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What is paranoia?

Paranoia refers to feelings of distrust, suspicion, or persecution that are not based in reality. Paranoia is a kind of delusion in which a person thinks he or she is being singled out in a negative way. People with paranoia will look for evidence to prove they are being singled out, and refuse to see that they have an exaggerated view of their own significance.

The exact cause of paranoia is not known. Paranoia is more common in men than in women, though the exact prevalence of paranoia is not known. Paranoia is a mental and emotional symptom of many types of mental illness, including paranoid personality disorder and paranoid schizophrenia. There are many types of paranoia.

Paranoia is characterized by delusions that others have hidden motives or a wish to harm you, feelings of mistrust and hostility, a sense of being persecuted, and social isolation and withdrawal. Paranoia should be evaluated by a mental health care practitioner. It is often difficult to treat paranoia, because people with paranoia are frequently suspicious of medical intervention.

For those who do receive treatment, therapy and medication may help to reduce feelings of paranoia. Usually, paranoia occurs as part of a personality disorder or mental illness, so full treatment depends on the underlying disorder. Untreated paranoia may lead to social isolation and absenteeism from work or school.

Seek immediate medical care (call 911) if you experience paranoia along with hearing voices or seeing things that are not real (hallucinations), if you are unable to care for your basic needs, or if you have thoughts of harming yourself or others.

If your paranoia is persistent or causes you concern, seek prompt medical care.

What other symptoms might occur with paranoia?

Paranoia may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Mental and emotional symptoms such as paranoia may be a sign of a complicated mental illness.

Schizophrenia symptoms that may occur along with paranoia

Paranoia may accompany other symptoms related to schizophrenia including:

  • Beliefs that are not grounded in reality (delusions)
  • Difficulty concentrating
  • Difficulty sleeping
  • Disorganization
  • Sensations that are not real (hallucinations)
  • Social isolation
  • Unresponsiveness to other people and the environment (catatonia)
  • Withdrawal or depression

Other symptoms that may occur along with paranoia

Paranoia may occur on its own or be a symptom of paranoid personality disorder or obsessive compulsive disorder. Other symptoms that may occur along with paranoia include:

  • Anxiety
  • Detachment
  • Harbor grudges
  • Hostility
  • Hypersensitivity to perceived slights
  • Inability to perform daily tasks
  • Recurrent thoughts (obsession)
  • Repeated actions you cannot control (compulsions)

Serious symptoms that might indicate a life-threatening condition

In some cases, paranoia may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Being a danger to yourself or others, including threatening, irrational or suicidal behavior
  • Inability to care for yourself
  • Seeing or hearing things that are not there (hallucinations)

What causes paranoia?

The exact cause of paranoia is not known. It may be related to a chemical imbalance in the brain, heredity, stress, or a traumatic life event. In some cases it may be due to injury or infection of the brain. Usually, paranoia is a symptom of a mental illness.

Mental disorder causes of paranoia

Paranoia may be caused by a variety of mental disorders including:

  • Agoraphobia
  • Obsessive compulsive disorder
  • Paranoid personality disorder
  • Schizophrenia

Other causes of paranoia

Paranoia can also be caused by a variety of events or other conditions including:

Questions for diagnosing the cause of paranoia

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your paranoia including:

  • How long have you felt your paranoia? Or, when did you first notice your paranoia?
  • Are there specific events that trigger your paranoia?
  • Do you have a family history of mental illness?
  • Do you have any other symptoms?
  • Have you had a recent injury or infection?
  • Have you had a recent lifestyle change or difficult life event?
  • What medications are you taking?

What are the potential complications of paranoia?

Paranoia is often difficult to treat due to the suspicion of health care workers. Because people with paranoia do not seek treatment, it is likely that any problem underlying the paranoia will be allowed to continue. Because paranoia can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

  • Absenteeism from work or school
  • Adverse effects of treatment
  • Development of an anxiety disorder
  • Development of another mental disorder
  • Inability to perform daily tasks
  • Loss of employment
  • Loss of relationships
  • Social isolation
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 2
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Schizophrenia. National Institute of Mental Health.
  2. Paranoid personality disorder. PubMed Health, a service of the NLM from the NIH.
  3. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
  4. Kuepper R, van Os J, Lieb R, et al. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ 2011; 342:d738.
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