Bipolar Disorder Paranoia: Signs, Symptoms, And Treatments

According to the National Institute for Mental Health (NIMH), an estimated 4.4% of adults in the United States will experience bipolar disorder during their lives. Individuals with this condition may experience a variety of symptoms, including paranoia in some cases. In order to recognize the signs of bipolar disorder paranoia, it may be beneficial to begin by understanding what bipolar disorder is and how its different types can manifest. 

What is bipolar disorder?

Bipolar disorder is a mental illness that can cause individuals to experience significant changes in their emotional state, energy levels, and cognition. Those with bipolar disorder may experience mood swings between any of these three states:

• Mania: Manic episodes can be characterized by symptoms like a significantly elevated mood, more energy, a decreased need for sleep, and irrational behavior.
• Hypomania: Hypomanic episodes often have similar symptoms as manic episodes, only milder.
• Depression: Depressive episodes can involve symptoms like a significant drop in energy, depressed mood, and social isolation.

How long a person spends in each of these states and how quickly they change can depend on a variety of factors, including the severity of symptoms, whether they have comorbid conditions, and what type of bipolar disorder they have. 

What are the different types of bipolar disorder?

There are three primary types of bipolar disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5): bipolar I disorder, bipolar II disorder, and cyclothymic disorder. 

• Bipolar I disorder: Bipolar I disorder typically involves a person experiencing manic episodes that last a minimum of seven days, with symptoms occurring for the majority of the time during those seven days. In many cases, depressive episodes will also occur, often lasting for at least two weeks. Some individuals may also experience episodes with mixed manic and depressive features.
• Bipolar II disorder: Individuals with bipolar II disorder may experience hypomanic episodes and depressive episodes. These can alternate in much the same way as in bipolar I disorder; however, hypomanic episodes are typically less severe than manic episodes. 
• Cyclothymic disorder: Cyclothymic disorder can cause individuals to experience less intense (but more frequent) depressive and hypomanic symptoms. These symptoms typically do not last long enough to qualify as either a hypomanic or depressive episode. 

Bipolar disorder symptoms

Which bipolar disorder symptoms a person experiences can vary depending on the specific illness they have. However, it may be easier to understand the impact of these symptoms by categorizing them by the types of episodes they occur in. According to the UK National Health Service (NHS), key symptoms of manic, hypomanic, and depressive symptoms may include the following.

Bipolar disorder symptoms: manic episodes

Mania (and its less intense variation, hypomania) can present with symptoms that may include things like:

• Feelings of extreme happiness or elation
• High energy
• Rapid speech
• Racing thoughts
• Low threshold for agitation
• Delusions
• Hallucinations
• Decreased need for sleep
• Reckless behavior, such as substance misuse or overspending
• Risky decision-making

Depending on what type of bipolar disorder a person is experiencing, these symptoms can last for several days or longer.

Bipolar disorder symptoms: depressive episodes

Depressive episodes can cause a person to experience a variety of symptoms, such as:

• Difficulties with concentration and memory
• Fatigue
• Feelings of sadness and hopelessness
• Irritability
• Low self-esteem
• Feelings of worthlessness or emptiness
• Difficulty enjoying previously enjoyable activities
• Sleep disturbances
• Lack of appetite
• Suicidal ideation

The symptoms that a person can experience during a manic or depressive episode may vary, as each case of bipolar disorder is unique. One example of a symptom that is not listed here but may still be experienced in some cases is bipolar disorder paranoia.

What is bipolar disorder paranoia?

Paranoid delusions are a more severe form of paranoia that can cause a person to hold a false belief, even if there is little evidence to support that belief. In some cases, there may even be evidence that disproves a delusion, but a person may believe this evidence was fabricated or is part of a conspiracy. Examples of paranoid delusions can include believing without evidence that a government agency wants to kidnap you, that your neighbors will break into your home if you leave, or that your doctor is poisoning you slowly with your medications. 

Can other mental health conditions cause paranoia?

Several different mental health conditions can feature paranoid symptoms. Some of these include paranoid personality disorder, delusional disorder, and schizophrenia. Each of these mental health disorders can vary in severity and may require different types of treatment to address paranoia-related symptoms. 

