Explains paranoia, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.
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.
- Paranoid Thoughts website
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 disorder is another 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.
What causes paranoid thoughts?
Paranoia is a complex blend of thoughts and feelings, so it’s unlikely to have one simple cause. A combination of factors is likely to play a role.
A sudden increase in stress can be very significant. If you have lost a job or a relationship has ended, this can make you feel very isolated and might mean that you turn inwards and feel insecure and under threat. Life events that involve a betrayal or emotional pain for example, if you are bullied in your workplace, or your home is burgled can also form the root of suspicious thoughts that then develop into paranoia.
Some research has suggested that paranoid thoughts are more common if you live in an urban environment or a community where you feel isolated rather than connected. Media reports of crime, terrorism, violence and other social issues might also play a role in triggering paranoid feelings. High levels of stress associated with modern lifestyles might also put you at greater risk.
Anxiety and depression
Anxiety and depression can act as triggers for paranoid thoughts in some people. If you’re anxious you are likely to be on edge and more fearful than normal. Depression can lower your self-esteem, and make you more likely to misinterpret other people’s intentions towards you.
If you have trouble sleeping this can also have a big impact on paranoia. Fears and worries can develop late at night when you are alone with your thoughts, and feeling constantly tired can trigger feelings of insecurity.
The effects of drugs and alcohol
Chemicals can sometimes be a factor. Drugs such as cocaine, cannabis, alcohol, ecstasy, LSD and amphetamine can all trigger paranoia. So do certain steroids taken by some athletes and weightlifters. Certain insecticides, fuel and paint have also been associated with symptoms. (See The mental health effects of street drugs.)
What happens in your childhood might play a part. If you were brought up to believe that the world is a very unsafe place and that people are untrustworthy, this might affect the way you think as an adult. If your childhood was abusive or neglectful you are also likely to feel mistrustful and suspicious of others.
Paranoia, as a symptom, is linked with certain physical illnesses, such as Huntington’s disease, Parkinson’s disease, strokes, Alzheimer’s disease and other forms of dementia. Hearing loss can also trigger paranoid thoughts for some people.
How can I help myself?
How can I help myself?
Taking steps to change paranoid thoughts can seem like a daunting task, especially if you feel that there are good reasons for you feeling suspicious and fearful. However, there are strategies which can make a difference to the way you respond to your fears, and help you to recognise and avoid triggers.
Using these strategies does not mean that you need to handle everything on your own – they can be used in combination with other treatments and support from friends, family and professionals.
Some of the possible causes or triggers for paranoid thoughts explored in the last section are connected to lifestyle. If you are able to improve your overall wellbeing, you are likely to feel more grounded, and will be better able to cope with your fears if they arise.
Lack of sleep can be a major trigger in the development of paranoid
thoughts. Try to prioritise a regular sleep pattern over other activities. Relaxing with a bath or a good book before bed can help, and making sure you have had enough exercise during the day to physically tire you out can help you to sleep more easily. See How to cope with sleep problems for more information.
Avoid drugs and alcohol
There are clear links between drugs and alcohol and paranoid feelings. Stopping or reducing your use of them will help you feel more in control of your thoughts, and make it easier to rationalise your feelings. See The mental health effects of street drugs for more information.
Although it is unlikely that any foods cause paranoid thoughts, if you eat regular healthy meals it can make a big difference to your overall sense of wellbeing. The links between food and the way you feel are explored further on the Mental Health Foundation’s website.
Clear your mind
If your paranoia is triggered by anxiety, stress and worry then you might find the techniques of mindfulness or meditation can help you to calm your feelings and stop you becoming overwhelmed by them.
It’s definitely worse when I’m tired. Therefore plenty of rest, no alcohol or stimulants in the evening which may interrupt sleep… Meditation taught me to relax, which of course is handy anyway. But also I learnt to picture my mind as a big blue sky, and any thought as a drifting cloud… I can just let it drift on by.
- Paranoid thoughts website
Three key features of paranoia which can make understanding and
communication with other people difficult are: feelings of alarm, the content of your thoughts, and your fear of sharing your thoughts. Reflecting on these areas can help you to understand your experiences more deeply.
Techniques associated with cognitive behaviour therapy can help you to take a step back from your immediate situation, and begin to analyse your thoughts.
Keep a diary
You might find it helpful to track your thoughts and feelings for a short time. At the end of each day, or every few days, take some time to write down the thought or thoughts that have been troubling you most of all and make a note of how many times a day they worry you.
Rate your worries
Try and look for patterns in the thoughts you have recorded. It might be helpful to give them a numerical rating, from 1-10, showing how strongly you believe them, and how distressing you find them. Carrying a notepad to ‘let the thought out’ can feel positive and give you something to reflect on later.
Look for triggers
As you build up a picture of how your thoughts are affecting you, you can start to think about things that might be acting as triggers; for example, if you have had an argument with someone or if you slept badly.
Consider your reactions
It might be helpful to take a few different situations and try to write down how the paranoia developed.
