Paranoia

Written by Katherine Nicholls
Katherine Nicholls
Counselling Directory Content Team

Reviewed by Kaye Bewley
Last updated 3rd November 2022 | Next update due 2nd November 2025

Paranoia is when we think or feel that we’re in danger or under threat, with little to no evidence. On this page, we’ll look into the topic of paranoia in more detail, including how it can affect you, what causes paranoia, and how to find help.

What is paranoia?

People can have paranoid thoughts (also described as delusions) about many different things. Everyone’s experience with paranoia is different. Common paranoid thoughts may involve worrying someone is out to hurt you or those close to you, or that they are spreading nasty rumours about you. 

You may worry that people are talking about you behind your back or that you’re being watched. You may think organisations like the government or the police are monitoring you. There may be people in your life, such as friends and family, who you think are deliberately trying to upset you or bring harm to you.

You might think people are trying to steal from you, or even that your thoughts and actions are being interfered with. Something a stranger does or says might trigger you into thinking they’re out to hurt you, or that there’s a sinister reason for them crossing your path.

These types of thoughts may pop up occasionally and not worry you much. In more extreme cases, you may experience them regularly and be distressed by them. Paranoia can affect how you interact with the world around you and can have a huge effect on your quality of life.

It’s important to note that we all feel suspicious sometimes, and indeed in some cases, these suspicions are justified. The key is understanding the difference between a justified suspicious thought and a paranoid thought.

While paranoia itself is not a mental health condition, it is often a symptom of underlying mental health conditions. If your paranoia is severe, treatment may be needed to help you feel better and less afraid.

Therapists who can help with paranoia

How do you tell the difference between suspicion and paranoia? 

Here are some examples of when suspicion may be paranoia:

  • if there’s no concrete evidence to support your suspicion
  • if no one else shares your suspicion
  • if there’s evidence to suggest your suspicion is not warranted
  • if other people’s reassurances don’t make you feel better
  • if your suspicions are more based on feelings, hunches or ambiguous events

Counsellor Ian Stockbridge, BSc. (CBT), PGCert (Clinical Supervision), BACP (Accred), explains more about how counselling can help support people with paranoia, as well as their friends and family.


Signs and symptoms of paranoia

If you’re experiencing paranoia, there are certain behaviours you may experience. These include safety behaviours, acting differently towards other people, isolating yourself and low mood. Some signs and symptoms can include:

Safety behaviours

There may be particular things you feel you need to do in order to be safe from whatever you are worried about. For example, you may feel like you need to wear protective clothing, not speak on the phone or check your house for cameras. As it’s likely that nothing will happen to you while you perform your safety behaviours, which can then feed into your paranoia (as you believe it’s the safety behaviour keeping you safe).

Acting differently towards others

Paranoid thoughts can often lead you to worry that other people are out to cause you harm. This can lead you to change the way you behave with others; you may avoid certain people and cut yourself off from your social circles. You may also feel the need to find hidden motives in what others are doing. These types of behaviours can in turn make other people act differently towards you, which can feed into your paranoia. 

Isolating yourself

When you have paranoid thoughts, you can feel like it’s better for you to be alone. You may push others away and isolate yourself, maybe even deciding not to leave the house. You might think that nobody else understands you or believes you, and this can be very frightening and upsetting.

Low mood and anxiety

Due to all of the above, it’s not unusual for your mood to be affected. You may start to struggle with low mood or even depression as a result. Anxiety is also common as you may feel very anxious about certain situations. Paranoid thoughts have also been found to be more distressing to those who struggle with anxiety and low mood.

Other signs can include:

  • becoming more argumentative, irritable, aggressive, or violent towards others
  • being unable to see how irrational some beliefs may be
  • holding grudges for perceived digressions (whether real or not)
  • different recollections of events to what others remember happening
  • seeming defensive, hypervigilant, or unable to relate
  • the consistent belief that your partner is being unfaithful
  • repeatedly pursuing legal action for the belief that your rights have been violated

It is common for those experiencing signs of paranoia to continue to engage in work or studies, despite their paranoid behaviour.  


What causes paranoia?

Experts aren’t sure what exactly causes paranoia. There are lots of different theories and explanations. Currently, researchers think it is likely to be a combination of things. General risk factors that can make paranoid thoughts more likely include:

Childhood experiences

If you were brought up in a stressful environment where you felt vulnerable and unsafe, you may find it hard to trust people.

Other life experiences

Stressful and negative experiences later in life can also have an impact. If you’ve been bullied or if you’ve been mugged, for example, you may be more likely to develop paranoia.

Your environment

Some research has found that those who live in an urban environment, and those who feel isolated from their community may be more likely to develop paranoia. Media portrayal of world events can also contribute to this.

Physical illness

In some instances, paranoia is a result of a physical illness such as Alzheimer’s disease, Parkinson’s, Huntington’s and even strokes. For some, hearing loss can also lead to paranoid thoughts.

Lack of sleep

When we don’t sleep enough we may be more likely to experience hallucinations and unsettling feelings. You may find these thoughts get worse late at night.

Drugs and alcohol

Illegal drugs like cocaine, cannabis, LSD, ecstasy and amphetamines are known to trigger paranoia in some cases. Alcohol abuse, certain insecticides, fuel and even paint have also been linked to paranoia.

A side-effect of excessive cocaine use is paranoia, and some days it would grab hold of me so badly that I would be looking for people in the bushes, or would be convinced that someone was in my house. I sometimes even found myself scared of my own shadow.

- Read Edward's story.

Genetics

Research has found that genes also have a role to play in the development of paranoia, however, it has not yet been discovered which genes increase our risk.

