Is There A Link Between ADHD And Paranoia?

A variety of mental health challenges may lead to paranoid ideas about being persecuted or plotted against by others. Some people living with attention-deficit/hyperactivity disorder may experience excessive distrust toward others, but is this a coincidence symptom of their condition?

Paranoia is not considered a characteristic symptom of ADHD. However, those with this condition may be at higher risk for other forms of mental illness that may involve paranoid ideation or delusions. In addition, this disorder could lead to unpleasant life experiences, distorted thinking, and emotional stress, potentially increasing the likelihood of paranoia. This article will explore the potential connections between ADHD and paranoia and discuss how those affected can constructively manage their feelings.

How do mental health professionals define paranoia?

In the most general sense, paranoia means an exaggerated suspicion that other people are secretly hostile to you or are attempting to harm you, often in cooperation with each other. Psychological research suggests that paranoia is a trait that’s present in varying levels in the general population, not a unique symptom of mental illness.

In older medical literature ”paranoia” is also used as a term for delusions—fixed, false beliefs—about being the target of a complex and malicious conspiracy. Current terminology would describe these beliefs as paranoid delusions or persecutory delusions. Persecutory delusions can be symptoms of psychotic illnesses like delusional disorder or schizophrenia.

Another mental illness sometimes referred to as “paranoia” is paranoid personality disorder. This condition involves a pervasive pattern of distrustful and hostile thinking and behavior, in which the affected individual frequently suspects others of having malicious intentions or actively attempting to hurt, oppose, or undermine them. 

Do ADHD symptoms include paranoia?

While ADHD may lead to various forms of mental distress, it may not cause paranoia by itself. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the core symptoms of ADHD are persistent patterns of inattention and/or hyperactivity:

1. Inattentive symptoms may include difficulties with the following:
2. Having a sustained focus on tasks
3. Taking note of small details
4. Feeling motivated to do things involving sustained mental effort
5. Maintaining organization and tidiness
6. Remembering important responsibilities, deadlines, etc.
7. Hyperactivity often includes tendencies toward:
8. Fidgeting
9. Restlessness
10. Impulsive or reckless behavior
11. Excessive talking or interrupting others

These symptoms may pose obstacles in many different areas of life, but by themselves, they aren’t typically associated with paranoid thoughts or feelings.

Mental health comorbidities in attention-deficit/hyperactivity disorder

Psychotic disorders

Delusions of persecution are among the most frequently observed symptoms of schizophrenia, and having ADHD may increase a person’s risk of developing this illness. Other serious psychotic illnesses, like delusional disorder and schizoaffective disorder, can also involve irrational and paranoid beliefs. Evidence suggests that this overlap may be due to genetic variables that increase the risk for both ADHD and psychosis spectrum disorders. 

Personality disorders

Personality disorders are characterized by persistent and pervasive habits of thought, behavior, and emotional reactivity that can disrupt a person’s life and interpersonal relationships. One of the most well-known is borderline personality disorder (BPD), which can involve  during times of emotional stress. Researchers have found that ADHD is associated with elevated risk of experiencing BPD and other personality disorders.

Mood disorders

ADHD has also been linked to a greater risk of mood disorders, such as depression and bipolar disorder. These conditions may be linked to paranoid thoughts and feelings through multiple pathways. For example, bipolar disorder can lead to psychotic symptoms, possibly including paranoid delusions, while researchers have found evidence that feeling depressed can increase paranoia. 

Anxiety disorders

Repeated studies have shown links between ADHD and anxiety disorders. The feelings of worry and dread associated with clinical anxiety may lead to paranoia in some individuals.

ADHD medication and paranoia

The most common medications used to treat ADHD are stimulants, including amphetamines and methylphenidate. Some children, adolescents, and young adults treated with these substances experience temporary symptoms of psychosis as a side effect—including paranoid thoughts and delusions. 

Not everyone experiences these rare side effects, and they might occur only at the beginning of treatment while the body is still adjusting to the medicine. Most cases last no longer than two weeks. The risk of psychosis from stimulants appears to be higher when they’re taken at high doses or without a proper diagnosis, so following your doctor’s recommendations is crucial. 

If you notice yourself having paranoid thoughts about the people in your life after starting a new ADHD medication, it’s recommended that you talk to your doctor as soon as possible. 

