Paranoia, Mental Illness, And Available Treatments

People experiencing paranoia generally hold unfounded beliefs that others are plotting against them, are out to get them, or intend to cause them harm. Paranoid thoughts can range from mild to severe and from plausible to unrealistic, bizarre, or impossible. The effect paranoia may have on a person's life can also range from causing mild stress to greatly impairing a person's ability to maintain relationships or function properly in the world.

People often associate paranoia with mental illness. However, paranoia generally exists on a spectrum in terms of both severity and mental health, with some people having both paranoia and mental illness and others only having occasional paranoia. If paranoid thoughts are negatively impacting your mental health, consider scheduling a session with a licensed therapist.

Paranoid thoughts and mental health

If you are having paranoid thoughts, it doesn’t necessarily mean you’re living with a mental illness. In both people who have a mental illness and those who do not, paranoia may be prompted or exacerbated by stress. So, while paranoia doesn't always indicate a mental illness, it could indicate that something else is going on with a person's mental health, like heightened stress levels. Instead of being further stressed by the presence of paranoia, viewing it as a signal to reduce stress or seek treatment might be helpful.

When does paranoia indicate paranoid personality disorder?

In paranoid personality disorder (PPD), a person typically has paranoia as a personality trait, meaning they routinely experience paranoia rather than only experiencing short-term instances of it. 

Up to 4.4% of people may have paranoid personality disorder, and the disorder may occur more often in men. You may be wondering how paranoid personality disorder is diagnosed. To be diagnosed with paranoid personality disorder, a person must persistently display distrust and suspicion of others, as well as have the presence of four or more of the following:

• The belief that others are exploiting, harming, or deceiving them, despite a lack of evidence
• A preoccupation with thoughts about how trustworthy or reliable people they know may be
• Hesitance to confide in others due to the fear that others could use the information against them
• A tendency to misinterpret neutral comments or happenings as having been threatening or hostile
• A pattern of holding grudges about others' past insults or wrongdoings 
• A tendency to believe that their reputation or character has been attacked and a quickness to defend themselves, counterattack, or become angry 
• Recurring suspicions that their romantic partner is unfaithful, despite a lack of evidence 

Other mental illnesses that can involve paranoia

While paranoid personality disorder usually always involves paranoia, other mental illnesses can involve paranoia as a symptom, too. 

Borderline personality disorder is another personality disorder that can involve paranoia, while schizophrenia and delusional disorder are two psychotic disorders that may involve paranoia. 

Borderline personality disorder

The paranoia seen in borderline personality disorder (BPD) tends to differ quite a bit from the paranoia seen in paranoid personality disorder. Instead of being a steady, long-term trait, paranoia in borderline personality disorder is generally temporary and induced by stress.

Borderline personality disorder can be characterized by mood swings, rocky relationships, and an unstable sense of self. Often, these symptoms stem from a deep fear of abandonment, and the disorder is often associated with childhood emotional neglect. 

Paranoia associated with this disorder can also stem from a fear of abandonment. For example, when a person with borderline personality disorder experiences relationship troubles, they may become paranoid about the relationship and suspect their partner wants to hurt or abandon them, even if that's untrue.

Schizophrenia

In schizophrenia, a person may experience hallucinations, delusions, and disorganized thoughts and speech. Hallucinations normally involve sensory experiences of nonexistent stimuli. Delusions can describe unfounded, persistent beliefs that don’t align with reality. Both hallucinations and delusions normally indicate a disconnect from reality.

While people with schizophrenia can hold any type of delusion, the most common type is usually a paranoid delusion. Paranoid delusions among people with schizophrenia are often bizarre or unrealistic. For example, a person may become paranoid that aliens are altering news headlines to share hidden messages about something bad that's going to happen to them.

Delusional disorder

Like schizophrenia, delusional disorder typically involves a disconnect from reality. People with delusional disorder generally hold a delusion for over a month. However, the delusions associated with delusional disorder usually are not bizarre, like they often are in schizophrenia. 

While these delusions may be untrue, they tend to be more plausible and are usually related to people in the individual’s life. For example, a person may suspect that their coworker is conspiring to get them fired, when that isn't true.

People with delusional disorder can hold any type of delusion. Those who hold paranoid delusions are normally said to have the persecutory type of delusional disorder. Persecutory delusions are typically centered on incorrectly believing one is being harassed, attacked, plotted against, or that others are trying to interfere with their goals in some way.

Paranoia and anxiety disorders

Paranoia isn't a diagnostic criterion of anxiety disorders like it is with paranoid personality disorder, borderline personality disorder, schizophrenia, and delusional disorder. That said, authors of a systematic review of 19 studies concluded that there may be a cause-and-effect relationship between anxiety and paranoia. More research is needed to clarify how anxiety, anxiety disorders, and paranoia may relate, but experts argue that anxiety often precedes and worsens paranoia.

Paranoia and depression

As with anxiety, paranoia isn't a diagnostic criterion of depression, and the connection between the two hasn't been widely studied. However, although updated evidence may be needed, one research study found that, along with worry, anxiety, and insomnia, the presence of depression could be a predictor of paranoid thinking. 

Available treatments for paranoia

Since paranoia is a symptom rather than a disorder, there aren't specific treatments widely given to people with paranoia. The treatment given to a person experiencing paranoia usually depends on its underlying cause. People unsure of the cause of their paranoia symptoms may want to see a therapist or doctor who can determine the best course of treatment.

Mental health treatment for psychotic disorders

If a person has a psychotic disorder like schizophrenia or delusional disorder, the best course of action is likely to treat the disorder itself, rather than paranoia as a symptom. These two disorders are often treated similarly, with a combination of therapy and prescription medication. 

Paranoid personality disorder treatment

There is not yet an established treatment for paranoid personality disorder. Often, practitioners recommend therapy or a combination of cognitive behavioral therapy (CBT) and medication. The specific medication and dose can vary, depending on a person's unique situation and what their psychiatrist or doctor believes might be best for them. 

People with paranoid personality disorder treated by a doctor or psychiatrist may go through a period of trial-and-error with different treatments to find something that works. The goal of treatment is usually to reduce any distress about symptoms, help a person with PPD understand the challenges they are facing, and reduce any behaviors that may negatively impact their life. 

Sometimes, people with paranoid personality disorder resist treatment because they do not realize their perceptions are contributing to their challenges. However, people who stick with treatment may see improvement. One case study found that after six months of therapy, a man with paranoid personality disorder no longer met the diagnostic criteria for the disorder.

Stress reduction practices

In people who do not have a mental illness, paranoia is often preceded or exacerbated by stress. In these instances, focusing on stress reduction may reduce paranoid thoughts. There are many approaches a person can take to reduce stress:

• Therapy
• Mindfulness meditation
• Yoga or tai chi
• Other forms of exercise
• Time in nature

Seeking therapy for paranoia

If you're having paranoid thoughts, you may consider trying therapy. Remote therapy could be an especially appealing treatment option since it doesn't require you to travel anywhere or interact with the public. With remote therapy, you can connect with your therapist digitally through video chat, phone calls, or online chat. BetterHelp is a remote therapy platform that can connect you with a suitable therapist.

Research hasn't focused on remote therapy specifically for paranoia, but researchers have looked at various therapy options that help with paranoia. One study found that 10 weeks of anxiety-based cognitive behavioral therapy (CBT) usually reduced paranoid thoughts and improved overall function. 

A growing body of evidence suggests that online CBT tends to be just as effective as in-person CBT, meaning that online treatment could effectively reduce paranoia. However, individuals experiencing acute psychosis may need to seek care in person.