Mental health conditions

There are a number of mental health conditions that can increase your risk of developing paranoia. There are also some mental health conditions where paranoia is a direct symptom.  

Conditions like depression and anxiety can make you more likely to develop paranoia. The relationship between paranoia and anxiety in particular is a complicated one. Both involve reacting to a perceived threat. Paranoid thoughts can lead you to feel anxious and anxiety can lead to paranoid thoughts, therefore it’s not uncommon for both to exist alongside each other.

In other cases, paranoid thoughts are a symptom of a mental health condition:

  • Paranoid schizophrenia - This is a common type of schizophrenia which involves prominent hallucinations and extreme paranoia, to the point of them being considered delusions.
  • Paranoid personality disorder - This is characterised by an extreme distrust of others and severe paranoid thoughts.
  • Psychosis - This is when the line between fiction and reality gets blurred for some people. They may see and hear things that aren’t there and this can lead to a sense of paranoia.

When does paranoia become a concern?

If you are able to recognise that your thoughts and worries don’t make sense, it can be a positive sign that you are aware that something is wrong and may need help. If feelings of paranoia begin to happen most or all of the time, start to get in the way of your home or work life or affect your day-to-day activities, it can be a cause for concern. Speak with your GP or mental health practitioner.

If you’re unsure if your thoughts, worries, or concerns may be paranoia or not, speaking with an outside, impartial person can be a big help. Your GP or therapist can listen in confidence and without judgment, offering further guidance and suggestions for the best course of action to find the right support for you.

Many people experience mild paranoia at some point in their lives. According to the mental health charity Mind, around a third of us experience non-clinical paranoia at some point. Typically, these paranoid thoughts change over time, leading you to realise they aren’t justified or stopping by themselves.

Severe paranoia (also referred to as clinical paranoia or persecutory delusions) is a more severe form which is likely to need treatment. 


Treatments for paranoia

If you find your paranoid thoughts are having a significant impact on your life, seeking treatment is advised. For most people, visiting their GP will be the first port of call. If you’re already seeing a mental health professional for another condition, be sure to tell them you’re worried about paranoid thoughts.

Self-help for paranoia

If you think you might be experiencing paranoid thoughts, there are a number of different things you can do to try and help yourself cope. These can include:

  • Speak with friends and family - Talking about any worrying thoughts or feelings can help you to find support from someone you know and trust.
  • Keep a diary - Writing down your thoughts, how frequently you think about them, how they make you feel, and how they affect your sleep can be helpful. Over time, this can help you to identify possible triggers, recognise paranoid thoughts, challenge them, and discover helpful coping strategies.
  • Challenge paranoid thoughts - Question if your thoughts are justified or if they may be paranoia.
  • Look after yourself - Reducing stress levels, practising mindfulness, and exploring relaxation techniques can help. Ensuring you are getting enough sleep, eating regularly, and keeping active can all help boost your mood and energy levels, helping you feel more able to cope with triggers and challenges. 

Can counselling help paranoia?

There are different therapies that can be used to help, including talking therapies.

Talking therapy (counselling) is often offered as a treatment for paranoia. Cognitive behavioural therapy (CBT) is the most common talking therapy to be offered to help with paranoia. CBT helps you look at the way your thoughts and behaviours affect one another, helping you to consider alternative interpretations. CBT can also be a big help in reducing any associated anxiety.

Other talking therapies that may be beneficial include family therapy, psychodynamic therapy and one-to-one counselling. The speed and type of therapy you may be offered can vary depending on local NHS wait times and services provided.

Private therapy can be a quicker path to access mental health support, offering a greater choice of the type of therapy and which therapist you want to work with.

Arts and creative therapies may also be recommended as an option. These use the power of the arts (whether that’s music, drama or art) to help you communicate your thoughts and feelings. This can be particularly helpful if you find it difficult to articulate your experience.

Your doctor may also prescribe you medication. This may include antipsychotic drugs (if you have been diagnosed with paranoid schizophrenia for example) or antidepressants (if you’re struggling with low mood and/or anxiety).

One of the more challenging aspects of treatment for paranoia is finding a therapist you can trust. The very nature of paranoia can make it difficult for you to put your trust in others, making talk therapy more difficult. It’s therefore important for you to take time choosing a therapist you feel comfortable with and if possible, be open with them about your concerns.

Hopefully, over time, you’ll build trust with your therapist and feel able to work together to lessen the impact of your paranoid thoughts.


Supporting a friend, family member or loved one with paranoia

It can be difficult to know how to support a friend, family member, or loved one who may be experiencing paranoia. It’s important to let them know that you are there for them. It can be helpful to:

  • Consider if their beliefs may have a basis or be justified - It’s easy to dismiss thoughts or beliefs as paranoia if they don’t match your experiences, or if they have previously had delusions. Try not to make assumptions. Paranoid thoughts often develop from anxieties about real situations. Try to find out if there may be a basis for their fears, so you can both better understand how these thoughts may have developed.
  • Talk with them - Openly talking can help to reduce feelings of stress and isolation. Sharing your perspective with them may help them to see things in a different way, or offer reassurance.
  • Listen and focus on their feelings - Try not to dismiss or minimise their fears. It’s important to recognise that how they are feeling is real - even if those feelings are based on thoughts or beliefs that aren’t founded. You can recognise and acknowledge their feelings without agreeing with the reasons why they may feel this way.
  • Encourage them to get help - Reassure them that it’s OK to ask for help whenever they are ready. 

Fighting the stigma

Paranoia is an area that people can struggle to understand. There are misconceptions about paranoia and this can lead to you being faced with stigma. Helping to educate people on what paranoia is can help.

You may want to print out this page for friends and family to read, share your experiences with others or search for support groups with others who experience paranoia.

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