Paranoia: causes, symptoms, and treatments

Paranoia is a mental state wherein a person feels they are being threatened somehow. An individual with paranoia feels unsafe and believes other people are against them, even if they have no evidence to prove anything. 

The causes of paranoia are relatively unknown, but a combination of different factors could be to blame. Some of the most common factors that contribute to the development of paranoia include sleep deprivation, stress, drug use, mental health disorders, and memory loss. 

Symptoms of paranoia include confrontational and aggressive behavior, increased sensitivity to offense, beliefs of being always right, difficulty taking criticism, lack of trust in others, and interpreting hidden messages and people’s behaviors.

The treatment of paranoia depends on the underlying cause. In many cases, it can be treated effectively. The most common treatment approaches for paranoia are medications, therapy, coping skills, and, in the most severe cases, hospitalization. 

What is paranoia?

Paranoia is defined as the irrational and persistent feeling of being threatened, unsafe, or lied to even if there is no evidence for such claims. The term paranoia has a Greek origin and is a combination of para (beyond, irregular) and noos (mind). In other words, paranoia is the irregularity of the mind that produces irrational and obsessive distrust of others.

The word paranoia was first used during plays by Greek tragedians, and it was also used by Hippocrates and Plato. At the time, it was mainly taken as the equivalent of high fever or delirium.

Paranoia itself is not a specific disease, but it is present as a symptom or a major component of several mental health conditions.

Paranoia has been around for thousands of years. One of the earliest descriptions of paranoia or paranoid personality comes from Valentin Mangan, a French psychiatrist. He described the case of fragile personality indicated by undue sensitivity, idiosyncratic thinking, hypochondriasis, suspiciousness, and referential thinking.

Although the term paranoia has been used since ancient times, the understanding of this mental state was quite poor. In 1621, Robert Burton, an English writer, published the book The Anatomy of Melancholy where he introduced the concept of paranoia with more modern meaning. 

A major contribution to the understanding of paranoia came in 1818 when Johann Christian August Heinroth, a German physician, described it as a disorder of thought with unaltered perceptions. German and French psychiatry at the time agreed that paranoia was a partial psychosis with a maintained functioning level and absence of deterioration. 

Over the years, many psychiatrists and scientists worked on learning as much as possible about paranoia. One of them was Emil Kraepelin, 1921, who gave the most precise description of paranoia. This German psychiatrist described both psychogenic and biological components. 

Some people have mild paranoia whereas others have a severe form of this mental state. To diagnose paranoia, a healthcare provider will perform a medical exam and take a medical history to rule out physical or medical reasons behind paranoid thoughts and behavior. If paranoia is a psychiatric issue, the doctor will refer a patient to a psychiatrist or psychologist. They will perform a psychological evaluation to determine a patient’s mental status. Once a diagnosis is confirmed, the doctor will recommend the most suitable treatment approach.

Generally speaking, the outlook for persons with paranoia is positive when they seek treatment in a timely manner and adhere to the treatment protocol.

What are the symptoms of paranoia?

The symptoms of paranoia, varying in severity, are listed below.

• Being confrontational, belligerent, and defensive 
• Being sensitive to offense
• Having difficulties letting your guard down or relaxing because you think you’re always correct
• Being unable to pardon yourself, forgive others, or take criticism
• Being unable to confide in or trust others
• Interpreting hidden messages in people’s everyday actions

1. Being confrontational, belligerent, and defensive

A person with paranoia believes their thinking pattern is the reality i.e. the truth, which is why they may become confrontational and aggressive. Paranoia changes the way a person perceives reality, and paranoid thoughts can be intense and persistent.

Many people with paranoia believe someone wants to harm them or demean them in some way. They may confront those persons and become aggressive even when they have no evidence to support their claims. Since they’re feeling threatened or have paranoid thoughts that paint a different picture of reality, persons with paranoia become defensive as well.

In order to identify these symptoms, it’s important to closely observe someone’s behavior. Confrontational or aggressive individuals tend to choose words or actions purposely to push buttons and keep a person off balance. That way, they create an advantage from which they can exploit someone’s weakness. This weakness sometimes serves as “evidence” of being right about those people. 

Persons with paranoia tend to engage in arguments and disputes quite often. While doing so, they use accusatory words to express their beliefs about the supposed intentions of the other person.

