Paranoia – Causes, symptoms

Paranoia

Also called: Paranoid Disorder

Summary

Paranoia is a term used to describe feelings of suspicion or mistrust by an individual that are either highly exaggerated or completely unwarranted. For example, people with paranoia may believe that others are plotting against them. People who are paranoid often have feelings of exaggerated sense of self-importance and believe that they are persecuted by others.

Medical conditions can cause paranoia. Paranoia is also a feature of many mental health conditions, but is most prominent in four disorders:

  • Paranoid personality disorder. Condition in which a person regularly becomes suspicious without cause.
  • Delusional (paranoid) disorder(persecutory type). Condition that involves persistent, nonbizarre delusions (delusions about situations that may occur in real life, such as being followed, poisoned or deceived by a spouse or lover). Delusions are beliefs that an individual holds that are not true, not shared by others in a culture and cannot be easily modified.
  • Paranoid schizophrenia. Condition marked by extremely bizarre delusions or hallucinations that are almost always based on a specific theme.
  • Substance abuse and dependence.  Paranoia is associated with the use of many substances, most prominently alcohol, cocaine, steroids and amphetamines.   

People who are paranoid may manifest several other related symptoms. Continual mistrust and suspicion are closely associated with paranoia, as are hypersensitivity and a tendency to be emotionally cold or aloof. The causes of paranoia are not clearly understood, and treatment may be difficult because patients often are both reluctant to seek help and suspicious of those who offer to help. Nonetheless, both psychotherapy and the use of antipsychotic medications can help patients to better control their feelings of paranoia and to function better in social situations.

About paranoia

Paranoia is a term used to describe feelings of suspicion or mistrust that are out of proportion to any threat posed to an individual. In some cases, no actual threat may exist, but the patient nonetheless imagines unseen dangers. People who are paranoid may have an exaggerated sense of self-importance and believe that others are persecuting them.

Occasional feelings of suspicion are not indicative of paranoia. Suspicion is sometimes justified based on previous experiences or on information learned from the experiences of others. Isolation or cultural differences may produce miscommunication that leads to suspicion. However, paranoia takes these feelings a step further as it involves suspicion that is either highly exaggerated or not warranted. For example, patients may believe that coworkers are plotting against them.

Beliefs and actions commonly associated with paranoia include:

  • Argumentative disposition
  • Difficulty forgiving others
  • Defensiveness when encountering what is perceived as criticism
  • Fear of being manipulated or deceived
  • Feelings of mistrust
  • Inability to relax
  • Perfectionism
  • Preoccupation with others’ hidden motives
  • Self-righteousness
  • Being easily offended

Though many people may demonstrate these beliefs and actions, one is only considered paranoid if the beliefs and actions impair their ability to function.

Other symptoms related to paranoia

People who are paranoid may manifest several other related symptoms. Continual mistrust and suspicion are closely associated with paranoia. People who are paranoid tend to view the world as threatening and regularly confirm their suspicions with even the smallest piece of evidence that supports these views. For instance, they may view cancellation of a dinner date as a sign that all people are untrustworthy.

Hypersensitivity is another symptom closely related to paranoia. This may lead a person to be offended by a simple comment or gesture that was not intended to be injurious. Hypersensitivity can cause a person to be defensive and antagonistic, and leave them unable to bear even slight criticism. Despite their own hypersensitivity to criticism, paranoid people tend to be highly critical of others. Other symptoms that may be closely associated with paranoia include coldness or aloofness, a tendency to be argumentative or unwilling to compromise, and a pattern of developing very few intimate relationships with others.

Conditions related to paranoia

There are four major disorders that are associated with significant paranoia. They include:

  • Paranoid personality disorder. Condition in which a person regularly becomes suspicious without cause. To be diagnosed with this disorder, paranoid thoughts must become so severe that they cause the patient significant distress and impair their ability to function. However, like with many mental illnesses, paranoid personality disorder often goes undiagnosed because people with this condition are unlikely to seek treatment. People with this disorder are often able to function in society, generally remaining grounded in reality, and may seek out others who accept their moralistic or punitive approach to life.
  • Delusional (paranoid) disorder(persecutory type). Involves a persistent, plausible delusion that does not have the features of other mental disorders. Delusions are beliefs that an individual holds that are not true, not shared by others in a culture and cannot be easily modified.

