Can Anxiety Cause Paranoia? How Are They Linked?
When a person has paranoid thoughts, they typically become convinced that others are out to get them or cause them harm. While paranoia has been associated with mental illness, up to one in three people has had paranoid feelings and thoughts at some point, which suggests that paranoid thought is also common among people without mental illness. People with mental illness tend to have more severe paranoid delusions, while those without mental illness may have more mild paranoid thoughts.
Both long- and short-term paranoia can negatively impact a person's everyday life, causing distress and interfering with relationships. Experts have explored potential causes of paranoia, and some have asked, can anxiety cause paranoia? Research suggests there are links between anxiety and paranoia, which we will delve into below.
Anxiety and paranoia often overlap
Experts have found overlap among people who have paranoid thoughts and those who have anxious thoughts. The occurrence of both anxiety and paranoia is common in people with psychiatric disorders and those without them. The connection between anxiety and paranoia is impactful to study because findings could lead to treatments that help people experiencing either or both challenges. Early research has found that anxiety-focused cognitive-behavioral therapy reduces paranoia.
Researchers have explored the overlap between anxiety and paranoia, outlining potential relationships between the two phenomena. Some experts have posited that anxiety causes paranoia, while others believe that paranoia causes anxiety. There are also other variables associated with both anxiety and paranoia that may help explain the connection between the two.
Discerning between anxiety and paranoia
People who have both anxiety and paranoia may struggle to understand the difference between the two symptoms. To clarify, anxiety describes when a person experiences a stress response, which can involve a variety of symptoms. A person with anxiety may experience worried thoughts, muscle tension, and other physical symptoms, like an increased heart rate.
Paranoia describes a specific type of thought, which may or may not be accompanied by anxiety. Paranoid thoughts typically involve believing others are out to cause one harm, despite this not being true. People with paranoia may feel like they are being unfairly targeted, persecuted, or oppressed, or they may feel as if others are plotting to harass them or cause them harm.
Anxiety may precede paranoid thoughts
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Those arguing that anxiety is likely to precede or cause paranoia hypothesize this could be due to a concept called the threat-anticipation model. In the threat-anticipation model, delusions that one is being persecuted or targeted for harm develop when three processes occur together in response to a stressor or life event. The three processes involve thinking and feeling about oneself, others and the world in an anxious way, having anomalous experiences and arousal, and having cognitive biases.
In the threat-anticipation model, because anxious thoughts are a key part of the development of paranoid thoughts, reducing anxiety may then reduce paranoia. Similarly, increasing anxiety may increase paranoia. Research somewhat supports this idea, as past studies have found people who experience difficulty regulating their anxiety have more paranoia.
Anxiety and paranoia may involve similar factors
Some researchers have broken down the threat-anticipation model into greater specifics, detailing the exact types of anxiety-related thoughts and feelings that might precede the development of paranoia. These include stress, negative thoughts, selective attention to threats, worry, and biases regarding risks. Below, we’ll explore each of these types of anxiety-related tendencies and occurrences and outline the research surrounding their relationship to paranoia.
Stress
Experiencing stressors may lead to a stress response and emotions that then lead to negative beliefs that spark or reinforce paranoia. While the negative beliefs and thoughts are a problem, they may not have occurred without the original stress. Studies have shown that stress and paranoid thoughts are connected.
One study found that about 19% of people sampled from across several countries experienced paranoia related to the COVID-19 pandemic. The study authors noted that the rates of this "pandemic paranoia" were roughly consistent with other mental health measures taken during the pandemic, such as the prevalence of anxiety. While the study did not directly investigate if there was a connection between anxiety and paranoia, both occurred in response to a global stressful event, reinforcing the idea that stress plays a role in both anxiety and paranoia.
Negative thoughts
As mentioned above, stress may give rise to negative thinking, which may then make paranoia more likely. Negative thinking can be distinct from anxious thought, but the two often overlap with each other, as well as with paranoia. For example, a person who feels anxious and paranoid about others causing them harm may hold negative thoughts about how they are vulnerable, other people are unkind, or the world is dangerous. These irrational thoughts can lead to low self-esteem and negative views of other people and the world at large. When people hold these types of negative beliefs, they tend to make distorted judgments.
