Dr Jozelle Miller
June 25, 2019
What is Paranoia and how can it be managed?

Paranoia is thinking and feeling as if you are under threat even though there is no (or very little) evidence that you are. Paranoid thoughts can also be described as delusions. There are lots of different kinds of threat you might be scared and worried about.
Paranoid thoughts could also be exaggerated suspicions. For example, someone made a nasty comment about you once, and you believe that they are directing a hate campaign against you.
In paranoia, your fears become amplified and everyone you meet becomes drawn into that web. You become the centre of a threatening universe.

What kind of things can you be paranoid about?

Everyone has a different experience of paranoia. The following are some examples of the common types of paranoid thoughts, persons are likely challenged by:
You might think that:

  •  you are being talked about behind your back or watched by people or organizations (either on or offline)
  • other people are trying to make you look bad or exclude you
  • you are at risk of being physically harmed or killed
  • people are using hints and double meanings to secretly threaten you or make you feel bad
  • other people are deliberately trying to upset or irritate you
  • people are trying to take your money or possessions
  • your actions or thoughts are being interfered with by others
  • you are being controlled or that the government is targeting you

You might have these thoughts very strongly all the time, or just occasionally when you are in a stressful situation. They might cause you a lot of distress or you might not really mind them too much.

“I find it really hard to trust people as my head tells me they’re out to get me.”

Most people have paranoid thoughts about threats or harm to themselves but you can also have paranoid thoughts about threats or harm to other people, to your culture or to society as a whole.
What counts as a paranoid thought?

Paranoid thoughts relates to your ideas about other people and what they might do. It can be difficult to work out whether a suspicious thought is paranoid or not. People might disagree on what is a paranoid thought. Someone else (a friend, family member or doctor) might say your thoughts are paranoid when you don’t think they are.
People may think about risks in different ways and believe different things are good or bad evidence for suspicious thoughts. People might also believe different things based on the same evidence.
Ultimately the individual decides for him or herself.

Suspicious thoughts are more likely to be paranoid if:

  • no one else shares the suspicious thought
  • there’s no definite evidence for the suspicious thought
  • there is evidence against the suspicious thought
  • it’s unlikely you would be singled out
  • you still have the suspicious thought despite reassurance from others
  • your suspicions are based on feelings and ambiguous events

What are the Signs of Paranoia?

Symptoms of paranoia and delusional disorders include intense and irrational mistrust or suspicion, which can bring on sense of fear, anger, and betrayal. Some identifiable beliefs and behaviors of individuals with symptoms of paranoia include mistrust, hypervigilence, difficulty with forgiveness, defensive attitude in response to imagined criticism, preoccupation with hidden motives, fear of being deceived or taken advantage of, inability to relax, or are argumentative.

What Causes Paranoia?

The cause of paranoia is a breakdown of various mental and emotional functions involving reasoning and assigned meanings. The reasons for these breakdowns are varied and uncertain. Some symptoms of paranoia relate to repressed, denied or projected feelings. Often, paranoid thoughts and feelings are related to events and relationships in a person’s life, thereby increasing isolation and difficulty with getting help.


Because paranoia can be a serious symptom of mental illness, it is important to see a doctor as soon as possible if you have experienced significant paranoid feelings—particularly if they have gone on for several days and you are starting to believe that others actually are against you. Remember: it is natural for people who are feeling paranoid to fear to talk to those in authority, including doctors, so try to keep it at the forefront of your mind that your doctor’s only interest is helping you to feel better.

A psychologist or psychiatrist will be able to assess your mental and physical health and advise you on the cause of your paranoia. If you have been using drugs, it may include a period of detoxification. Drug use can trigger dormant mental health problems, so if you continue to use drugs while you’re having paranoid feelings, it could lead to serious consequences.

Treatment for paranoia is often successful and will depend on the underlying cause of the symptoms. Pharmaceutical treatments or drugs for paranoia are very effective in treating the condition when it is caused by depression, bipolar disorder, and psychosis, but only a physician can determine the right medication needed. Cognitive Behavioral Therapy may also be helpful for paranoia when it is substance or medication-induced, and paranoia as a symptom of mental health problems.

  • Source: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders – DSM 5. 5th Edition. Washington, DC: American Psychiatric Association; 2013.
  • Cromarty P, Dudley R. Understanding paranoia and unusual beliefs. Turkington D, Kingdon D, Rathod S, Wikcock S, Brabban A, Cromarty P, Dudley R, Gray R, Pelton J, Siddle R, Weiden P. eds.. Back to Life, Back to Normality: Cognitive Therapy, Recovery and Psychosis. Cambridge: Cambridge University Press; 2009:35-60.