What is paranoia?
It is common to have suspicious thoughts or worries about other people from time to time. These fears are described as paranoid when they are exaggerated and not based in fact. There are three key features of paranoid thoughts:
- you fear that something bad will happen
- you think that others are responsible
- your belief is exaggerated or unfounded.
However, the central thought which is present with paranoia is a sense of threat.
There are different types of threat or harm that you may feel paranoid about; for example:
- psychological or emotional harm – bullying, spreading rumours about you
- physical harm – trying to physically hurt or injure you, or even trying to kill you
- financial harm – stealing from you, damaging your property or tricking you into giving away your money.
You might feel threatened by one person, a group of people, an
organisation, an event or an object.
Depending on what your paranoid thoughts are, they can bring up a wide range of emotions. You may feel:
- anxious and stressed
- mistrustful of other people and organisations
- victimised or persecuted
- tired - from worrying all the time
What are the different types of paranoia?
Certain types of paranoid thought are believed to be common in the population and are closely related to anxiety. These thoughts can be distressing and leave you feeling under threat, but will not normally stop you from living your normal life.
More severe paranoid thoughts are less common, but have a more significant impact on day-to-day life. They are likely to be very alarming, and leave you feeling terrified, isolated and exhausted.
This pyramid diagram shows some of the levels of threat you might feel – the more personal the threat, the higher the level of paranoia. The thoughts at the bottom of the triangle are experienced by more people than those at the top.
Based on a model created by Freeman D et al. ‘Psychological investigation of the structure of paranoia in a non-clinical population’ BJP 2005;186:427-435
In the examples in the diagram, thoughts are divided into distinct levels of threat; however, in reality, you are likely to find that your thoughts move between levels at different times. You might also find the ‘lower level’ concerns cause significant distress if they last for a long period of time. Also, the sense of threat you experience can develop and get stronger over time.
I have always been afraid of the dark. As I got older it has progressed. It isn’t as much the dark that I’m afraid of now, it’s the feeling of what may be in the room that I cannot see. I always feel like someone is there, and is going to either kidnap, rape, or kill me.
If you experience mild paranoia over a short time period, you will probably have some insight into your thoughts and realise that although they are worrying, your suspicions might be groundless or exaggerated. It can be difficult to share these thoughts with others, as you might worry that they will judge you.
If your thoughts are more extreme, or have been present for a long time, it will feel that your fears are real. This can be very isolating, as other people are unlikely to share your views. Having to cope with your own feelings of alarm and not being believed can be very distressing.
Paranoia and mental health problems
As outlined in the previous sections, paranoid thoughts can be very distressing, and can lead to problems such as anxiety and depression; however, the measures that doctors use to diagnose mental health problems do not currently recognise paranoia as a diagnosis in its own right. More severe paranoid thoughts are likely to be seen as symptoms or indicators of some of the less common mental health diagnoses.
Paranoid schizophrenia is a particular type of schizophrenia that features extreme paranoid thoughts. If you experience paranoid schizophrenia, then you may also hear voices, which might confirm your paranoid feelings and cause you further distress by mocking or threatening you. You might also feel that you are an important or powerful person, such as a religious figure or royalty, which is why you are being persecuted.
Delusional or paranoid disorder
If you experience delusional disorder you are likely to develop one particular dominating, paranoid idea, of great complexity, that puts you in conflict with those around you. You are more likely to contact the police or a lawyer than a psychiatrist for help, as you will feel your persecution is real.
Paranoid personality disorder
Paranoid personality disanorder is other diagnosis which is usually considered if your paranoid feelings have been around for some time, perhaps since adolescence. If you have received this diagnosis, you are likely to feel very suspicious and find it difficult to trust other people. You might feel that people are plotting against you, and will find it difficult to accept that these feelings might be exaggerated or unfounded.
Other diagnoses that may include paranoid feelings are bipolar disorder, schizoaffective disorder, severe anxiety or depression, and postnatal psychosis.