Signs Of Paranoia In Mental Illness

Paranoia is when a person experiences an intense and irrational distrust of others and behaves in an overly suspicious manner as a result. While anyone can experience occasional paranoid thoughts from time to time, episodes of clinical paranoia are typically persistent and distressing and may affect well-being, daily functioning, and mental health in general. Read on to learn more about this clinical symptom as well as signs to watch out for, conditions that may cause it, and treatment options.

About paranoia

According to Mental Health America, the exact causes of paranoia are unknown, but the development of this symptom may be influenced by a combination of biological and environmental factors. Some examples include childhood emotional neglect, childhood physical neglect, childhood supervision neglect, and genetics. 

About psychosis: delusions, hallucinations, and paranoia

Paranoid symptoms can also be a component of psychosis, a broader collection of symptoms that involve a disconnection from reality. Psychosis—and, therefore, paranoia—can occur as a result of several different mental health conditions. The type and effectiveness of treatment often depend on what the underlying condition is. In general, it’s recommended that you meet with a doctor or mental health professional if you’re experiencing signs of paranoia.

Key signs and symptoms of paranoia and delusional thinking

For example, some of those living with paranoia may primarily experience a sense of mistrust, which causes them to be suspicious of other people’s intentions and have difficulty confiding in or even being around others—even without any evidence to support their suspicions. People with this manifestation of paranoia may think others are out to get them, assume that people are talking about them behind their backs, or obsess over whether their friends and family are trustworthy or loyal.

Another manifestation of paranoia is known as “ideas of reference.” Ideas of reference paranoia is when a person believes, falsely, that random events are directly related to them—such as believing that their actions, thoughts, or presence have caused certain events to occur. For example, someone may see a news headline and think that it refers to them and their life specifically. Or, they may get on a train, hear people talking, and assume that everyone is speaking about them.

Persecutory delusions may be the most severe type of paranoid feelings. These refer to when someone believes another person is spying on them and/or attempting to harm them. The individual may believe in extreme or especially convoluted conspiracy theories—particularly those that involve everyone plotting against them. This type of paranoia in particular can make treating the mental health conditions that may be causing it more challenging, since the individual is likely to have trouble trusting their healthcare provider. 

The link between mental health conditions and psychotic symptoms like paranoia, delusions, and hallucinations 

Again, paranoia often occurs as part of a broader pattern of symptoms known as psychosis. Psychosis is a feature of a variety of mental health conditions. Researchers believe that psychosis and the conditions that can cause it may occur due to a combination of genetic factors, environmental factors like trauma, and differences in brain structure. 

Psychosis can be triggered by substance misuse, sleep deprivation, a medical condition like Parkinson’s disease or Alzheimer’s disease, or a mental health condition. Some mental health conditions that typically or sometimes cause paranoia include paranoid personality disorder, schizophrenia, substance misuse disorders, and bipolar disorder. Note that it’s also possible for a mental health condition to cause paranoid thoughts without other symptoms of psychosis.

Personality disorders and paranoia

Personality disorders are one example of a type of mental illness that may cause paranoia as a symptom. Learning more about what personality disorders are and which types may cause paranoia can be useful for recognizing this and other symptoms and seeking treatment if they appear.

What is a personality disorder?

According to the American Psychiatric Association, a personality disorder can be defined as an illness in which “one's way of thinking, feeling and behaving deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) lists 10 different personality disorders.

Because these illnesses affect an individual’s personality, it can sometimes be difficult for the person or those around them to realize that a mental health condition may be at play and that they should seek help. Paranoid personality disorder is one type of personality disorder in which paranoia is typically a key symptom.

Paranoid personality disorder

Paranoid personality disorder (PPD) is a mental health condition characterized by a pervasive pattern of unwarranted suspicion and distrust of others. People with paranoid personality disorder suspect that others are planning to deceive…” as it is not always the case that every person is not trusted is planning to deceive, harm, or exploit them. Because PPD is a personality disorder, the symptoms are usually long-lasting and pervasive, though ongoing mental health treatment may help a person learn to better manage their symptoms.

Schizophrenia (formerly paranoid schizophrenia) and paranoia

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), schizophrenia is a serious mental illness that affects how a person interprets reality. To put it another way, this condition is characterized by a loss of touch with reality, making it difficult for individuals living with it to participate in daily activities. 