Rumination and paranoia in attention-deficit/hyperactivity disorder

Although the stereotypical image of ADHD involves an inability to focus, some people with this condition also experience the opposite challenge, becoming overly fixated on certain things. In certain individuals, this can include a  on negative thoughts.

When the intense focus of ADHD is turned toward unpleasant thoughts and feelings, it may lead to paranoia. Psychological researchers have identified negative rumination—the tendency to think repetitively about distressing emotions and occurrences—as a significant factor in the development of paranoia in everyday life for people with psychotic disorders. 

Rejection sensitivity symptoms and paranoia in ADHD

Emerging research suggests that many young adults with ADHD experience an additional cluster of symptoms called rejection-sensitive disorder (RSD). This form of emotional dysregulation typically causes difficulty moderating the intensity of painful feelings when an individual believes someone else has rejected, criticized, or mocked them. The experience of social rejection can trigger a sudden and severe dysphoric mood. 

This may suggest an additional reason why some people with ADHD experience paranoia. A 2018 systematic review found that greater levels of paranoid thinking were associated with greater feelings of social vulnerability and a higher tendency to overthink interpersonal interactions. A high sensitivity to rejection may cause some people with ADHD to suspect that other people are deliberately trying to hurt, ostracize, or undermine them. 

How to recognize paranoia in ADHD

Correctly determining when you’re experiencing paranoia can be challenging, since this symptom typically involves irrational and distorted thought processes. However, if you’re being troubled by anxious and suspicious thoughts, you may be able to determine that they’re not justified by asking yourself questions like:

• Am I jumping to conclusions? Are your fears of others plotting against you based on concrete evidence, or are you speculating based on things like their tone of voice or facial expressions?
• Do my worries match my experience? Are you afraid that someone you’ve always trusted in the past is secretly undermining you? Does this fit with your observations of their past behavior?
• Are my theories elaborate and unlikely? Extremely complex, difficult plots involving large numbers of people and substantial material resources are typically uncommon in the real world.
• Do the people I trust agree with me? If you have people in your life who you’re sure would not mislead you, you may want to talk with them about your fears and get their opinions.
• Am I emotionally volatile? Paranoia may cause heightened, explosive emotional reactions.
• Have you been under a lot of stress recently? If your suspicions have emerged during a period of severe mental or emotional fatigue, it could be a sign that you’re experiencing stress-induced paranoia. 

Treatment options for paranoia and ADHD symptoms

The proper treatment for paranoid thinking typically depends on the specific diagnosis. For example, someone experiencing paranoid fears as a result of ADHD-related depression may call for a very different approach from that used for someone with a comorbid psychotic disorder. 

Treating mood-related paranoia in attention-deficit/hyperactivity disorder

Sometimes, treating feelings of anxiety and depression in someone with ADHD may be the most effective way to relieve their feelings of paranoia. Psychotherapy methods such as cognitive-behavioral therapy and interpersonal therapy can be highly effective for these conditions. In the case of anxiety disorders, . Supplementing therapy with antidepressants or other prescriptions under the guidance of a doctor may also help.

Treating paranoia related to ADHD symptoms

Psychotherapy could also be an effective treatment if your paranoid feelings are exacerbated by ADHD symptoms, such as hyperfixation and rejection sensitivity. You may also benefit from stimulant medications to reduce impairments in attentional control, though you may need to watch out for a possible increase in paranoia as a side effect. 

Treating paranoid psychosis symptoms in ADHD

Psychotic symptoms such as delusions of persecution can often be effectively treated with antipsychotic medications. Psychotherapy, especially cognitive-behavioral therapy, can assist with managing secondary symptoms like depression and anger.

Treating paranoia in people with comorbid personality disorders

Personality disorders can be difficult to treat since the affected individuals are often resistant to the idea that they need help. However, dialectical behavior therapy may help people with personality disorders, especially borderline personality disorder.

Therapy can help with both ADHD symptoms and paranoid thoughts

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Online mental health treatment for paranoia in attention-deficit/hyperactivity disorder

Engaging in therapy can feel intimidating if you’re experiencing paranoia, since you may find it hard to trust authority figures. Getting treatment online may make this easier. Many participants in online therapy find that the remote setting allows them to retain a greater sense of control, which may improve their comfort level with the therapeutic process.

In addition, evidence is growing that online therapy can work well for a variety of mental health concerns. A 2017 clinical trial found that mindfulness-based treatment over the Internet significantly reduced paranoia by helping patients gain more insight into their mental processes.