    The most common delusion in this disorder is the belief that one is being persecuted. Patients may believe that they are the target of a plot, or that they are in danger of being poisoned, drugged or spied upon.
  • Paranoid schizophrenia. Marked by extremely bizarre delusions or hallucinations that are nearly always based on a specific theme. Patients may hear voices or believe that their thoughts are being controlled. The delusions of paranoid schizophrenia tend to be more prominent and more impossible or bizarre than those associated with other types of paranoid disorders. People with this condition are intellectually confused and may not be able to work or socialize. They are also more likely to experience disturbances in social and family life than those with other paranoid disorders.
  • Substance abuse and dependence.  Paranoia is associated with the use of a variety of drugs.  Alcohol, cocaine, steroids, and amphetamines are among the most commonly used substances frequently associated with paranoia. 

In addition, paranoia may be present in individuals with certain cognitive disorders, such as Alzheimer’s disease.  Therapeutic use of certain medications, such as steroids, can also cause paranoia in some individuals.

Potential causes of paranoia

The causes of paranoia are not clearly understood. Researchers have found that family history of paranoia is not greater in paranoid patients than in those without paranoia. However, studies of twins have shown a potential genetic influence on some paranoid symptoms in patients with schizophrenia. Other research has shown that paranoid disorders are much more common in relatives of people with schizophrenia.

The role of abnormal brain chemistry in paranoia remains unclear. Some research has indicated that paranoid schizophrenia has different biochemical characteristics than other nonparanoid forms of schizophrenia.

Use and abuse of certain substances may lead to symptoms of paranoid thinking or behavior. Examples include abuse of amphetamines, cocaine, steroids and alcohol. Research continues into how biochemical actions of these drugs may trigger paranoia. Researchers are also investigating the potential role of stress as a trigger for paranoia. People who are under high levels of stress, such as soldiers returning from combat, appear to have higher levels of paranoia.

Relief options for paranoia

Treatment of paranoia can be extremely difficult because patients are both reluctant to seek help and suspicious of those who try to offer help. Paranoid behavior can be a greater problem for family and friends than for the patient, who does not recognize that a problem exists. Patients tend to be suspicious of the types of questions a mental health professional may ask regarding their history of paranoia. In addition, patients with paranoia often fear real or imagined dangers associated with hospitalization or treatment with medications.

Nonetheless, psychotherapy and medications remain the mainstays in relieving a patient’s symptoms of paranoia. Psychotherapy tends to focus on helping improve a patient’s social functioning despite their paranoid thoughts. Some evidence suggests that merely talking about suspicions and self-doubts can make such thoughts less intrusive. Art therapy, family therapy and group therapy may also be effective in diminishing the effect of paranoid delusions.

If the paranoia is related to certain mental disorders, most notably paranoid schizophrenia, Antipsychotic medications are usually used. Patients with paranoia may resist these treatments. However, those who are unable to take oral medications consistently can be given injections of antipsychotic medications that provide treatment for several weeks.Patients whose paranoia is caused by substance abuse or dependence may undergo treatment for their problem, which, in turn, may help reduce their paranoia.

Questions for your doctor regarding paranoia

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients and their loved ones may wish to ask the doctor the following paranoia-related questions:

  1. What is causing my loved one’s paranoia?
  2. Does my loved one have any underlying condition that may be causing or contributing to his/her paranoia?
  3. Doos my loved one have a major disorder associated with paranoia?
  4. Could stress, drug or alcohol use be contributing to my loved one’s paranoia?
  5. I am sometimes suspicious of the motives of others. Does this mean I’m paranoid?
  6. Will my loved one’s paranoia get progressively worse over time?
  7. What are my loved one’s treatment options?
  8. Is my loved one likely to benefit from medications? Which do you recommend and why? What are the potential side effects?
  9. Should my loved one undergo therapy? Can you recommend a qualified therapist?
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