Paranoia Overview

While occasional paranoid thoughts are common, if a person experiences them for a prolonged period, it may be a symptom of a mental health condition.

Definition of Paranoia

Paranoia refers to irrational and persistent thoughts and feelings that cause a person to believe that others are trying to harm, deceive, or exploit them. This may involve people feeling that others are watching, listening to, or following them, despite there being little or no evidence to suggest this.

This unfounded mistrust can make it difficult for people with paranoia to function socially or form close relationships.

Some people may refer to paranoid thoughts as delusions. This is when irrational thoughts and false beliefs become so fixed that not even contrary evidence can convince a person that what they think is not true.

While mild paranoid thoughts are relatively common, experiencing long-term paranoia may indicate a mental health condition. But it is important to note that paranoia does not necessarily suggest a mental health condition.

Signs and Symptoms of Paranoia

Symptoms of paranoia can vary, but may include the following:

• Always being on the defensive 
• Being hostile, aggressive, or argumentative
• Difficulty trusting others
• Finding relationships difficult
• Not confiding in others
• Being overly suspicious of others
• Considering the world to be a place of constant threat
• Taking offensive and assigning harmful meaning to comments from other people
• Not compromising
• Constant feelings of persecution
• Difficulty forgiving others
• Assuming other people frequently speak ill of them
• Belief in unfounded conspiracy theories 
• Not coping well with criticism

Causes of Paranoia

Scientists are still unsure of the exact cause of paranoia, and research is still ongoing. Evidence suggests that a combination of different factors likely play a role. Potential causes of paranoia may include the following:

• Genetics: Having certain genes may affect how likely a person is to develop paranoia. For example, a 2018 article highlights a genetic variation, known as SNP rs850807, as being strongly associated with paranoia.
• Brain chemistry: Neurotransmitters are chemical messengers that play a key role in brain function and affect thoughts and feelings. For example, a 2018 article suggests the role of dopamine in paranoid ideation.
• Trauma: Past trauma may distort a person’s thoughts and feelings. For example, a 2017 study notes that childhood trauma is significantly associated with paranoid beliefs and a 2019 study adds that it increases the risk for psychosis.
• Stress: Evidence suggests that paranoia may be more common in people who have experienced severe or ongoing stress. For example, a 2016 study indicates that stress can result in paranoia, and stress management strategies may help reduce it.

Paranoia Conditions

While paranoia is a symptom that can be part of a number of conditions, many people typically associate paranoia with:

• Paranoid personality disorder: This is a cluster A personality disorder, meaning people display behaviors that others may find unusual. It typically involves suspiciousness of others and interpretation their actions as threatening or demeaning.
• Delusional Disorder: This is a mental illness that causes people to have false beliefs, or delusional thoughts, for a prolonged period despite evidence to the contrary. The thoughts are not necessarily unrealistic, but may not be realistic.
• Schizophrenia: This is a serious mental health condition that can affect a person’s perception and may involve delusional thinking, such as paranoid thoughts. In the past, experts considered paranoid schizophrenia to be a distinct type of the disorder, but now classify paranoia as a symptom.

Diagnosis of Paranoia

It can be difficult to diagnose paranoia, as it is not only a symptom of many conditions, but patients experiencing paranoia may try to avoid doctors, hospitals, and other medical settings and may not recognize that they have paranoid thoughts.

Typically, a diagnosis will involve a doctor or mental health professional asking questions about a person’s medical history, performing a physical examination, and assessing symptoms.

A doctor may then require a person to complete psychological tests, blood tests, and scans. This can help a doctor to rule out other possible causes for the symptoms.

Treatment of Paranoia

If paranoid thoughts are causing distress or are a symptom of a mental health condition, the following treatments may be beneficial:

• Talking therapies: These types of therapy may help a person to understand their experiences and develop coping strategies to manage paranoid thoughts.
• Art and creative therapies : These encourage people to channel and express their thoughts and feelings. This may be beneficial if people have difficulty talking about their experiences.
• Medications: If a person receives a diagnosis of a condition such as schizophrenia, a doctor may suggest antipsychotic medications. These can help reduce paranoid thoughts and allow a person to think clearly and logically. Antipsychotic medications can also help people who do not have schizophrenia but who do experience distressing paranoid thoughts.

Complications of Paranoia

Evidence suggests that potential complications of paranoia may involve the following:

• Safety behaviors: This refers to behaviors that people may do to make themselves feel safe. This may cause people to avoid certain situations, act aggressively toward others, and push people away.
• Isolation: Not only may people with paranoid thoughts avoid others, but they may also feel as if no one understands them and find it difficult if others do not agree with their thoughts.
• Stigma: Due to misunderstandings about paranoia and how people with paranoia may act, they may be subject to discrimination by others. 
• Worry and sadness: Paranoid thoughts may also cause people to experience anxiety and low mood due to how they believe their thoughts may affect their life.

Seeking Help for Paranoia

If an individual suspects they may be experiencing paranoid thoughts, they may wish to seek help. Initially, it may be beneficial to keep a diary and question their paranoid thinking.

People may also want to confide in someone they trust, try to manage their stress, and try other healthy behaviors, such as a healthful diet, regular exercise, and getting sufficient sleep.

If paranoia begins to disrupt daily life, a person should consider speaking with a doctor or mental health professional.

While this idea may seem daunting, a person should realize that medical professionals will not intend to harm them, and are instead there to provide them with support, manage symptoms, and reduce distress.

Summary

Paranoia refers to an irrational thought process that causes people to exhibit an extreme mistrust or suspiciousness of others. While research is unclear, evidence suggests that genetics, brain chemistry, trauma, and stress likely play a role.

It can be difficult to diagnose, and people may be hesitant to seek help due to their doubts about other people. Certain therapies and medications may help to manage and reduce paranoid thoughts.