2. Being sensitive to offense

A person with paranoia is often hypersensitive, and their self-esteem is very low. Combined, these factors make an individual with paranoia more sensitive to offense. In other words, they get offended easily. 

Paranoid thoughts represent reality differently. Someone’s actions may not seem genuine or a person may believe they can’t trust them. In these situations, it’s easy to regard everything as offensive. An individual with paranoia may think someone wants to humiliate them on purpose. But in reality, that specific person has no such intentions. Instead, paranoia makes people with this problem feel like they’re victims. 

Identifying this symptom of paranoia in oneself or others isn’t that difficult. Being overly sensitive to everything, feeling offended, victimized, or like everyone’s against you are the telltale signs. 

3. Having difficulties letting your guard down or relaxing because you think you’re always correct

Paranoia is a type of mental health problem where people believe others are lying or being unfair. Constantly oppressed by negative, paranoid thoughts about others, a person is constantly looking out for danger. They can’t relax mainly because in these situations a person believes something might happen. In their minds, persons with paranoia are always correct. 

A person without paranoia usually doesn’t assume their thoughts are always true. They leave the possibility that they may not be right after all. However, for someone with paranoia, paranoid thoughts about other people are the only truth they need. They don’t do it on purpose, paranoia changes the way a person perceives reality and other people. So, beliefs that others lie, cheat, deceive, and aim to harm or threaten become facts in their minds.

To identify this symptom it’s necessary to consider whether a person has chronic anxiety. They may appear on the edge always, can’t “chill” or relax, and also refuse to change their mind. A person with paranoia sticks to their conclusions or assumptions even when there’s no proof to support them.

4. Being unable to pardon yourself, forgive others, or take criticism 

An individual with paranoia is unable to pardon themselves for things they see as mistakes and at the same time, they can’t forgive others. A person with paranoia usually isn’t able to compromise. This is associated with the belief they’re always right. For that reason, forgiveness isn’t something they can practice.

If they believe someone wants to harm them, they won’t be able to forgive that person even if their conclusion was wrong. Since a person with paranoia believes their thinking pattern is always correct, they’re unable to accept criticism or accept they are wrong. 

It’s not difficult to identify these symptoms. A person can’t take criticism or presume it’s something constructive. Instead, they may take it as an insult. They can be strict with others and themselves, leave no space for mistakes, and refuse to let things go. 

5. Being unable to confide in or trust others

Paranoia manifests itself as a lack of trust in other people, including their significant other. A person with paranoia constantly feels someone is cheating on them. They may also assume the other person is always lying or wants to harm them. Since they negatively perceive the other person, they can’t trust them or confide in them. This often leads to feelings of loneliness and isolation. 

It’s useful to keep in mind that trust issues and paranoia aren’t the same. Having trust issues is usually caused by some specific problem that a person doesn’t want to relive again. On the flip side, paranoia is an intense, irrational suspicion and mistrust. 

6. Interpreting hidden messages in people’s everyday actions

Someone with paranoia may start analyzing or deciphering the behavior of a specific person or more people, because paranoia makes a person mainly focused on the perceived threat or harm. They may look for clues and hidden messages in people’s behaviors. Sometimes they may be convinced some behaviors are evidence to support their claims, but in reality, that is far from true. 

One can spot this symptom in themselves or others by focusing on their actions. If the person is concentrated and only thinks about someone’s motives or hidden messages or clues, it’s highly likely they may have some form of paranoia.

What are the causes of paranoia?

The exact causes of paranoia are unclear, it is thought that various factors can contribute to its development. The most common contributing causes of paranoia are listed below.

• Not enough sleep
• Stress
• Psychiatric disorders
• Drug use
• Memory loss

1. Not enough sleep

Sleep deprivation wreaks havoc on both physical and psychological health and well-being. Failing to get enough good night’s rest can contribute to the development of paranoia, among other things. According to a paper from Schizophrenia Research, many people with persecutory paranoia experience difficulties initiating and maintaining sleep. The stressful experience of sleep deprivation can affect mood and contribute to anomalies behind persecutory ideation. 

Lack of sleep could contribute to the development of paranoia through several mechanisms of action. For instance, sleep deprivation could contribute to or worsen anxiety and depression. Both mood disorders can make it easier for paranoia to appear. Additionally, lack of sleep can lead to a puzzling internal state for a person that, in the anxiety context, is incorrectly associated with an external threat.

