Do I Have Paranoia? Features Of Paranoia

Some people wonder, "Do I have paranoia?" when experiencing an intense mistrust of others and their motives. Paranoid feelings can involve a sense of persecution, such as being singled out for mistreatment despite evidence to the contrary. Severe paranoia may be a sign of a serious mental health challenge. 

Often tied to adverse early life experiences, paranoid thoughts are a symptom of various mental health conditions and may cause considerable distress, difficulty trusting and relating to others, as well as a sense of isolation in those who experience it. Below, learn more about the features of paranoia, the causes, and possible ways to address symptoms. 

Paranoia defined

Possible causes of paranoia

Researchers are unsure of the exact causes of paranoia but speculate that biological and environmental factors may play a role. Factors such as childhood emotional neglect, childhood physical neglect, and a possible genetic link with psychiatric disorders such as schizophrenia may play a role. Paranoia is associated with many mental disorders, advanced stages of Alzheimer's disease, and stress. While the reason some people develop paranoia is not fully understood, paranoia may be a symptom of a common mental illness like anxiety, a personality disorder, or a side effect of substance use.

Paranoia within a personality disorder 

Paranoia may be a feature of a personality disorder, such as paranoid personality disorder. Personality disorders are conditions that cause deviant personality traits that cause functional difficulties, especially in relationships. Someone with a personality disorder is considered to have a more rigid way of thinking, reacting, and behaving than those without a personality disorder, which can cause distress and challenges adapting to different situations in a person's life.

Personality disorder types 

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), personality disorders may be viewed within a dimensional trait model of five features, which evaluates traits such as extraversion, antagonism, conscientiousness, neuroticism, and openness. To be considered a personality disorder, a person's thinking, feelings, and behavior patterns must persist over time, cause distress, and fall outside cultural norms and expectations. Personality disorders include the following: 

• Schizoid personality disorder (SPD) 
• Schizotypal personality disorder (STPD) 
• Dependent personality disorder (DPD) 
• Narcissistic personality disorder (NPD)  
• Borderline personality disorder (BPD) 
• Avoidant personality disorder (AvPD) 
• Antisocial personality disorder (ASPD) 

Paranoid personality disorder (PPD) defined

One of the more common personality types featuring paranoia is paranoid personality disorder (PPD). The APA defines paranoid personality disorder as a personality disorder in which one experiences pervasive suspicion and distrust of others. People may experience a preoccupation with others' motives or meanings in gestures, becoming easily offended or slighted (hypersensitivity), reacting stubbornly or defensively, and experiencing emotional coldness or reduced sense of humor due to their perception of situations (restrictive affectivity).  

Paranoid personality disorder features

A person with paranoid personality disorder (PPD) may exhibit certain personality traits that may be considered less adaptable and generally involve an irrational and pervasive distrust of others and their motives. Some researchers view PPD as existing on a continuum between interpersonal sensitivity and more rigid (fixed) delusions. A person with PPD may experience delusions, which consist of unusual beliefs that a person insists are true despite evidence to the contrary. Some delusions involve paranoia, such as persecutory delusions. Symptoms of paranoid personality disorder may include:

• Negative emotionality, such as feeling fear, anger, or a strong sense of betrayal
• Intense or irrational mistrust of others 
• Hypervigilance, which involves constantly looking out for threats or confirmation of one's beliefs of being threatened, conspired against, slighted, or ridiculed
• Difficulty forgiving others
• Defensiveness to perceived criticism
• Fear or expectation of being tricked or taken advantage of
• Hostility
• Difficulty relaxing
• Hypersensitivity
• Suspicion that others may be trying to exploit or deceive them
• Searching for hidden meaning in actions and words
• An intense desire for control and autonomy
• Reluctance to confide in others 
• A tendency to suspect the unfaithfulness of partners
• Distrust of friends and loved ones
• Misinterpretation of remarks or comments
• Preoccupation with the reliability of others
• Anticipation of criticism

While relatively rare, affecting less than 5% of the US population, PPD is thought to be more prevalent among those who have a family history of the condition. Some people with paranoid personality disorder may also have experienced adverse life experiences, such as childhood neglect or abuse.

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Differences between paranoid psychosis and paranoid personality 

In more severe cases, paranoia can manifest as paranoid psychosis, which may involve paranoid delusions. Unlike a personality disorder like PPD, however, paranoid psychosis typically involves hallucinations, delusions, and disorganized thinking and is more often associated with schizophrenia, schizoaffective disorder, and delusional disorder.

Addressing paranoid thinking patterns and paranoid personality disorder

Having paranoid thoughts and feelings can lead one to experience a heightened sense of vulnerability, making relating to others and interpreting their words, gestures, and motives more difficult. Paranoia can also be a feature of a mental health condition that can interfere with a person's ability to function, so those experiencing symptoms may seek mental health support to find an underlying cause. 

A medical doctor may also help you rule out symptoms of dementia or other conditions that may affect your perception of situations and events. Depending on the underlying cause of paranoid thoughts and feelings, medication may also be prescribed. In addition, seeking support from a mental health professional may reduce the effects of distressing thoughts and feelings associated with paranoia. 

The BetterHelp platform is not intended to provide any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.

Types of therapy for paranoid thinking patterns and paranoid personality disorder

The primary therapy approaches for paranoid personality disorder include cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT). CBT is a type of psychotherapy that helps people identify and change negative thought patterns and behaviors. Based on the principle that thoughts, feelings, and behaviors are interconnected, CBT helps individuals reframe negative thought patterns and behaviors that may be causing distress. DBT is a variant of CBT that incorporates CBT principles and focuses on teaching skills in mindfulness, acceptance of reality, distress tolerance, emotional regulation, and interpersonal skills. 

Mental health tips for dealing with paranoid thinking patterns 

Self-care can also help one manage symptoms of paranoia and promote well-being. Helpful practices and activities may include:

• Eating nutritious meals
• Getting enough sleep (seven to nine hours a night) 
• Exercising regularly
• Managing stress through mindfulness, deep breathing, yoga, and other holistic approaches to wellness 
• Doing enjoyable activities
• Walking in nature

Is suspicion getting in the way of your relationships?

Connect with a compassionate therapist

Considering therapy to manage paranoia and foster mental health

Some people experience difficulties trusting others, including therapists. Online therapy through platforms like BetterHelp allows you to have sessions with a licensed therapist from the comfort of your own home or space, which may be more comfortable. You can speak to a therapist by phone or video and exchange in-app messaging, which can be helpful when you’re struggling to discern paranoid thoughts from reasonable assumptions. 

Therapists working on online platforms often specialize in cognitive-behavioral therapy, which may help individuals reframe maladaptive thinking and behavioral patterns. Several studies support the use of CBT delivered online. One literature review, which examined the results of several studies, evaluated the effectiveness of online versus in-person therapy for treating various conditions. The researchers found that online CBT can be a cost-effective way to reduce symptoms of mental health illnesses and improve client care.