s ability to function. However, it is crucial that the therapist gains the trust of the sufferer first as a paranoid person may district them. The following therapy techniques are usually used for treating this condition:

  • Cognitive behavioral therapy (CBT 8 )
  • Art therapy 9
  • Milieu therapy
  • Psychodynamic psychotherapy
  • Cognitive enhancement therapy
  • Vocational training therapy

2. Medications

Doctors can prescribe antipsychotic drugs 10 and/or anti-anxiety medications for relieving symptoms in addition to therapy. Moreover, antidepressants may also be prescribed in some cases. However, it can be challenging to convince the patient to take medications as they mistakenly believe that it may harm them.

3. Hospital admission

In extreme cases, hospitalization may become necessary to stabilize the patient and manage symptoms, especially if the sufferer is prone to suicidal or homicidal thoughts.

Mental Health America (MHA) explains “It can be difficult to treat a person with paranoia since symptoms result in increased irritability, emotionally guardedness, and possible hostility. Oftentimes, progress on paranoid delusions and especially delusional disorder is slow. Regardless of how slow the process, recovery and reconnection is possible.”

Read More About Treatment of Paranoia Here.

Coping Strategies Of Paranoia

Apart from seeking medical help and consulting a doctor or mental health professional, you can also practice certain self-help strategies that can increase the efficacy of the recovery process. Some of the most helpful coping techniques for paranoia may include the following:

  • Stick to the treatment regime and closely follow the instructions of your doctor.
  • Challenge your paranoid beliefs and delusions and question yourself about the justification of your thoughts.
  • Share your thoughts and emotions openly with your loved ones and talk honestly with them.
  • Make sure to stay away from caffeine, alcohol and recreational drugs.
  • Follow a healthy diet, get enough sleep and exercise regularly.
  • Learn relaxation techniques such as deep breathing, meditation and yoga.
  • Build your relationships, reconnect with cherished loved ones and try to socialize with friends.
  • Pursue your passions and hobbies and do things that you enjoy on a daily basis.
  • Get adequate exposure to sunlight and spend more time in nature as it will help you to relax.

Read More About Coping With Paranoia Here.

How To Help Someone With Paranoia

If your friend, family member or a loved one is affected by this thought disorder, then here are few things you can do to help them feel better and to care for them:

  • Listen to the paranoid person
  • Don’t try to force your opinions or perspective on them
  • Don’t judge them or tell them they are wrong
  • Gently assure them that they should look at things differently
  • Learn about paranoia and associated mental health conditions
  • Encourage them to see a doctor
  • Ensure they follow the treatment plan

Read More About Helping Someone With Paranoia Here.

Recovering And Living An Anxiety-Free Life

People with paranoia are often worried that others are targeting them and trying to hurt them in some way. This can significantly affect their mental, emotional and physical well-being. Moreover, it can also adversely affect their career, relationships and quality of life. However, with effective treatment, a paranoid person can learn to manage their symptoms and overcome the condition to live a more meaningful life without worry or anxiety.

Ongoing therapy and medications, coupled with support from loved ones and self-help strategies can help you make great progress. If you or someone you know is paranoid, then make sure to seek professional help immediately.

References:
  1. Raihani, N. J., & Bell, V. (2017). Paranoia and the social representation of others: a large-scale game theory approach. Scientific reports7(1), 4544. https://doi.org/10.1038/s41598-017-04805-3 []
  2. Castagnini A. ‘Paranoia and its historical development (systematized delusion)’, by Eugenio Tanzi (1884). Hist Psychiatry. 2016 Jun;27(2):229-40. doi: 10.1177/0957154X16630501. PMID: 27145948. []
  3. Encyclopedia of Mental Health []
  4. Encyclopedia of Stress []
  5. Paranoia. (n.d.). Avon and Wiltshire Mental Health Partnership NHS Trust – Avon and Wiltshire Mental Health Partnership NHS Trust. https://www.awp.nhs.uk/advice-support/conditions/paranoia/ []
  6. Pinkham, A. E., Harvey, P. D., & Penn, D. L. (2016). Paranoid individuals with schizophrenia show greater social cognitive bias and worse social functioning than non-paranoid individuals with schizophrenia. Schizophrenia Research: Cognition, 3, 33-38. https://doi.org/10.1016/j.scog.2015.11.002 []
  7. Ritzler BA. Paranoia–prognosis and treatment: a review. Schizophr Bull. 1981;7(4):710-28. doi: 10.1093/schbul/7.4.710. PMID: 7034193. []
  8. Freeman, D., Dunn, G., Startup, H., Pugh, K., Cordwell, J., Mander, H., Černis, E., Wingham, G., Shirvell, K., & Kingdon, D. (2015). Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. The lancet. Psychiatry, 2(4), 305–313. https://doi.org/10.1016/S2215-0366(15)00039-5 []
  9. Abbing, A., Baars, E. W., de Sonneville, L., Ponstein, A. S., & Swaab, H. (2019). The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial. Frontiers in psychology, 10, 1203. https://doi.org/10.3389/fpsyg.2019.01203 []
  10. Birkeland SF. Psychopharmacological treatment and course in paranoid personality disorder: a case series. Int Clin Psychopharmacol. 2013 Sep;28(5):283-5. doi: 10.1097/YIC.0b013e328363f676. PMID: 23820335. []