Paranoia Vs. Delusion: What Separates These Mental Health Symptoms?

“Paranoia” and “delusion” are terms that refer to ways of thinking about the world that don’t correspond to observable reality, and they can both be symptoms of mental illness. However, these states of mind are not the same, though they sometimes overlap. Recognizing the differences between these two types of disordered thought may make realizing when you or someone you know is experiencing a mental disorder easier and lead to support opportunities. 

Paranoia is the suspicion or belief that others are secretly working to harm, oppose, or undermine you. In contrast, a delusion can refer to any strongly persistent belief that conflicts with evidence and can’t be explained by cultural conformity. While some people can have paranoid delusions, others may experience non-paranoid delusions or non-delusional paranoia. Explore the commonalities and differences in depth below. 

What are delusions?

The American Psychological Association (APA) defines a delusion as a firmly held belief that’s resistant to change despite being irrational or having strong evidence against it. People with delusions tend to be extremely resistant to being convinced by argumentation, and they may twist, deny, or misinterpret facts to fit their worldview. Delusions can take many forms, including the following: 

• Grandiose delusions: Believing you’re someone much more powerful, influential, famous, or beloved than you are
• Jealous delusions: Believing that a romantic partner is unfaithful without evidence
• Erotomania delusions: Believing that someone else (usually someone high-status) is secretly in love with you
• Bizarre delusions: Believing in ideas that are impossible or extremely unlikely

Having delusions is often considered a symptom of psychosis, a type of disordered psychology in which a person’s ability to accurately understand reality is impaired. A delusion is usually idiosyncratic or personal, so holding false beliefs that are common in one’s culture or subculture is not considered a sign of a mental health disorder.

What is paranoia?

In the past, the term “paranoia” has been used to refer to a wide variety of mental illnesses. However, in modern psychology, psychologists use the word to refer to a state of mind marked by intense suspicion and distrust of others. A person experiencing paranoia may have intense worries about other people plotting against them, gossiping about them, or otherwise trying to secretly work against their interests. 

Paranoia can be a symptom of one or more mental disorders. However, transient or mild paranoid thoughts could occur on their own. Psychological research suggests that paranoid ideation exists on a spectrum within the general population, with some people experiencing stronger worries and suspicions of persecution than others. 

Intense paranoia and delusional disorder

When someone’s paranoid ideas are extremely severe and resistant to change, they may be considered paranoid delusions, also known as persecutory delusions. Long-term persecutory delusions not explained by other diseases or causal factors (such as the use of mind-altering substances) can be symptoms of delusional disorder. Delusional disorder causes psychosis in which delusions are present without other psychotic symptoms, such as hallucinations or disordered speech.

Other mental health conditions with paranoid or delusional symptoms

Delusional disorder isn’t the only psychological illness that can involve delusional or paranoid thinking. Other mental, emotional, and neurological disorders may amplify suspicious and hostile thoughts or lead to the formation of unsupported beliefs. Notable examples include the following conditions. 

Schizophrenia

Schizophrenia is a severe form of psychosis that can involve potentially debilitating symptoms, including delusions, hallucinations, and irrational and disorganized thinking and behavior. Paranoid delusions may be more common in schizophrenia than in delusional disorder. A research review estimates these symptoms occur in more than 70% of cases.

Personality disorders

Personality disorders cause deeply rooted thinking and behavior patterns that can disrupt interpersonal functioning and life success. Several personality disorders can include paranoid thinking, most notably paranoid personality disorder, which can cause a long-running tendency to regard others with distrust and hostility. However, borderline personality disorder (BPD) and antisocial personality disorder (ASPD) can also cause paranoia in some people. 

Mood disorders

Paranoid ideation and delusions can arise in severe cases of mood disorders like depression and bipolar disorder. They may be extremely distressing and can significantly increase the risk of suicidal behavior in affected individuals. 

Neurodegenerative disorders

Conditions like Alzheimer’s disease and Parkinson’s disease, in which the cells and structures of the nervous system slowly break down, can lead to various kinds of delusional thinking. Paranoia is one common manifestation of this effect that may be related to memory loss. Often, the affected person believes that others are stealing from them or lying to them when they are losing or forgetting items themselves. 

Can paranoia and delusions be treated with cognitive-behavioral therapy?

Cognitive-behavioral therapy (CBT) is often viewed as the “gold standard” for psychotherapeutic treatment of mental illness. This technique involves guiding a client in a systematic reappraisal of the maladaptive thoughts, feelings, and beliefs that may be contributing to their symptoms. A mental health professional providing CBT might suggest alternative ways for their clients to interpret their experiences and provide practical exercises that may guide clients in regulating their emotions and behaviors more effectively.