A paper from Psychiatry Research explained that, although a lot more studies are necessary, sleep problems are associated with paranoia through negative moods and alexithymia, an inability to identify and describe emotions experienced by oneself. 

Sleep quality is a factor in the development of paranoia, which means that insomnia isn’t the only issue that may lead to paranoid thoughts. Sleep deprivation can come in different forms, such as failing to get enough sleep during the night or not having a healthy sleep schedule. A person who doesn’t get enough sleep, especially when the problem persists, is more likely to develop paranoid or delusional thinking. However, this doesn’t automatically mean every person with a lack of sleep is bound to develop paranoia. Other factors are also involved. 

2. Stress 

Stress is a normal human reaction to pressure, feeling threatened, and other negative stimuli. Not all stress is bad, but when left unmanaged it can turn into a huge problem and negatively affect a person’s mental health. Long-term stress can increase the risk of mental health problems such as anxiety and depression. It can also contribute to the development of paranoia.

A study from Psychological Medicine confirmed the increase in paranoia, depression, and negative emotion in stress. The increase in paranoia is likely mediated by anxiety and moderated by the level of vulnerability. 

The Schizophrenia Bulletin published an interesting study that found that environmental social stress elicited paranoia and distress in a dose-dependent manner. More stressors led to higher levels of paranoia.

Men and women with high-stress levels are more likely to experience paranoid thoughts because they are vulnerable. When a person is stressed out and vulnerable, they’re more prone to having negative thoughts and bad moods, all of which can pave the way to paranoia. The relationship between stress and paranoia is particularly strong in people who already have some mental health problems.

Plus, it’s useful to mention that sleep deprivation is an essential component of what stress is. Lack of sleep contributes to stress, and their relationship is bidirectional.

3. Psychiatric disorders

Psychiatric disorders are among the most common causes of paranoia. People with conditions such as anxiety, depression, schizophrenia, and some personality disorders are more susceptible to experiencing paranoid thoughts or being more upset by them. It’s not entirely clear why it happens, but individuals with these conditions could be more on edge or they worry a lot. Also, they are more likely to interpret some things negatively. 

To explain the relationship between psychiatric disorders and paranoia, we’re going to focus on 5 psychiatric disorders – anxiety, depression, schizophrenia, paranoid personality disorder (PPD), and delusional disorder.

Anxiety is defined as the feeling of unease, intense fear, or worry, that can be mild or severe. It often worsens with time. One of the main components of anxiety is the presence of unusual or irrational thoughts, which is also the connection between anxiety and paranoia. A paranoid thought is a type of anxious thought, which is why anxiety can contribute to the development or worsening of paranoia. It can affect what a person is paranoid about and how long the feeling lasts. A paper from the Schizophrenia Bulletin revealed anxiety can increase paranoia and lead to jumping to conclusions. The link between anxiety and paranoia was moderated by the severity of baseline symptoms and mediated by an increased tendency to jump to conclusions. Also, anxiety tends to narrow attention to emotionally relevant cues.

Depression is also a mental health problem that can contribute to the development of paranoia. The likelihood of developing paranoia is a lot higher in individuals with comorbid depression and anxiety. Social Psychiatry and Psychiatric Epidemiology published a study that confirmed that depressive disorder was among the major clinical factors behind the presence of paranoia in clinical high-risk patients. People with depression tend to have low self-esteem, which is associated with some types of paranoia as well. When discussing depression as a potential cause of paranoia, it’s important to mention depressive psychosis. It is a combination of major depression and psychotic symptoms. The latter include hallucinations, delusions, and paranoia. Chemical imbalances are considered the main cause of depressive psychosis. This shows once again that depression and paranoia can be linked to one another.

Schizophrenia is also strongly related to paranoia. In fact, paranoia is one of the most common symptoms of this severe mental health condition. It’s not entirely clear what causes paranoid schizophrenia, but it could be a combination of genetic mutations inherited from one or both parents, complications during pregnancy, and exposure to some chemicals and substances. Patients with schizophrenia have an unrealistic perception of reality, which affects the way they think and behave. 

Paranoid personality disorder (PPD) is another psychiatric disorder related to paranoia. A paranoid personality disorder is characterized by a pattern of distrust and suspicion of others without any reason to be suspicious. People with PPD have persistent paranoid thoughts that someone wants to harm, demean, or threaten them. Although it’s unknown why it happens, a combination of biological and environmental factors can lead to PPD and its main symptom – paranoia.