Some research has also examined the relationship among anxiety, paranoia, and negative metacognitions, which are negative thoughts about thinking itself. For example, a person experiencing negative metacognition may believe that their anxious thoughts are out of control or that their thoughts reveal something negative about their personality or mental health. Researchers found that the presence of negative metacognitions predicted the presence of both anxiety and paranoia a year later. A concept called the metacognitive model helps explain this phenomenon, arguing that the way people view and respond to their anxious thoughts impacts their mental health moving forward.
Selective attention to threats
In addition to stress and negative thoughts, both anxiety and paranoia also often involve selective attention to threats. When a person has a tendency toward paying selective attention to threats, they notice potentially threatening information, or situations more than others do. They may also perceive threats in an exaggerated way, wrongly assuming that a potentially threatening situation is more likely to progress into a dangerous situation than it actually is.
Risk perception biases
Risk perception biases go hand-in-hand with selective attention to threats and are more likely to occur in both anxiety and paranoia. When a person has a risk perception bias, they are typically likely to exaggerate the potential risk associated with a situation. As with selective attention to threats, they tend to incorrectly assume a situation will become dangerous or harmful. However, they also tend to have an exaggerated assumption about how much harm the situation will cause or how damaging the outcome will be.
A research study on risk perception biases looked at two groups of people — those with symptoms of generalized anxiety disorder and those with paranoia stemming from psychotic delusions. Both people with anxiety and those with paranoia tended to believe that negative events were more likely to happen to them in the near future compared to people who do not have anxiety or paranoia. Both groups also viewed negative events as causing more harm compared to people without anxiety or paranoia. These findings may help experts identify treatments for both anxiety and paranoia, as changing people's perceptions of risk may reduce such symptoms.
Worry
Some experts argue that worry may be a connector between anxiety and paranoia. People who experience both anxiety and paranoia tend to have more worries pertaining to daily life, as well as more metacognitive worry. A form of negative metacognition, metacognitive worry describes when a person worries about how much they've been worrying.
Other research has found that worry is often present with paranoia. While anxiety often involves worry, the two are not one and the same. Worry involves anxiously thinking about the future, often moving the mind through hypothetical situations of negative outcomes. Worry can be seen through trouble relaxing or physical symptoms, such as muscle tension or a rapid heartbeat. More research is needed to clarify, but one possibility is that anxiety only causes paranoia when certain elements, like worry, negative thinking, or other mental practices, are present. One study with over 2,000 participants found that worry was a risk factor for the development of new paranoid thinking.
Some experts argue that worry may be part of a paranoia continuum. According to the paranoia continuum idea, people with mild paranoia experience worry, while those with severe paranoia experience extreme delusions and feel convinced of plots against them. Within this framework, worry and paranoid delusion are not two separate phenomena, but opposite ends on a scale describing the full range of mild to severe paranoia.
Anxiety and paranoia are both mental health disorder symptoms
Anxiety and paranoia are also linked in the sense that they're both mental illness symptoms. Multiple mental health disorders are characterized by the presence of paranoia, anxiety, or both. Below, we’ll look at a brief overview of these disorders.
Paranoid personality disorder (PPD)
Paranoid personality disorder is likely the disorder most commonly associated with paranoia. With this disorder, a person typically has long-term paranoia as a personality trait, though treatment may help reduce symptoms. This disorder is considered a risk factor for developing an anxiety disorder.
Borderline personality disorder (BPD)
Borderline personality disorder typically involves severe mood swings, poor self-image, and troubled relationships, often due to an underlying fear of abandonment. Although borderline personality disorder isn't primarily characterized by paranoia, one symptom of BPD is developing short-term paranoia in times of stress. Often, this paranoia relates to fear of abandonment. In addition to temporary paranoia, people with BPD may also experience anxiety disorders or anxiety around the possibility of losing relationships.
