6 Types Of Paranoia: Causes And Manifestations Of Paranoid Thinking
Casual discussions of paranoia often overlook the fact that this term can mean a variety of different things in the context of mental health. Paranoia can be a symptom, a personality trait, or a category of psychotic delusion.
While some extreme forms can be pathological, most people experience at least mild paranoid thoughts and feelings occasionally. However, these experiences can vary considerably in severity, duration, and persistence, with more intense forms of paranoia causing considerable distress. In this article, we’ll explore the different types of paranoia as described by psychological researchers and clinicians.
#1: Temporary paranoid thoughts and feelings
As defined by the American Psychological Association, a paranoid mental state or condition is marked by a belief in persecution or grandiosity. In other words, individuals with paranoia may think or suspect that other people are deliberately attempting to attack, oppose, or undermine them, and they may also have an exaggerated view of their own importance. These ideas must be incorrect or irrational to constitute paranoia. Accurately recognizing other people acting against you is not paranoia.
People experiencing a paranoid state may be highly suspicious of the motivations of others they encounter. They may also be inclined to assume that bad things that happen in their lives are the result of deliberate malice from their supposed enemies.
Stress and temporary paranoid thoughts
Paranoid thinking may emerge in healthy individuals as a result of emotional and social stress. Different people may be more or less susceptible to this reaction based on their emotional self-regulation skills. Paranoid beliefs can serve as a defense against the impact of stress on self-esteem for those who have difficulty managing negative feelings in other ways.
Paranoid thoughts in borderline personality disorder
Some mental illnesses may lead to temporary or prolonged experiences of paranoia. For example, people with borderline personality disorder (BPD) typically don’t display consistent paranoid traits, but they may experience delusional paranoia and other psychotic symptoms. In many cases, this is a temporary response to stress, but it can sometimes develop into chronic psychosis.
Paranoid thoughts in other mental health conditions
Non-psychotic paranoid symptoms can also appear in other mental disorders, such as depression or anxiety. Experiences of paranoia can significantly increase distress in someone already living with a mental illness, and studies indicate that this symptom is linked with higher rates of suicidal behavior.
#2: Paranoia as a personality trait
The term “paranoia” may also be used to describe a person’s general tendency toward a paranoid mindset. Research suggests that this personality trait exists on a spectrum within the general population. Some people have a naturally higher disposition than others toward distrustful attitudes and beliefs about others attempting to harm them.
Some psychologists dispute that paranoia is a single mental factor, arguing instead that it’s better described as a combination of multiple traits that aren’t always present to the same degree. For example, a 2017 paper suggested that paranoia consists of the following three factors:
- Mistrustful thoughts
- Beliefs about persecution from others
- Self-deprecation (lack of positive self-regard)
Psychometric tests like the General Paranoia Scale may be able to accurately assess a person’s level of paranoid personality features.
#3: Paranoid personality disorder
People with extremely high levels of paranoid thinking may have a condition known as paranoid personality disorder (PPD). Personality disorders are mental disorders marked by dysfunctional ways of thinking about the world and relating to others, typically present throughout a person’s life.
In PPD, the primary counterproductive pattern is a consistent attitude of suspicion toward other people and alertness for threats. People with this disorder tend to assume that people are trying to exploit, deceive, undermine, or actively harm them. They often worry excessively about whether friends and associates are loyal to them, and they may be reluctant to offer up any information about themselves or depend on other people. Estimates suggest that this condition affects between 1.2% and 4.4% of adults.
PPD can have a variety of negative consequences. In addition to interfering with the ability to maintain healthy relationships, it may substantially increase the risk of criminal or violent behavior. Some research also suggests that people with PPD are disproportionately likely to engage in socially destructive behaviors like filing frivolous lawsuits or making frequent petty complaints.
#4: Delusional disorder (persecutory subtype)
Paranoid thoughts and beliefs can vary substantially in their severity and content. If someone holds paranoid ideas that are strongly resistant to modification by outside evidence or persuasion from others, they may be experiencing delusional disorder. This is a form of psychosis marked by fixed beliefs that don’t correspond to reality or cultural norms. The average age of onset is approximately 40, but it can appear at any time during adulthood.
The kinds of delusions experienced by people with psychosis can be grouped into many subcategories. Those involving paranoid beliefs about secret conspiracies against them are called persecutory delusions. Studies suggest that this may be the most common category of delusional disorder.
Delusional disorder vs. ordinary paranoid thinking
Understanding the difference between delusions and irrational but non-psychotic paranoid thoughts may not always be easy. Mental health professionals may draw the distinction based on a person’s ability to distinguish between reality and unreality and update their beliefs based on evidence. This is often called “reality testing.”
