Extreme Paranoia: Causes, Symptoms, And Research

According to the Practitioner's Guide to Evidence-Based Psychotherapy, paranoia is defined by an unwarranted and pervasive suspiciousness and mistrust of others. It can range in severity, from mild unease to more severe manifestations that may significantly impact daily life. Whether mild or severe, paranoia can be a difficult experience. However, individuals who experience severe or extreme paranoia may experience unique challenges. Understanding the causes and symptoms of extreme paranoia can help individuals recognize when it is occurring and explore potential treatments that could be beneficial. 

What is extreme paranoia?

Extreme paranoia can be a more intense form of paranoia that may cause individuals to experience severe symptoms. Extreme paranoia could cause someone to question their reality and whether the people around them mean to do them harm. For example, a person may think that people waiting outside of their house are talking about them or waiting for them to leave. As a result, that person may choose not to leave their home or may alter other aspects of behavior in their everyday life. 

What are the symptoms of extreme paranoia? 

Is extreme paranoia a mental illness?

While extreme paranoia may not be a mental illness on its own, it could be a component of various mental health disorders, such as delusional disorder. Extreme paranoia may also occur as a result of stressful events, the side effects of medications, or certain physical conditions. However, in the case of mental illnesses, paranoia may be a key feature in a number of personality disorders and other mental illnesses. 

What personality disorders or other mental illnesses can relate to paranoia? 

While numerous disorders can involve paranoia, it may be a primary element of paranoid personality disorder, bipolar disorder, and schizophrenia. Although individuals may experience different levels of paranoia depending on the severity of their disorder, it may be possible for each of these disorders to feature extreme paranoia. 

What is paranoid personality disorder?

Paranoia-related psychiatric disorders, such as paranoid personality disorder, typically involve a pervasive and unwarranted sense of distrust and suspicion. Individuals with PPD may expect that others mean to do them harm, looking for hidden motives or secret meanings in their interactions with loved ones and acquaintances. Paranoid personality disorder can also cause a person to be hypersensitive to perceived or real slights, while also having the potential to cause restricted emotional affect. 

Paranoid personality disorder symptoms

While each person’s experience with paranoid personality disorder can differ, there may be several common symptoms. These symptoms can include:

• Struggling with forgiveness
• Questioning the loyalty of friends and family
• Struggling to connect with others emotionally or reveal personal information
• Misinterpreting benign comments as attacks on one’s character
• Having a persistent sense of suspiciousness
• Experiencing difficulty expressing emotions in a relationship
• Having difficulty relaxing
• Showing hostility or stubbornness
• Perceiving that others are attacking their character

What is bipolar disorder?

Bipolar disorder is a mental disorder that can involve states of mania, hypomania, and depression. There are several types of bipolar disorder, namely bipolar I, bipolar II, and cyclothymic disorder. Each of these bipolar types can involve varying degrees of depression and mania. 

Bipolar disorder symptoms

Paranoia can occur during depressive and manic episodes, which may occur at different intervals depending on which type of bipolar disorder a person is experiencing. The symptoms of each bipolar type can include: 

• Bipolar I symptoms: Those with bipolar I disorder may experience manic episodes, which can involve sleep disturbances, restlessness, rapid speech, and racing thoughts. Those with bipolar I disorder can also experience depressive episodes. These can involve fatigue, increased sleep, difficulty concentrating, and feelings of guilt or worthlessness.
• Bipolar II symptoms: Bipolar II disorder can present with similar symptoms to those of bipolar I disorder. One of the more significant differences is that bipolar II typically involves at least one depressive episode and one hypomanic episode. 
• Cyclothymic disorder symptoms: Cyclothymic disorder can often be more mild than other types of bipolar disorder, with individuals experiencing a mix of hypomanic and depressive symptoms. While less intense, these symptoms can cycle more frequently and persist for longer periods of time. 

What is schizophrenia?

Schizophrenia is a psychotic disorder that can result in paranoia-related symptoms, such as delusions. These delusions can take many forms, such as:

• Persecutory delusions: Persecutory delusions may be most commonly associated with paranoia and may be referred to as “paranoid delusions.” These delusions can cause a person to believe they are being monitored or targeted by an individual or a group of people who mean to do them harm. 
• Referential delusions: Those with schizophrenia may see patterns between places, people, and events that they believe have a personal connection to their lives, even if there is no logical reason or evidence to support this belief. 
• Grandiose delusions: Delusions of grandeur can make a person believe they are better than everyone around them, whether that be in ability, status, or wealth. In some cases, these delusions may exceed what is physically possible; for example, a person may believe they have supernatural or superhuman abilities. 
• Bizarre delusions: Individuals with schizophrenia may experience bizarre delusions, or beliefs that are based on situations that are not technically possible. For example, a person may believe that someone has hacked into their brain and is controlling their thoughts or implanting paranoid thoughts in their head. 

Other symptoms of schizophrenia

In addition to delusions, schizophrenia can involve symptoms like hallucinations and disordered thinking and speech. Hallucinations can cause a person to have false sensory experiences. These can fall into a number of categories, including auditory hallucinations, visual hallucinations, and tactile hallucinations. Disordered thinking and speech, on the other hand, can affect how a person speaks and communicates. Individuals with schizophrenia may experience difficulty telling someone what they are thinking or have trouble making sense of their own patterns of thought, which could result in distress. 

Are there mental health treatments for paranoia-related personality disorders?

Which mental health treatments are effective can depend on what condition a person experiences. Some mental health professionals may recommend medication, therapy, or a combination of both. Below are some recommended treatments for bipolar disorder, paranoid personality disorder, and schizophrenia. Remember to never start, stop or change any medications without first consulting with your physician. 

Mental health treatments for bipolar disorder

According to the UK National Health Service (NHS), treatment for bipolar disorder may involve the use of medications, such as mood stabilizers, and various therapeutic approaches, such as cognitive behavioral therapy (CBT). CBT may be particularly effective during depressive episodes, as it could allow individuals with bipolar disorder to identify potentially negative thought patterns and restructure them. 

Mental health treatments for paranoid personality disorder

Like bipolar disorder, paranoid personality disorder may be treated with medication and therapy. Medications could include a prescription for antipsychotics, while therapeutic approaches may include cognitive behavioral therapy or psychodynamic therapy. Psychodynamic therapy may involve discussing a person’s childhood to try to find connections to the challenges they are facing as adults. This can help individuals address past traumas in order to understand how they may influence their current disorder. 

Mental health treatments for schizophrenia

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), schizophrenia may be treated with medications (such as antipsychotics) and therapy. While each case of schizophrenia is different, common approaches include family therapy and cognitive behavioral therapy. 

While these therapeutic approaches can be beneficial, in-person therapy may not be available or convenient for everyone. For example, some may prefer to attend therapy from the comfort of their own home through alternative communication formats, such as texting, phone calls, or video chats. Others could lack reliable transportation or the time necessary to travel to a mental health professional. In these situations, it may be beneficial to try other options, such as online therapy. 

Is online therapy effective for mental illness?

Research shows that online therapy can be as effective as in-person therapy for the treatment of certain mental health conditions. In a 2022 meta-analysis and systematic review, researchers compared data from studies involving the use of telehealth therapy and in-person therapy. They found no significant differences between these therapeutic approaches by a variety of outcomes measured both immediately after treatment and during check-ins at 3, 6, and 12 months. These outcomes included symptom severity, function, overall improvement, working alliance, and client satisfaction.