Paranoia And PTSD: Are They Linked?

Post-traumatic stress disorder (PTSD), sometimes listed as posttraumatic stress disorder, is a mental illness in the Diagnostic and Statistical Manual of Mental Disorders and is caused by a traumatic experience. It can result in several different symptoms, one of which is hypervigilance, or “a state of abnormally heightened alertness, particularly to threatening or potentially dangerous stimuli.” Hypervigilance is not the same as paranoia, but the two may have similar features in some cases. Read on to learn more about PTSD, hypervigilant people and symptoms, paranoia, and the link between them.

What is post-traumatic stress disorder?

Posttraumatic stress disorder is a mental health condition that may develop as a result of experiencing or witnessing a traumatic event. Someone can show symptoms of PTSD after almost any type of event or situation that was traumatic for them. In some cases, it doesn't even need to be something they experienced personally; witnessing or receiving news of something traumatic can also sometimes lead to PTSD. Examples of traumatic events that could cause PTSD include war, car crashes, sexual violence, natural disasters, and domestic violence.

PTSD symptoms

Signs of this disorder typically begin to appear in the affected person within a few months of the traumatic event—but in some cases, they may not arise until months or years later. According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), symptoms must be present for at least a month before a PTSD diagnosis can be considered. However, that doesn't mean that you need to wait for a month to seek help and treatment if you experience symptoms like the ones described below.

The symptoms that are positively correlated with PTSD can vary somewhat from one person to the next depending on many factors. In general, though, they fall into the following four categories.

1. Negative beliefs, thoughts, & feelings

After a traumatic event, some people start believing that there’s no one they can trust, or they may feel guilt and shame about the situation they experienced. They may lose interest in things they used to enjoy and experience consistent feelings of fear. 

2. Reexperiencing

When someone has PTSD, they may experience frequent, intrusive memories of the traumatic event that caused it. These could take the form of flashbacks or nightmares that make them feel like the situation is happening all over again. This category of symptoms can cause significant emotional distress, trouble functioning at work or school, and trouble sleeping.

3. Avoidance of reminders of the traumatic event

Avoidance refers to a person engaging in behaviors to limit their exposure to certain stimuli because they remind them of the traumatic event. Stimuli that could be triggering can include certain people, conversation topics, places, objects, or even smells.

4. Reactivity

A person with reactive PTSD symptoms may experience increased irritability, angry outbursts, or self-destructive behaviors. These symptoms can make it difficult for them to sleep or concentrate and they may also lead to interpersonal conflicts or harm.

What is paranoia?

Mental Health America defines paranoia as “intense anxious or fearful feelings and thoughts often related to persecution, threat, or conspiracy.” It belongs to a category of indicators known as psychotic symptoms. A person experiencing clinically identifiable paranoid thoughts typically has negative alterations in their cognitive patterns, often feeling suspicious of other people and believing that others are seeking to harm them in some way. When left untreated, paranoia can seriously impact an individual’s ability to function. 

The following are some common signs of paranoid ideation:

• Suspicion and mistrust. An individual may feel that family, friends, acquaintances, or even strangers have ulterior motives or are planning to harm them.
• A tendency to read too much into someone else's behavior. An individual with paranoia may try to pick up on expressions or a tone of voice that may signal someone’s deceit or malicious intent.
• Defensive and argumentative behavior. Someone experiencing paranoia may seem defensive during interactions with others. 
• A tendency to look for hidden messages. When a person experiences paranoia, they may search for hidden messages in things like newspapers or billboards.

There are some similarities between paranoia and certain PTSD symptoms—particularly hypervigilance, or an increased alertness to potential danger. So while paranoia is generally not considered a symptom of PTSD, an experience of trauma and a case of PTSD could produce similar feelings. This type of symptom can be particularly common in those who experienced trauma that was directly and intentionally caused by another individual, such as in cases of assault.

Hypervigilance can mimic paranoia in many ways. You may notice elevated blood pressure, increased jumpiness, and an extreme focus on your environment, which can intensify feelings of panic or anxiety. You might also have trouble trusting others, since PTSD can make you look at the world with a negative slant.

One older study examined the link between paranoia and PTSD in people who had experienced assault. The findings suggest that 80% of people experienced heightened fear of others after the event, which is a primary characteristic of paranoia. The researchers report that "paranoia after an assault may be common and distinguishable from PTSD but predicted by a strikingly similar range of factors." Keep in mind that mental health research is constantly evolving.

Seeking help for PTSD, hypervigilance, and paranoia

Getting professional treatment for symptoms of PTSD can be important. They’re likely to worsen and not go away without professional treatment. Some possible symptoms of PTSD—such as substance misuse and suicidal thoughts—can be life-threatening.

If you’re experiencing paranoia but without other signs of PTSD, it might indicate another type of concern—such as a mental health condition like schizophrenia or certain physical illnesses. Meeting with a doctor or mental health care provider is recommended in this case. Even if you’re not experiencing specific symptoms of any disorder but are looking for support in processing a traumatic experience, seeking the support of a mental health professional or a support group is still often recommended.

The recommended treatment for PTSD patients according to the National Institute of Mental Health typically consists of some form of therapy, sometimes in combination with medication. Cognitive behavioral therapy, or CBT, is one common type of talk therapy for PTSD and many other disorders. It aims to help you learn to recognize and shift distorted thought patterns that may be causing distress. 

Prolonged exposure therapy is another modality that may be used, either directly or via virtual reality. It’s designed to help reduce the type of response that you have when you experience triggers. It works by gradually exposing you to stimuli that are associated with a traumatic event, which could help you manage avoidance and reactivity symptoms that may be causing hypervigilance.

Cognitive processing therapy and eye movement desensitization and reprocessing (EMDR) are other modalities that may be recommended by your care provider, among others.

Working through trauma in mental health therapy

If you’re experiencing symptoms of a mental health condition, seeking the support of a licensed mental health professional is typically recommended. They can evaluate your symptoms and suggest treatment options accordingly. They can also offer a safe space where you can express your emotions and learn healthy coping techniques for managing symptoms.

If your symptoms make it difficult to leave home, you might consider trying online therapy instead of traditional, in-person sessions. It can offer similar effectiveness to face-to-face care in many cases. Consider, for example, a 2023 study that suggests that participants who engaged in online CBT for PTSD experienced significant reductions in their symptoms. 

With an online therapy platform like BetterHelp, you can choose how you’d like to communicate with a licensed therapist: via phone or via video call from anywhere you have an internet connection. You can also contact your therapist at any time via in-app messaging, and they’ll respond as soon as they can. See below for reviews of BetterHelp therapists from those who have sought help for similar challenges in the past.