For instance, you might imagine that someone believes their friends and family are preparing a secret plot to kidnap them. If they later discover that their loved ones were simply planning a surprise party and they’re relieved, it suggests that what they were experiencing was paranoia but not psychosis. On the other hand, if they decide that the surprise party is simply an elaborate distraction to make a kidnapping plan easier, it could indicate the kind of inflexible thinking characteristic of a delusion.
#5: Schizophrenia spectrum disorder
Like delusional disorder, schizophrenia often involves a form of psychosis involving delusions. However, people with schizophrenia may also frequently experience hallucinations, disorganized and unusual thoughts and speech, and highly eccentric behavior. They may also display “negative symptoms,” in which typical functions such as motivation, language use, intentional movement, and pleasure are sharply reduced.
Schizophrenia is often classified as a spectrum disorder, closely related to conditions like schizoaffective disorder and schizophreniform disorder. According to the Substance Abuse and Mental Health Services Administration, this condition usually emerges in early adulthood, between the ages of 16 and 30.
Paranoid and persecutory delusions are among the most frequently observed symptoms in schizophrenia, to such an extent that “paranoid schizophrenia” was formerly classified as a distinct subtype of the disease. Paranoid ideas in people with schizophrenia may be associated with “delusions of reference”—misinterpretations of outside events as linked with the affected individual's thoughts, fears, or desires.
#6: Paranoid delusions in brief psychotic disorder
While conditions like schizophrenia and delusional disorder involve symptoms lasting for at least one month — often lingering for years — some people may experience shorter psychotic episodes followed by complete remission. This condition is classified as “brief psychotic disorder,” and it often includes the same kind of persecutory paranoia seen in other forms of psychosis.
Scientists aren’t yet sure whether these transient psychotic episodes have the same genetic risk factors as chronic psychotic conditions like schizophrenia. The most well-established contributing factor is stress—some people experience psychotic episodes after a highly distressing life experience.
Mental health treatment for paranoia
Many people can effectively manage their paranoid thoughts and feelings with psychotherapy. Research suggests that certain known habits of thought may contribute to paranoia, such as a tendency to interpret neutral external information in a negative light. Therapy may help patients reduce these cognitive biases and learn emotion regulation skills.
Some individuals experiencing paranoia may also benefit from medication. The right pharmacological treatments may reduce symptoms of psychosis or depression that contribute to feelings of paranoia.
Below are a few specific examples of potentially helpful paranoia treatment approaches.
Cognitive-behavioral therapy for paranoid thoughts
Cognitive-behavioral therapy, or CBT, is a form of psychotherapy with considerable evidence of effectiveness that’s employed in a wide variety of mental health conditions. It aims to help people identify and overcome the cognitive biases, emotional reactions, and negative behavioral reactions that feed into their symptoms. CBT may effectively reduce paranoid thinking in both healthy individuals and those with serious illnesses, such as major depressive disorder or psychosis.
Dialectical behavior therapy for borderline or paranoid personality disorder
Personality disorders can be resistant to traditional therapy because patients may have a hard time recognizing their habitual thoughts and feelings as disordered. Dialectical behavior therapy (DBT) is one approach that may work well.
Developed for use in borderline personality disorder, DBT combines self-acceptance and interpersonal skill learning with elements of CBT. Research suggests DBT can be effective in treating personality disorder symptoms—potentially including paranoia—as well as many other types of mental illness
Antipsychotics for psychotic mental health conditions
Psychosis can impair an individual’s ability to accurately gauge what’s real and rational, which can pose a serious obstacle to treating their paranoid feelings with talk therapy alone. These patients may benefit from treatment that includes antipsychotic medications like clozapine, haloperidol, and olanzapine. These medications can reduce psychotic symptoms and treat conditions like delusional disorder or schizophrenia.
Online therapy for paranoia
If you’re experiencing paranoid thoughts and feelings, you may be feeling conflicted — while you might want to get help, you may find it difficult to trust mental health professionals and other authorities. Seeking therapy over the Internet may relieve this difficulty. With online therapy, you can communicate with a therapist through audio, video, or live chat. Many patients report that the distance created by remote treatment helps them feel more at ease and in control, increasing their ability to participate fully in therapy.
There’s also evidence that online treatments can be effective in relieving paranoid thinking. A 2017 trial of a mindfulness-based intervention accessed through the Internet showed that it significantly reduced paranoid ideation in participants.
Takeaway
If you’re experiencing paranoia, know that you don’t have to face it alone. With BetterHelp, you can typically be matched with a therapist in 48 hours. Take the first step toward getting support with paranoia and reach out to BetterHelp today.
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