What Is Paranoia?

According to Mental Health America, paranoia “involves intense anxious or fearful feelings and thoughts often related to persecution, threat, or conspiracy.” Experiencing paranoia can be difficult, especially if it is the symptom of a mental health condition. Thoroughly answering the question “What is paranoia?” may start by understanding the nature of paranoid thoughts. 

What are paranoid thoughts? 

Paranoid thought patterns can cause a person to experience stress and mistrust toward those around them, as well as their environment. Individuals experiencing paranoid thoughts could feel that no one else understands what they are going through or that there is an imminent threat they cannot avoid. This may cause them to isolate and avoid contact with others. 

Are there different types of paranoid thoughts? 

Are paranoid thoughts always the sign of a mental disorder?

On their own, paranoia and paranoid thoughts may not always be a sign of a mental disorder, as many individuals living without mental illness can experience paranoia. However, persistent paranoia can cause distress and have a negative impact on an individual's mental health. Paranoia and paranoid thoughts can also be symptoms of several psychiatric disorders. 

What mental disorders can cause paranoid thoughts? 

While the symptoms of paranoia may not be indicative of a mental health condition, there are disorders that can involve paranoid and irrational thoughts. These may include paranoid personality disorder, borderline personality disorder, and schizophrenia. Each of these disorders could involve varying levels of paranoia and different types of paranoid feelings, as well as other distinct symptoms and experiences. 

What is paranoid personality disorder? 

Paranoid personality disorder (PPD) is a mental health disorder that can be characterized by consistent suspicion and a lack of trust in others. Individuals experiencing PPD could experience challenges with self-awareness, which can make it difficult to understand how their behavior is affecting those around them. Due to their paranoid thoughts, those with PPD could threaten or even harm others if they believe they are plotting against them.

What are the signs and symptoms of paranoid personality disorder?

Individuals living with PPD can experience a variety of signs and symptoms, such as: 

• Engagement in constant conflicts
• Preoccupation with paranoid thoughts
• Suspicion of others without justification
• A tendency to hold grudges against others for long periods of time
• Emotional outbursts
• Difficulty with interpersonal relationships
• Difficulty relaxing
• Hypersensitivity to criticism
• Low self-esteem

What is borderline personality disorder? 

Paranoia can be a feature of other disorders as well, such as borderline personality disorder (BPD). Borderline personality disorder is one of 10 personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Those with BPD may find it difficult to trust others, due partially to fear of abandonment. In some cases, people living with BPD may look for reasons to leave someone first to avoid abandonment. 

Symptoms of borderline personality disorder

In addition to paranoia, individuals with BPD can also experience other symptoms, such as:

• Dissociation: Dissociation can cause a person to feel detached from themselves and their environment. This can be a response to paranoia, stress, or any other component of BPD that a person may feel is overwhelming. 
• Mood changes: Those with BPD may experience rapid mood swings, in some cases transitioning quickly from happiness to anger or from joy to sadness. This can create instability in interpersonal relationships and cause an individual with BPD to feel confused or in pain. 
• Impulsive behavior: BPD can cause a person to become impulsive, with behaviors that have the potential to harm themselves or others. These behaviors could include engaging in risky sexual activity, substance use (formerly referred to as “substance abuse”), and self-harm. 

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What is schizophrenia? 

Schizophrenia is a mental illness that can cause a person to experience paranoia, as well as delusions, hallucinations, and disorganized speech and thinking. These symptoms may make it difficult for a person to function and could disrupt their ability to perceive reality.

Paranoid delusions

Paranoid delusions, also known as persecutory delusions, can cause a person to hold beliefs that may not be based in reality. While other types of delusions can differ in focus, those who experience paranoid delusions may believe they are being followed or targeted by another person, a group, or an organization. Those who experience delusions may also have difficulty controlling their emotions, sometimes feeling violent or angry. 

Hallucinations

Hallucinations can cause a person to have sensory experiences that aren’t real. These hallucinations can impact any of the senses, including sight, hearing, taste, smell, and touch. Some hallucinations may be more common than others. For example, a person with schizophrenia could experience auditory hallucinations (or “hearing voices”) more frequently than visual hallucinations. 

Disorganized speech and thinking

People with schizophrenia may experience disorganized speech and thinking, which can make it difficult to communicate. Disorganized speech and thinking can take many forms, including speaking rapidly, switching rapidly between topics, having difficulty understanding others, forgetting things, and having difficulty with memory. 

Can a mental health professional help with paranoia?

While each person’s situation is unique, a mental health professional may be able to help individuals experiencing paranoia. For those who are having paranoid thoughts, a therapist or counselor could provide a space to discuss these thoughts and determine whether there are any underlying causes. The causes of paranoia may vary but could include temporary situations happening in a person’s everyday life. However, persistent paranoia may relate to mental health conditions, which could require different or more intensive treatments. 

Treatments that a mental health professional can provide for paranoia-related conditions

Mental health professionals may be able to provide a variety of treatments. Types of therapy that may help with paranoia include:

• Cognitive behavioral therapy (CBT): CBT may help a person identify paranoid thought patterns that may be causing potentially harmful behaviors. Once these thoughts are identified, a therapist can show a person ways to shift their patterns of thought, which may improve their behaviors as well. 
• Dialectical behavior therapy (DBT): While CBT may help individuals identify and change thought patterns, DBT could allow people to recognize and accept their thoughts while finding ways to cope. Those participating in DBT can still work to change their behavior and may learn coping techniques that could steer them away from negative behaviors. 

While CBT and DBT could be beneficial for those with paranoia-related disorders, in-person therapy sessions may not be available or convenient for everyone. Some people might live in an area with few therapists, which could make it difficult for them to find a therapist or schedule an appointment. This can happen in remote regions or in large cities that lack a sufficient number of providers. Other people may not feel comfortable discussing their paranoia in person, preferring instead to meet a provider over the phone, through text, or via video chat. In these situations, online therapy may be more feasible. 

Research has shown that online therapy can be as effective as in-person therapy. In one systematic review, "Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials,” researchers compared multiple trials involving therapy delivered both in person and through telehealth. They found that there were no significant differences between these therapeutic formats in a variety of post-treatment outcomes. These outcomes included overall improvement, function, working alliance, symptom severity, and client satisfaction.