Paranoia

What is paranoia?

Paranoia refers to a strong and ongoing sense of suspicion or mistrust, where a person may believe that others intend to harm, trick, or work against them, even when there is no clear evidence to support these beliefs.

This unfounded mistrust of others can make it difficult for a person with paranoia to function socially or have close relationships.

Paranoia may be a symptom of a number of conditions, including:

• paranoid personality disorder
• delusional (paranoid) disorder
• schizophrenia.

The cause of paranoia is unknown but genetics are thought to play a role.

Treatment depends on the condition diagnosed as its cause, and may include treatment by psychological therapy or medication.

Symptoms

Paranoid symptoms may range from mild to severe. They depend on the cause but, generally, a person who is paranoid may:

• be easily offended
• find it difficult to trust others
• not cope with any type of criticism
• assign harmful meanings to other people’s remarks
• be always on the defensive
• be hostile, aggressive and argumentative
• not be able to compromise
• find it difficult, if not impossible, to ‘forgive and forget’
• assume that people are talking ill of them behind their back
• be overly suspicious – for example, think that other people are lying or scheming to cheat them or out to get them
• not be able to confide in anyone
• find relationships difficult
• consider the world to be a place of constant threat
• feel persecuted by the world at large
• believe in unfounded ‘conspiracy theories’.

Three main types of paranoia

Paranoia is associated with three principal conditions:

• Paranoid personality disorder – characterised by a long-standing pattern of distrust and suspicion of others, where individuals often interpret others’ motives as malicious or threatening, even in the absence of evidence. This mistrust is pervasive and can lead to difficulty in relationships, reluctance to confide in others, and a tendency to read harmful intent into neutral or ambiguous situations.
• Delusional (paranoid) disorder – characterised by the dominance of one delusion (false belief) without any other sign of mental illness. The person’s behaviour depends on which delusion they have. For example, a person who has a delusion of persecution believes that other people are spying on them or plotting to harm them in some way. Stalking can be the result of delusional (paranoid) disorder – for example, the person believes they are in a relationship with a movie star they have never met. In another case, a person may imagine they have a terrible illness, despite repeated reassurance from doctors.
• Paranoid schizophrenia – characterised by strange delusions, such as believing that one’s thoughts are being broadcast over the radio. Hallucinations, especially bizarre ones, are also common to the condition. A person with paranoid schizophrenia often finds the world confusing and functions poorly without treatment.

Causes of paranoia are unclear

The causes of paranoia are unclear and depend on the condition with which it is associated. Theories include:

• Genes – research is scanty and inconclusive. Some studies suggest a genetic link while others don’t. It is also unclear whether genetic predisposition to paranoia – if it exists – is inherited or not.
• Brain chemistry – brain chemicals (neurotransmitters) form the basis of thoughts and feelings. Certain drugs such as cocaine, marijuana and amphetamines alter brain chemistry and can bring on paranoid thoughts, feelings and behaviours. This leads some researchers to believe that paranoia may be a biochemical disorder of the brain. The causes of this possible disorder are unknown.
• Traumatic life events – for example, abuse in childhood may distort the way a person thinks and feels throughout life.
• Stress reaction – some studies have found that paranoia is more common in people who have experienced severe and ongoing stress – for example, prisoners of war. How stress can trigger paranoia is unclear.
• Mood-related paranoia – refers to suspicious or persecutory thoughts that occur during mood changes and tend to fluctuate with emotional state. In Bipolar Disorder, these thoughts may arise during manic or depressive episodes, while in Borderline Personality Disorder, they are typically brief and stress-related.
• A combination of factors – it may be that a number of genetic and environmental factors working in combination cause paranoia.

Diagnosing paranoia

The condition causing the paranoia can be difficult to diagnose because an exaggerated sense of mistrust is common to a range of mental disorders and also occurs in some people with dementia.

Another difficulty is that a person who has paranoia may avoid doctors, hospitals and other medical settings for fear of being harmed.

Diagnosis may include:

• medical history
• physical examination
• assessment of symptoms
• psychological tests
• tests to rule out other psychiatric disorders that may be causing the symptoms.

Paranoia treatment

While there is no absolute cure for the conditions that cause paranoia, treatment can help the person cope with their symptoms and live a happier, more productive life. Treatment depends on the type and severity of the condition but may include:

• Medications – anti-anxiety drugs or antipsychotic drugs can ease some of the symptoms. However, a person with paranoia may often refuse to take medication because they are afraid it will harm them.
• Therapy – this can help the person to cope with their symptoms and may improve their ability to function. However, a person with paranoia is unlikely to talk openly and freely to a therapist, so progress can be extremely slow.
• Coping skills – other treatments aim to improve the person’s ability to function socially. Options may include relaxation therapy, techniques to reduce anxiety, and behaviour modification.
• Hospital admission – in severe cases, the person may need to stay in hospital until the condition causing paranoia stabilises.

Where to get help

• Your GP (doctor)
• Psychiatrist
• Public hospital
• Community health centre
• Mental Health Foundation of Australia Tel. 1300 643 287
• SANE HelplineTel. 1800 187 263