Paranoia is the feeling of being threatened or persecuted in the absence of proof showing that’s the case. You may believe you’re being lied to, stolen from, or cheated on even though you have no evidence. In extreme cases, you may believe you’re being poisoned or have a tracking device inside your body.
Paranoia is a feature of some mental disorders such as bipolar disorder and schizophrenia. In these cases, paranoia can be extremely distressing and even disabling and dangerous. However, it may also be related to socioeconomic factors, physical factors, and cultural beliefs.
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People understand the world in part by making attributions through judging and assuming the causes of behaviors and events. In people with paranoia, these attributions are influenced by cognitive bias, which are known as attribution bias. This means they make systematic errors in evaluating reasons for their own and others’ behaviors.
The term “paranoia” is often associated with being silly or dramatic, but there are actually two essential elements that define paranoia: a belief that harm will occur, paired with the attribution bias that others intend to do harm.
Moreover, paranoia may be characterized by intense and irrational persistent feelings of fear, anger, and unfounded betrayal, which manifest in symptoms and behaviors such as:
- Argumentativeness
- Defensiveness toward imagined criticism
- Difficulty with forgiveness
- Hypervigilance
- Inability to relax, or chronic anxiety
- Isolation
- Feeling like a victim
- Feeling misunderstood
- Feeling persecuted
- Preoccupation with hidden motives or being taken advantage of or betrayed
- Poor relationships with others due to distrust
Phobias are also characterized by irrational and exaggerated fears, but are different from paranoia because they are not attached to the belief that one is being conspired against, cheated, spied on, followed, poisoned, or in other ways maligned, harassed, or obstructed.
Symptoms of paranoia can vary based on underlying beliefs. Scientists have grouped these beliefs into common subtypes or themes.
Some common paranoia subtypes include the following:
- Persecutory paranoia is generally considered the most common subtype. It involves feeling targeted as though someone may be surveilling, harassing, excluding, or sabotaging you. Symptoms include anger and attempts to stop the perceived threats, including calling the authorities for help or moving in hopes of leaving the persecutor behind.
- Grandiosity paranoia is also considered common. It refers to self-satisfying convictions (i.e., that you are inherently superior to others). Patients experiencing grandiose delusions may become argumentative or violent.
- Litigious paranoia refers to an unreasonable tendency to involve the law in everyday disputes. It is characterized by quarrels, persecution claims, and insistence of rights being breached, as well as attempts to seek retribution.
- Erotic or jealousy paranoia refers to the unwarranted conviction that your spouse or partner is being unfaithful. A person with this subtype confirms their inherent bias with dubious evidence.
While the exact causes of paranoia are unknown, environmental triggers can include exposure to trauma, insomnia, social isolation, and medication changes. It is often associated with the effects of substance use and mental disorder. There can be genetic contributions, particularly when it occurs as part of a mental disorder.
People with certain mental (psychiatric) disorders can have symptoms of paranoia as a central aspect of their presentation.
These mental disorders include:
- Paranoid personality disorder (PPD): True to its name, PPD is a type of personality disorder marked by paranoid behaviors, including unrelenting mistrust and suspicion of others even when there is no reason to be suspicious. Onset is linked to biological, genetic, and environmental factors, including physical and emotional trauma.
- Delusional disorder, persecutory type: This subtype of delusional disorder is defined by paranoid feelings of thoughts of persecution, including being conspired against and threatened by external forces. People may experience related hallucinations and even go as far as calling the police for help. Along with biological and genetic factors, stress can be a trigger.
Being of a lower socioeconomic class is a known contributing factor of cultural paranoia. These beliefs are not self-directed but a product of growing up in a society where socioeconomic status directly influences the number of daily struggles and feelings of security. Racism, feelings of powerlessness, and beliefs that the government or “powers that be” are conspiring against you are all markers of lower socioeconomic status.
The psychology of surveillance is another risk factor of cultural paranoia. It refers to the common belief that people’s personal information is being used for malevolent purposes.
Paranoia can also be the result of physical conditions that affect one’s cognitive abilities or result in cognitive decline.
The physical causes of paranoia include:
- Drug-induced paranoia results from drug toxicity and may be related to substance use disorder. It can occur during overdose, withdrawal, or when mixing substances. Some examples include amphetamines and hallucinogens.
- Alzheimer’s disease-related paranoia is typically linked to memory loss (e.g., a person forgets where they put their wallet and becomes suspicious of people stealing). It can also be linked to loss expression (e.g., a person doesn’t understand their memory loss, so they blame others as a way of making sense). It can get worse as memory function declines.
- Dementia is a group of diseases that cause brain changes, leading to memory and cognitive decline and even personality changes. Attempts to compensate memory gaps and make sense of reality can lead to faulty beliefs and result in paranoid thoughts and behaviors.
- Vascular dementia sometimes occurs after a stroke. It refers to dementia caused by decreased blood flow to the brain, which deprives it of necessary oxygen and nutrients. It can impact brain areas related to memory, movement, and speech. If memory is compromised, paranoia can result much in the same way as in Alzheimer’s disease.
If a mental disorder is the suspected cause of paranoia, the clinician will typically take a medical history and perform a physical exam. DSM-5 criteria will be used to determine which mental disorder a person has.
The DSM-5 criteria for mental disorders of which paranoia is a central part include:
- Paranoid personality disorder (PPD): Symptoms must begin by early adulthood; they involve unjustified suspicion and distrust resulting in reluctance to confide in others, and quickness to become hostile and misinterpret benign remarks as personal attacks.
- Delusion disorder, persecution type: Persecutory delusions must be non-bizarre (could take place in reality), not have the characteristic symptoms of other psychotic disorders, such as schizophrenia, and must be present for a month or longer.
While we all experience paranoid thoughts and feelings from time to time, paranoia can sometimes be a sign of an underlying condition. It’s therefore important to know when to seek help.
If your paranoia is becoming a problem, causing increased distress, arguments, and irritability, or you notice yourself becoming highly suspicious and distrusting of others, talk to your healthcare provider about what may be causing your paranoia. The earlier you seek help, the sooner you can begin treating the cause of your paranoia and the better your quality of life will be.
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