- My sister said she would call on Saturday.
- By 5pm she hadn’t called.
- She must be ignoring me.
- By 8.30pm there was still no call, she must hate me.
- My whole family hate me, none of them have called today.
- I phoned a friend and they didn’t answer.
- Convinced everyone hates me.
- Worried that they are plotting together to make me upset.
- Read old emails and started to see double meanings in them.
- Became increasingly scared and suspicious.
- Stayed awake most of the night.
Begin to assess evidence
The steps just outlined will help you to get some distance from your
thoughts, which can make it easier to consider whether they could be exaggerated. Once you have built this awareness, you can start to challenge your thinking. It can help to make a list of what you feel the ‘evidence for the thought’ is, and then compare it to a list of what the ‘evidence against the thought’ is.
In the example outlined, your list might look like this:
I feel that everyone hates me and they are conspiring to make me miserable
|Evidence For||Evidence Against|
|Sister didn’t call me.||My sister called on Sunday – she was really sorry she missed my call and had been asked to work at the last minute on Saturday.|
|My sister and other family members
have missed calls from me before.
|Mother called later to ask if I wanted
to go for dinner next week.
|I don’t receive many phone calls
|My friend has emailed to invite me
to his birthday next week.
|My friend didn’t answer her phone.||I don’t send many emails or make many phone calls, so perhaps it is not surprising that I don’t receive many back.
I am just one part of other people’s lives.
It is normal for people to be busy and not answer their phones.
I have not answered calls before and it hasn’t meant I hate the person. I know that my family and friends don’t know each other and couldn’t be plotting together.
As you build the evidence against your paranoid thoughts, it might be helpful to keep some of the most helpful statements on a piece of paper in your wallet, or as a note on your phone so you can refer to them if you start to feel anxious about your thoughts; for example, ’I have not answered calls before and it doesn’t mean that I hate the person calling’.
Sharing your thoughts
As well as reflecting on your own feelings and thoughts it might be helpful to consider how you disclose your thoughts to other people. You have the right to choose who you talk to, and how much you wish to tell them.
If you are experiencing particularly severe thoughts you might not have much control over what you say. If you have disclosed things that you feel unhappy about at a later point, you might find it helpful to discuss how you now feel, and agree what you are now comfortable talking about.
This section has given a short outline of some techniques that might help you to understand and challenge distressing thoughts and feelings. For more examples of ways people have managed their thoughts see ‘Coping Tips’ on the Paranoid Thoughts website.
How can friends and family help?
What can family and friends do to help?
This section is for friends or relatives who are would like to help someone they know with paranoid thoughts.
If you have a relative or friend who is experiencing paranoia it can be alarming and upsetting. You might feel unsure of how to offer support, particularly if you don’t agree with the thoughts that they are expressing.
Feeling this way is understandable and, although it might seem scary at first, there are ways you can offer support.
Be aware of feelings
Even if you don’t agree that your relative or friend is under threat or at risk, try to understand how they are feeling. Don’t be dismissive – the feelings that they have are real, even if the thing they fear is unfounded. Focus on the level of distress or alarm that they are experiencing and offer reassurance and comfort.
Respect privacy and boundaries
It is important to remember that your friend or relative has a right to their own boundaries. They might choose to tell you only a small amount of detail about their thoughts, or they might disclose a lot of their fears. The amount that they tell you might change depending on how they are feeling. Accept the boundaries that they feel comfortable with, and be aware that they might feel embarrassed about things they have said when they are unwell.
Consider if there is a basis for their fears
Many paranoid thoughts will have developed from a real situation. Explore with your friend or family member whether there is basis for their fears. This can help both of you to understand how fears have developed, and can also be helpful to see where ideas might seem improbable (see the 'Causes' tab).
If you are honest with your friend or family member about how you feel, it will help to establish trust over time. Your point of view might be reassuring to the person, reinforcing the possibility that what they fear may not actually be happening. It is possible to recognise their alarm and acknowledge their feelings without agreeing with the reason they feel this way.
Get support for yourself
It is important to look after yourself as well. It can be distressing to see someone you care about behaving differently than usual, and putting themselves at risk. You might find counselling or a support group can help, giving you the opportunity to talk about what the relationship is like for you, the feelings you have about the person and what you can do to look after yourself.
What treatments are available?
The first point of contact for professional help in the UK is usually your GP, who may refer you to a psychiatrist, clinical psychologist or a counsellor. Although counsellors and psychologists can be approached without a GP referral, they are likely to want a GP’s opinion first, to rule out any physical cause for the condition.
Cognitive behaviour therapy (CBT) is a type of psychological (talking) therapy that has become popular in the UK in recent years. It involves examining your thinking patterns and the evidence you have for your beliefs. It then aims to help you find alternative interpretations to the ones that are distressing you. Many people find CBT is a helpful way to cope with paranoid thoughts. It can help you to take a step back from your thoughts, and find new ways to deal with the alarm that they cause. (See Cognitive behaviour therapy (CBT).