Paranoia vs. Anxiety

Symptoms of delusional disorder include hallucinations and mood disturbances, such as feelings of extreme sadness or distress. Delusional thinking patterns can center around extreme jealousy and persecution.

Patients with anxiety present with symptoms of intense worry and sometimes panic, depending on the type.

A person can have delusional disorder and anxiety at the same time. Doctors treat both conditions with a mixture of psychotherapy and medication.

Delusional Disorder and Anxiety Symptoms

Delusional disorder and anxiety are distinct conditions with different symptoms.

Delusional Disorder

Delusional disorder does not impact behavior or well-being unless the person is experiencing or talking about something related to their delusion.

For example, an individual living with hypochondriacal psychosis, a delusion where they believe they have symptoms of a serious health condition, may feel extremely anxious when discussing anything about their health.

Generally, people with delusional disorder tend to feel socially isolated. They may also experience:

Changes in Thinking Patterns

Changes to a person’s thought patterns involving false beliefs are the most telling symptom of a delusion. Someone may feel persecuted and believe that certain organizations or people intend to cause them harm, or they may become fixated on the idea that their spouse is having an affair.

People with delusional disorder can experience a mixture of delusions with no common theme.

Mood Disturbances

A person’s mood may change when they are experiencing a delusion. They may feel more anxious, irritable, or depressed.

Changes in Perception

Some people experience auditory hallucinations as part of a delusion. During an auditory hallucination, an individual may hear sounds, such as voices, that are not really there.

Anxiety

Everybody feels anxious from time to time, and it is not unusual to worry before taking a test or starting a new job. However, when anxiety begins to take over a person’s routine and impact their quality of life, it is important they seek help.

There are several types of anxiety. Generalized anxiety disorder (GAD) is one of the most common, alongside social anxiety and phobias.

Symptoms of GAD include:

• Fatigue
• Difficulty controlling worries
• Feeling restless
• Irritable mood
• Sleep difficulties
• Muscle tension

Causes of Delusional Disorder and Anxiety

Many biological and psychological factors contribute to the development of delusional disorder and anxiety.

Delusional disorder

Researchers are unsure of the exact cause of delusional disorder. They know that biological triggers, such as substance use and some neurological conditions, can bring on delusions.

Psychological triggers of delusional disorder include social isolation, low self-esteem, and envy. When these states of psychological distress reach a high level, a person may develop a delusion to explain why they are feeling a particular way.

Anxiety

Many biological and psychological factors also contribute to anxiety.

Some people may be genetically predisposed to developing anxiety disorders, which can run in families.

Psychological factors that contribute to anxiety include trauma, such as the death of a loved one or an abusive relationship. A person may also experience symptoms if they are living with a prolonged illness or chronic stress.

Social and cultural factors can play a part in anxiety. For example, a 2015 review found a strong link between the experience of racism and the development of mental health difficulties including anxiety and depression. Research indicates that socioeconomic factors such as poverty experienced in childhood can also lead to mental illness.

Diagnosis of Delusional Disorder and Anxiety

Doctors use a combination of lab tests and psychological assessments to diagnose delusional disorder and anxiety.

Delusional Disorder

If a doctor thinks substances may be triggering a person’s delusions, they will order a urine test. They may also request an MRI scan or other form of imaging to rule out any other biological causes.

If there is no biological explanation, a doctor will begin a series of psychological assessments. They may also try to ascertain when the delusions started and if any life events triggered them.

Anxiety

A doctor may diagnose an anxiety disorder if a person presents with excessive worrying, sleep disturbance, and restlessness.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) states that these symptoms should be present for 6 months or more in cases of GAD. However, a doctor may make a diagnosis sooner than this. They will refer to the DSM-5 to rule out other psychological conditions.

A doctor may also consider other factors, such as a family history of anxiety. If a person is experiencing physical symptoms like fatigue, a doctor may do a blood test to eliminate any underlying conditions, such as an under-active thyroid. 

Treatment of Delusional Disorder and Anxiety

The most effective treatment plan for both delusional disorder and anxiety is usually a combination of therapy and medication.

Delusional Disorder

When treating delusional disorder, a doctor will likely begin with psychotherapy. They may then introduce antipsychotic medication as a trial for 6 weeks, adjusting the dose over time if needed.

If antipsychotic medication is not effective, lithium, valproic acid, and carbamazepine are alternative drug options.

Anxiety

GAD’s two main treatment options are cognitive behavioral therapy and medication, especially antidepressants.

To treat GAD, doctors generally prescribe antidepressants called selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Both these medications affect the levels of certain chemicals in a person’s brain.

If an individual is experiencing delusions and GAD, they will likely also take antipsychotics.

Is it Possible to Have Both Delusional Disorder and Anxiety?

A person can have both delusional disorder and anxiety at the same time. Naturally, if an individual’s delusions center around their health, or if they are convinced certain groups of people are plotting against them, they will feel some form of anxiety and nervousness.

It is possible that those with health-related anxiety might experience  COVID-19 related delusions, which may present with physical symptoms such as a runny nose. One 2021 case report observed that COVID-19-related delusions only ceased in one person after they took trifluoperazine (an antipsychotic medication) for 5 months.

Summary

Patients can have delusional disorder and anxiety at the same time. Anxiety creates feelings of intense worry. Delusional disorder symptoms revolve around false beliefs or inaccurate interpretations of real-life situations.

These interpretations persist even when the person encounters evidence that disproves the belief. For example, it is possible for someone with health anxiety to develop symptom delusions, despite testing negative for the presence of an infection.

A mixture of psychological and biological factors can bring on delusions and anxiety. A doctor will request a series of lab tests and conduct several psychological assessments to make a diagnosis.

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