Delusional disorder, a type of psychotic disorder, can also be tied to paranoia. Delusional disorder is indicated by the presence of one or more delusions and paranoid thoughts. A person with this condition can’t make a distinction between what’s real and imagined. Stress is the most common trigger of delusional disorder and paranoid thoughts associated with it.

4. Drug use

The use of some recreational drugs can contribute to the presence of paranoid thoughts. These include cocaine, LSD, ecstasy, amphetamines, and cannabis. Alcohol, as an addictive substance, may also lead to paranoia. The effects of recreational drugs and other substances on paranoia are particularly strong when a person is already in a low mood, anxious, or experiencing other mental health problems. That being said, it is not entirely known why these drugs cause paranoia. Taking excessively high amounts of some drugs can lead to drug-induced psychosis and the development of paranoid thinking. In these cases, paranoia happens because the level of toxicity of some substance induces paranoia and provokes a psychotic episode. 

Recreational drugs hurt a person’s brain and interfere with their understanding of the world. This effect is stronger with heavy, long-term use. Since the perception of reality becomes twisted, a person becomes more prone to paranoid thoughts, jumping to conclusions, or focusing on irrational beliefs that are real to them.  

Additionally, some recreational drugs, such as cannabis can overstimulate the amygdala, the brain area that regulates emotional processes. Hyperactivity of the amygdala leads to paranoia. At that point, a person experiences an increase in anxiety, fear, and worry. They are more susceptible to feeling threatened by someone. 

Other drugs, such as methamphetamine, also increase brain activity and thereby pave the way to paranoid thoughts and rumination.

5. Memory loss

Memory loss occurs due to a wide range of causes including neurodegenerative conditions such as dementia and its most common type, Alzheimer’s disease. Patients with Alzheimer’s disease may develop paranoia due to memory loss. For instance, an individual becomes paranoid if they forget where they put something, people around them, directions, and other things.

In these cases, paranoia is a way the person is expressing loss. The affected individual may blame others or accuse them of hiding things. They do so because their perception of reality has been changed and no other explanation makes sense to them, National Institute on Aging explains.

Evidence shows that delusions or paranoia are associated with memory deficits and they are caused by dysfunction in specific frontal and temporal cortical regions. Interestingly, the frontal lobe controls crucial functions associated with consciousness and communication, memory, and attention. 

What are the possible effects of paranoia?

The possible effects of paranoia include consequences or implications it has on a patient, their overall quality of life, and other people. The biggest effects of paranoia are listed below.

• Developing safety-seeking behaviors: a person with paranoia may develop safety behaviors i.e. do things that make them feel safe. For example, they may wear protective clothing or avoid certain people and/or places. They do so because they are convinced someone wants to harm them. Safety-seeking behaviors may appear odd to others, especially because paranoid thoughts are irrational. But, to the affected individual, those thoughts are real.
• Difficulty maintaining relationships: people with paranoia tend to question other people and their intentions a lot, even when they have no reason to doubt them. Plus, they can be argumentative and aggressive. For that reason, other people may start avoiding them. It can be difficult for a person with paranoia to maintain relationships, have friends, or get along with family members. Maintaining a relationship with a person with paranoia becomes particularly difficult if they refuse to seek help for their problem. This can be a major cause of relationship problems or impaired family dynamic. While other people are genuinely concerned and want to help their friends or family, a person with paranoia sees nothing wrong. In fact, they may keep accusing others of wanting to harm them.
• Isolation: paranoid thoughts can make a person feel totally alone. People with paranoia feel like nobody understands them. It can be quite lonely when other people don’t know what feels real to someone. Even if a person with paranoia doesn’t want to be isolated, their actions may push other people away. At the same time, isolation can further affect their mood and contribute to paranoid thoughts and behaviors. 
• Sadness and worry: a person with paranoia tends to worry about their paranoid thoughts and also sad about their meaning and the effect on their life. For example, they may be convinced someone they love is cheating on them.  This makes a person sad because they feel betrayed by that person. When the partner isn’t around, they may worry if they’re cheating. This leads to a vicious circle where accusations and insecurities are intertwined with sadness and worry. However, worry and sadness make a person more susceptible to paranoid thoughts and thereby worsen a person’s condition.
• Stigma: even though we live in the 21^st century, people with paranoia are still stigmatized. Paranoia is often mistaken for other mental health problems and people assume every person with paranoid thoughts is dangerous. The stigma surrounding paranoia makes a person reluctant to seek help, deepens their isolation, and worsens mental health. Dealing with stigma is particularly difficult when it’s present among family and friends. 
• Health problems: mental health has a strong influence on physical health and wellbeing. Paranoia can pave the way to avoidable and treatable conditions. Patients with paranoia may stop taking care of their health or they may not be able to make rational decisions about their physical wellbeing. This way, many health problems aren’t treated and addressed properly. Plus, they may not see the problem or refuse to take action when other people express their concerns. 
• Suicidal ideation: patients with paranoia are at a higher risk of suicidal thoughts and tendencies. A study from Comprehensive Psychiatry revealed patients with paranoia, especially the persecutory type, are usually in a severe state of psychological stress and at risk of suicide or high levels of suicidal ideation. Suicidal thoughts and tendencies are more pronounced in people who have paranoia due to some serious mental health problem. A good example is schizophrenia. 
• Unemployment: paranoia, regardless of the cause, affects different aspects of a person’s life such as their career. Paranoid thoughts can affect a person’s behaviors and jeopardize their work performance, teamwork functioning, making decisions, and problem-solving abilities. For example, someone may believe that their colleagues want to harm them, which can directly affect their behavior and productivity.  