Schizophrenia
Schizophrenia may involve a disconnect from reality through delusions, hallucinations, or both. Delusions are persistently false beliefs that may be paranoid in nature. While not everyone with schizophrenia has anxiety as well, anxiety or a co-occurring anxiety disorder may be common.
Delusional disorder
Delusional disorder is a relatively rare disorder that involves holding onto a false belief for over a month, despite evidence suggesting the belief isn't true. False beliefs that are paranoid in nature are some of the most common among people with delusional disorder. Those who have them are considered to have the persecutory type of the disorder. Although anxiety isn't a diagnostic criterion, many people with the persecutory type of delusional disorder also feel anxious and irritable.
Generalized anxiety disorder (GAD)
Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive worry. As discussed previously, some experts believe, and some research supports the idea that this worry could cause or worsen paranoia.
Social anxiety disorder
In social anxiety disorder, a person typically feels excessive anxiety in or about social situations. Paranoia is not a diagnostic criterion for social anxiety disorder. However, more research is needed to confirm if there is a link between social anxiety disorder and paranoia.
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after a person has experienced trauma that involves a threat or perceived threat to their life or someone else’s life. People with PTSD may experience intrusive thoughts, flashbacks, or nightmares about their trauma. They may also have a negative mood, changes in cognition, and a desire to avoid situations that remind them of the traumatic event.
In some cases, people with PTSD also develop hallucinations or delusions. These are not diagnostic criteria, however, and instead indicate that a person has a proposed variant of PTSD with psychotic features. Those with PTSD who develop delusions are likely to have paranoid delusions and believe people are persecuting them.
Mental health and paranoid thoughts
While paranoid thoughts can be involved in multiple mental illnesses, like those described above, not all people with paranoid thoughts have a mental illness. The frequency and severity of symptoms often determine whether or not a mental illness is present. Only a mental health professional can diagnose a disorder related to paranoid thoughts
Anxiety and paranoia may both stem from physical health problems
Paranoia is linked to physical health problems, primarily those impacting the brain. Dementia, epilepsy, brain tumors, and traumatic brain injury may all cause paranoia in a person. Similarly, research shows that anxiety may affect up to 71% of people with dementia, and it is also more common among people with medical illnesses more generally.
Insomnia is related to both anxiety and paranoia
Insomnia may both cause and result from anxiety and paranoia. When two factors impact one another in this way, experts call their relationship bidirectional. More research is needed to fully understand how anxiety, paranoia, and insomnia interrelate, but experiencing one may increase a person's risk of experiencing the others.
Substance use is related to both anxiety and paranoia
Substance use may also lead to paranoia. There are many anecdotal reports that alcohol, cannabis, stimulants, and other recreational drugs may bring about paranoia in some people. Similarly, many of these substances are said to also bring about anxiety.
The side effects of anxiety and paranoia may have been most studied among cannabis users. A systematic review of anxiety and cannabis found that the two are linked, and in many cases, cannabis users also reported paranoia. However, the study authors argue that the results lack substantial evidence to support the idea that cannabis causes anxiety. Instead, they hypothesize that people predisposed to anxiety seek out cannabis use to self-medicate.
Therapy for anxiety, paranoia, and paranoid personality disorder
While experts continue to try to figure out how anxiety and paranoia affect one another, those who experience these symptoms may benefit from seeking help. Therapy is one treatment option for both symptoms, whether a person has a mental illness like paranoid personality disorder or not. Therapy available remotely may be especially appealing, since a person can connect with a therapist from the comfort of home. With an online therapy platform like BetterHelp, individuals can typically be matched with a remote mental health care provider within 48 hours.
Research suggests that online therapy can be effective for anxiety and other mental disorders. One study published in 2017 found that online cognitive behavioral therapy was effective for generalized anxiety disorder, social anxiety, and bipolar disorder, the latter of which can cause paranoia in some people.
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