Many other forms of talking therapy are available, including psychotherapy, family therapy and group therapy. Although they have different underlying ideas, they generally involve talking over personal experiences, in detail, and exploring feelings. See Talking treatments, and the It’s Good to Talk website.
An important aspect of all talking treatments is finding a therapist that you trust and feel comfortable with. If you are feeling particularly threatened or suspicious of other people, you might find it difficult to establish a good relationship.
It might be helpful to agree with your therapist what action you will take if your paranoia worsens; for example, pausing sessions until you feel able to engage with the process again.
Medication is not normally prescribed to treat paranoid thoughts, but if you are particularly anxious or depressed, your GP might recommend antidepressants or tranquillisers to relieve the symptoms. There are side-effects associated with both types of drug. See Anti-depressants and Sleeping pills and minor tranquillisers for more information.
If you have received a more severe diagnosis of paranoid schizophrenia or paranoid or delusional disorder you are likely to be offered an antipsychotic drug. These should only be prescribed by a psychiatrist (a specialist mental health doctor).
Antipsychotics may lessen delusions, hallucinations, incoherent speech and thinking, and reduce confusion. The drugs can control anxiety and serious agitation, make you feel less threatened, and also reduce violent, disruptive and manic behaviour.
However, not everybody finds antipsychotics helpful, and they are only expected to lessen symptoms, not cure the problem. They can also have very serious physical and emotional side effects, causing problems with movement, weight and sexual function. For more information, see Antipsychotics.
If you are prescribed any medication, then you should be given an explanation of what the medication is for, possible side effects and any alternative treatment options by your doctor. In almost all circumstances your agreement is required before you are given medication. The only situation where this is not the case is if you are subject to certain parts of the Mental Capacity Act or the Mental Health Act, (see Consent to Treatment).
Some people find complementary therapies such as hypnotherapy,
massage and acupuncture help to manage anxiety and upsetting feelings associated with paranoid thoughts. The clinical evidence for these therapies is not always as robust as it is for other treatments. A body called the Complementary and Natural Healthcare Council exists to provide regulation for complementary therapists and lists details of therapists registered with recognised professional organisations.
Arts therapies are a way of using the arts – for example, music, painting, clay, dance, voice or drama – to express yourself in a therapeutic environment with a trained therapist. The therapist helps to make sense of what you have created in relation to your experiences and state of mind. See Mind’s online booklet Arts therapies, for more information.
As explored in the section on talking therapies, you might find these more beneficial if you are able to build a relationship of trust with the therapist.
You might find it helpful to take a break from your normal situation. There are a growing number of support groups offering a chance to talk to people who have had similar experiences. The National Paranoia Network is working to develop groups for people who experience paranoid thoughts and many local Minds also support groups for people with mental health issues. The Mind infoline can provide further information about local support if you find it difficult to find a group close to you.
Secondary care and hospital
If your paranoid thoughts are causing you significant distress and stopping you from being able to live your normal life, then you are likely to be referred to ‘secondary services’. Government policy is to provide as much care as possible in the community.
If you have a high level of need, or require support from more than one professional, you might be offered a package of care under the ‘Care Programme Approach’. You should have one professional (your care coordinator) who will consult with you to produce a care plan which sets out all of the services which you need to access. This should be tailored to your needs, and reviewed regularly. (See Community based mental health and social care).
Inpatient care in psychiatric wards or hospitals is normally only considered if it is felt you are unable to cope in your home. If your paranoia is this severe you are likely to feel very scared and under considerable threat. Unfortunately, going into hospital might make these feelings worse.
If you are not willing to go into hospital as a voluntary patient but you are assessed and felt to be a risk to yourself or others, you could be detained under a section of the Mental Health Act 1983. (See Civil admission to hospital.)
It is possible to recover from paranoia. This might mean that you no longer have any paranoid thoughts, or it could be that they no longer disrupt your life or cause you distress. After recovery you may feel inspired to continue with or take up a new direction in life. The Scottish Recovery Network website provides more information and resources about recovery and mental health.
tel. 08444 775 774
Support, help and information for those with anxiety disorders.
Website that explains the principles behind mindfulness, and gives details
of local courses and therapists
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
tel. 0161 705 4304
Can provide details of accredited therapists.
British Association for Counselling and Psychotherapy (BACP)
tel. 01455 883 300
For Information about counselling and therapy. See website or sister website, itsgoodtotalk, for details of local practitioners.
Complementary and Natural Healthcare Council
tel: 020 3178 2199
Maintains a register of complementary healthcare practitioners
helpline: 0808 808 7777
Independent Information and support for carers.
Hearing Voices Network
tel. 0114 271 8210
A support group providing nformation, support and understanding to people who hear voices and those who support them.
National Paranoia Network
tel: 0114 271 8210
Information, support and understanding for people who experience paranoid thoughts
Scottish Recovery Network
To be revised 2014
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