What are the different types of paranoia?

Different types of paranoia are, actually, different forms of paranoid reactions and underlying beliefs. Not all cases of paranoia are the same. Different types of paranoia are demonstrated in the table below.

What are the available paranoia treatments?

Paranoia treatment methods depend on the cause and severity of symptoms. Regardless of the treatment type, a person with paranoia needs to make lifestyle adjustments to support mental balance. Healthcare providers generally advise patients to exercise regularly, eat a healthy diet, and get enough sleep in addition to the recommended treatment option. The available treatment approaches for paranoia are listed below.

• Medications: a doctor may prescribe medications to people whose paranoia is caused by paranoid personality disorder and schizophrenia. These usually include anti-anxiety medications, antidepressants, and antipsychotic medications. Medications also work for patients with co-occurring mental health problems such as depression. The role of medications is to decrease paranoid thoughts or make a person feel less threatened by them. Some medications block the effect of dopamine to reduce the flow of messages it passes and thereby lessen the intensity of paranoia.
• Psychotherapy: helps patients develop coping skills to improve their communication and socialization. The most common type of therapy for patients with paranoia is cognitive-behavioral therapy (CBT). During CBT sessions, therapists help patients examine their thought patterns, but also understand that some thoughts are irrational. Since CBT decreases worry and anxiety, it can help lessen paranoia. As patients learn to look at the way their thoughts and behaviors affect one another, they can consider alternative interpretations. This reduces the focus on the irrational aspect. Besides individual therapy sessions, patients may also need family therapy. Cognitive-behavioral therapy is particularly useful for teaching patients the abovementioned communication skills. Patients may get an opportunity to learn to communicate with others more effectively or express their emotions. A major part of CBT is challenging or questioning irrational thoughts thereby decreasing the effect of paranoia.
• Coping skills: the main goal is to help patients cope with their symptoms and improve their functioning or quality of life. Cognitive-behavioral therapy isn’t the only strategy for learning coping skills. Other approaches may include relaxation techniques, behavior modification, and techniques to reduce anxiety. Relaxation techniques are incredibly helpful. By learning to relax or calm their mind, patients with paranoia pay less attention to their paranoid thoughts. Paranoia is stronger in times of stress and anxiety. That’s why relaxation techniques and mindfulness can help a person cope with this mental state. Good relaxation techniques to try are meditation, deep breathing, and even yoga can be helpful.  
• Hospitalization: in severe cases, when other treatment approaches fail to work, a person with paranoia may need to stay in the hospital until their condition stabilizes. Admission into the hospital is necessary for patients with serious mental health conditions such as schizophrenia and major depression. Laws regarding hospitalization for persons with paranoia may vary from one state to another. Generally speaking, hospitalization is recommended only in cases when a person is unable to care for themselves or when they pose a threat or danger to themselves and other people.