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“Paranoid schizophrenia” used to be a recognized subtype of this illness, but it’s no longer used as a classification. That said, paranoia can still be a symptom that those with this illness experience. Schizophrenia can range in severity and may affect people differently, but symptoms typically fall into the following three categories.

Psychotic symptoms of schizophrenia (formerly paranoid schizophrenia) 

Psychotic symptoms can make it difficult for people to recognize what is real and what is not. These may include hallucinations, delusions, and disorganized thinking. This symptom category is typically where paranoid thinking comes in, as hallucinations and delusions can cause or reinforce paranoia and disorganized thinking can make it harder to understand what is real and what is not.

Negative symptoms of this mental health condition

Negative symptoms in schizophrenia refer to the absence of certain behaviors. These can include showing few facial expressions, avoiding social interaction, or having low energy. Especially when combined with paranoia, negative symptoms can result in a person having trouble keeping their job, maintaining social relationships, or even leaving the house.

Cognitive symptoms of this mental illness

Cognitive symptoms of schizophrenia have to do with memory, concentration, and attention and they can make it difficult for a person to function. Examples of these symptoms can include having trouble processing information, paying attention, or remembering information even immediately after learning it. When these symptoms occur in combination with paranoia, it can make it harder for the individual to hold on to what’s real or be soothed or reassured.

Substance misuse and paranoia

Substance misuse can cause certain psychiatric symptoms, including paranoia. For example, cocaine use is commonly associated with the experience of paranoia. Methamphetamine and bath salts are also known to cause paranoia, and hallucinogens may as well. 

In addition, although rare, people can also experience paranoia due to psychosis associated with alcohol use, either as a result of acute intoxication, chronic alcohol use, or alcohol withdrawal. This type of psychosis typically causes symptoms similar to those seen in schizophrenia and is characterized by paranoia, hallucinations, and fear. Help is available for those experiencing challenges with substance use; speaking with a substance misuse counselor or your doctor is usually a recommended first step.

Bipolar disorder and paranoia

Bipolar disorder causes unusual shifts in energy, mood, concentration, and activity levels that can make it difficult to function in daily life. There are three types of bipolar disorder: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. 

Which type of bipolar disorder may cause paranoia or delusional thinking?

Extreme mood swings are a hallmark of bipolar disorders. Their frequency and severity can vary depending on the type of bipolar disorder a person is living with, but they’re typically categorized as either manic or hypomanic (feeling extremely up, energized, or euphoric) or depressive (feeling sad, hopeless, and indifferent). A person may be more likely to experience paranoia during a manic episode, particularly if they haven’t been sleeping enough.

Bipolar I disorder is generally considered to be the most severe of the three types and the most likely to manifest as psychotic symptoms like paranoia, since it’s the type most likely to cause a manic episode in general.

Getting treatment from a mental health professional for a mental illness that causes paranoia

If you suspect you may have an underlying mental health condition that is causing paranoia or are experiencing any type of distressing symptom, it can be important to seek mental health care as soon as possible. Paranoia in particular can lead to distress and social isolation and may increase the risk of dangerous behaviors and/or developing other mental health conditions if left untreated. Treatment for paranoia depends on what’s causing this symptom, but it often involves some form of psychotherapy, sometimes in combination with medication.

Meeting with a mental health professional virtually 

Meeting with a healthcare provider for evaluation is usually the first step in addressing mental health symptoms, but attending in-person appointments may not be feasible for everyone. For those experiencing mild to moderate symptoms, online therapy may be a preferable alternative. With a platform like BetterHelp, you can get matched and then meet with a licensed therapist remotely from the comfort of home. Most people who sign up are matched with a therapist within 48 hours, and you can change providers at any time for no charge until you find one who is a good fit for you.

A growing body of research indicates that online therapy may be effective for addressing many different types of mental health symptoms, potentially including paranoia. For example, one study suggests that internet-based cognitive behavioral therapy may be effective at improving reasoning and reducing paranoia in people with psychosis or schizophrenia. Speak to your doctor or another qualified healthcare professional to find out if online therapy might be right for your situation.