Can CBT help clients let go of paranoid and delusional thoughts and symptoms? 

There’s evidence that CBT may be helpful in some cases of treating paranoia and delusion. For example, a 2020 review reported that cognitive-behavioral therapy for psychosis (CBTp) has improved over time as a treatment for delusions. The effect sizes are often small to moderate, which suggests that treating severe delusional symptoms with CBT may be difficult. However, highly specialized treatments have shown promise in reducing symptoms of delusional disorder.

Conditions like paranoid personality disorder can be challenging to treat effectively since clients may have a strong tendency to distrust mental health clinicians and other caregivers or authority figures, potentially making them unlikely to seek out or participate in treatment. However, case studies indicate that CBT may reduce paranoid ideation for some people. 

Alternatives to cognitive-behavioral therapy for paranoia and delusional disorder

Individuals with delusional and paranoid ideation who don’t respond well to CBT may benefit from other forms of psychotherapy, such as the following modalities: 

• Dialectical behavior therapy (DBT): Originally developed as a treatment for borderline personality disorder, DBT involves a combination of self-acceptance and self-directed behavioral change skills. Studies suggest that DBT may reduce paranoia and psychotic symptoms. 
• Mentalization-based treatment (MBT): MBT is intended to help individuals reduce their tendency to misinterpret the thoughts and behaviors of other people, and there’s evidence the modality can decrease the symptoms of conditions like borderline personality disorder. 
• Antipsychotic medication: Some medications may suppress psychotic symptoms, potentially offering relief from delusional disorder. This treatment may not be effective for personality disorder symptoms.

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.

What causes paranoia?

The precise causes of paranoia aren’t well understood. Some scholars have suggested that paranoid thinking could be an exaggeration of an evolutionarily adaptive function. According to this theory, a tendency to interpret the behavior of others as hostile and conspiratorial could have benefits as a threat-detection mechanism in some cases, leading it to be passed down genetically.

Other theories suggest that paranoia can result from distortions in interpersonal thinking, such as a heightened feeling of social vulnerability and a tendency to overanalyze the behaviors of other people. In addition, some evidence shows that childhood trauma can increase a person’s risk of conditions like paranoid personality disorder. 

What causes delusions?

Delusions and other psychotic symptoms may have a wide range of causes. A robust body of evidence suggests that genetic factors account for a significant portion of the risk of psychosis, though there are thousands of different genes involved. Other contributing factors can include:

• Traumatic experiences in childhood
• Exposure to disease during infancy or fetal development
• Brain injuries during childhood or adolescence
• Neurodegenerative diseases such as vascular dementia or Alzheimer’s disease

How to distinguish between paranoia and delusions

Some delusional ideas lack paranoid elements. For example, someone thinking they’re the secret ruler of Earth or that a famous singer is sending them love notes through their lyrics might be experiencing these types of delusions. However, in the case of beliefs about persecution, conspiracies, and hidden enemies, determining the line between delusional and non-delusional paranoia may be difficult. 

In practice, diagnosing delusional disorder often involves assessing the person’s ability to imagine that their ideas might be wrong. Someone with a paranoid delusion may vehemently reject or reinterpret any evidence that would appear to contradict their worldviews. Someone with paranoid personality disorder might be more easily persuadable even though their tendency to adopt paranoid ideas can be higher than average. 

Seeking mental health treatment for delusions and paranoid symptoms

If you’re worried you may be experiencing pathological paranoia or delusions, you may benefit from seeking mental healthcare. Your primary care doctor can refer you to a mental health professional who can make a detailed assessment of your mental state and develop a treatment plan. You can also seek assistance through your health insurance provider or online databases such as the American Psychological Association’s Find A Psychologist tool. 

Another option is to work with a therapist through an online database like BetterHelp. Internet-based therapy platforms can connect you with an extensive pool of licensed care professionals taking new patients. By matching you with a therapist based on your stated preferences, they may be more easily able to ensure that you connect with someone you like. In addition, you can choose between phone, video, or live chat sessions, giving you more control over how you receive support. 

Early research suggests that online approaches like these can effectively treat maladaptive thinking patterns. For example, a 2017 trial found that a short mindfulness-based treatment delivered over the Internet successfully reduced feelings of paranoia in clients. Online therapy may also be effective in supporting people with conditions like anxiety and depression.