Paranoid personality disorder

Paranoid personality disorder (PPD) can cause someone to struggle with trust and question the intentions of those around them. Individuals with PPD could believe that close friends or loved ones are deceiving them or mean to do them harm, even if there is no reason to hold these beliefs. PPD can also cause someone to misinterpret the words and actions of others to be more harmful than they actually are, which could put a strain on interpersonal relationships. 

Delusional disorder

Delusional disorder can cause someone to experience a variety of delusions, including paranoid delusions. Other types of delusions a person can experience may include:

• Grandiose: Delusions of grandeur can cause someone to think they are more important or powerful than they actually are. This may include thinking that they possess special powers, have elevated athletic ability, are incredibly wealthy, or have worldwide renown. 
• Bizarre: Bizarre delusions can involve beliefs that are based on situations that aren’t actually possible. For example, a person may believe they traveled through time or that their thoughts are being broadcast nationwide on the radio. 
• Somatic: Somatic delusions can cause a person to think they have a medical condition, even if there is no evidence or they lack the symptoms to be diagnosed with that condition. 

Schizophrenia 

While paranoid schizophrenia is no longer a separate diagnosis, individuals with schizophrenia can still experience paranoia. This paranoia can influence several psychotic symptoms, including delusions and hallucinations. 

Schizophrenic hallucinations can cause a person to see, hear, feel, taste, or touch things that do not actually exist. This can manifest in a variety of ways, such as hearing the voices of deceased relatives, seeing flashing lights or strange figures, or feeling a touch on their shoulder when no one is there. 

Are there ways to treat these mental health conditions?

There are a few key ways to treat paranoid personality disorder, delusional disorder, and schizophrenia. In some cases, a medical or mental health professional may recommend certain types of medications. These may include anti-anxiety or antidepressant medications, such as paroxetine, escitalopram, or fluoxetine. For those with schizophrenia, antipsychotic medications may be recommended, like haloperidol, chlorpromazine, or thioridazine. 

In most cases, therapy will also be recommended. The types of therapy that are used can vary by disorder and symptom severity. For example, cognitive behavioral therapy (CBT) may be beneficial for individuals with PPD, delusional disorder, and schizophrenia, while dialectical behavior therapy (DBT) may be better suited for individuals living with either PPD or delusional disorder. 

How is bipolar disorder paranoia treated?

Bipolar disorder paranoia is often addressed along with other symptoms in a complete treatment plan that typically includes medication and therapy. Medications can include mood stabilizers, such as lithium, carbamazepine, or valproic acid. Never start, stop or change any medication without consulting with your doctor first. 

Therapeutic approaches can involve various types of talk therapy, such as CBT and family-focused therapy. 

Cognitive behavioral therapy (CBT) is a form of psychotherapy that can help an individual learn to identify and understand specific patterns of thought. In some cases, these thought patterns can contribute to symptoms such as paranoia and lead to behaviors that may have negative impacts. With the assistance of a CBT provider, individuals can find ways to restructure these thought patterns, which could help them alleviate symptoms and improve their overall mental health and well-being. 

Family-focused therapy (FFT) can involve both the individual with bipolar disorder and their loved ones meeting with a therapist to discuss symptoms and coping skills. This can help family members understand what their loved one is experiencing and learn potentially effective ways to help them. An FFT provider can also help families develop a relapse prevention plan, which can allow them to better prevent and prepare for manic and depressive episodes as a family. 

Online therapy for bipolar disorder symptoms

While CBT, FFT, and other forms of therapy can be effective, in-person therapy may not be available or convenient for everyone. Some individuals with bipolar disorder could find it difficult to travel to a therapist's office, preferring instead to speak with a provider from the comfort of their own home. Others could live in an area that lacks a sufficient number of mental health professionals, sometimes referred to as a health professional shortage area (HSPA). 

In these situations, alternatives such as online therapy can be beneficial. While a person with bipolar disorder—especially someone experiencing severe symptoms—may also need in-person treatment, online therapy can sometimes be a helpful supplement. Research suggests that online therapy can be helpful in reducing symptoms of anxiety and depression in individuals with previously diagnosed bipolar disorder, for example.