Medically Reviewed by Jennifer Casarella, MD on September 21, 2023
5 min read

Paranoia is the feeling that you’re being threatened in some way, such as people watching you or acting against you, even though there’s no proof that it’s true. It happens to a lot of people at some point. Even when you know that your concerns aren’t based in reality, they can be troubling if they happen too often.

Clinical paranoia is more severe. It’s a rare mental health condition in which you believe that others are unfair, lying, or actively trying to harm you when there’s no proof. You don’t think you’re paranoid at all because you feel sure it’s true. As the old saying goes, “It isn’t paranoia if they’re really out to get you.”

A paranoid thought is a type of anxious thought. Anxiety can cause paranoia, affecting what you’re paranoid about and how long the feeling lasts. But paranoid thoughts can also make you anxious.

It’s normal to be anxious sometimes, especially if you’re going through something hard like losing a job or the end of a relationship. When in large groups of people, you may worry that others will judge the things you say or the way you dress or behave. You might walk into a party by yourself and think, “Everyone is wondering why I’m alone.”

Some call this paranoid, but we all have thoughts like this from time to time. Just because you’re worried that people might be talking about you doesn’t mean you have a mental illness. Clinical paranoia happens when you’re 100% convinced of it, even when facts prove that it isn’t true.

If you worry that your thoughts are paranoid, you probably have some anxiety rather than paranoia. If your anxiety isn’t linked to anything obvious and it never seems to get better or go away, you may need to talk to a doctor about it. Feelings of anxiety and panic that last a long time or get in the way of your daily life might be signs of an anxiety disorder. Symptoms of paranoia may be more severe. 

The symptoms of paranoia can include:

  • Being defensive, hostile, and aggressive
  • Being easily offended
  • Believing you are always right and having trouble relaxing or letting your guard down
  • Not being able to compromise, forgive, or accept criticism
  • Not being able to trust or confide in other people
  • Reading hidden meanings into people’s normal behaviors

Too Little Sleep

A single restless night probably won’t cause paranoid thoughts. But if you often go without sleep, it can start to take a toll. You might not think as clearly, and you’re more likely to clash with others or have misunderstandings with them. It may start to look like people are working against you when they’re just acting like they always do. If you go without sleep for long enough, you could even start to see and hear things that aren’t there (your doctor will call them hallucinations).

Adults should shoot for 7 to 9 hours of sleep a night to stay alert and mentally healthy.


When the tension ratchets up in your life, you could start to feel more suspicious of other people. And the stress doesn’t have to be something negative like illness or job loss. Even a happy occasion, like a wedding, can create a kind of stress that brings out paranoid thoughts along with the joy.

To help ease the tension, you can:

  • Take time to relax and try to forget about what’s stressing you out
  • Spend time with friends
  • Find something to smile and laugh about
  • Get plenty of exercise
  • Meditate to clear your mind

Psychiatric Disorders

One condition, paranoid personality disorder, can make it hard to trust others. It can cause negative thoughts about people that just aren’t true, like “They don’t like me,” “They’re making fun of me,” or even “They’re plotting against me.” In some cases, no amount of evidence will convince you otherwise. This can lead to true clinical paranoia. Though you might not believe every unrealistic thought that enters your head, you believe some of them.

Schizophrenia, another serious disorder, can make it hard to tell what’s real and what’s imagined. Most of the time, you simply don’t know when your thoughts have become paranoid. Friends, loved ones, or medical professionals often have to point it out and try to help you get treatment.

Borderline personality disorder, in which you have fast emotional swings where you can worship someone one moment and hate them the next, can also cause paranoid thoughts and even clinical paranoia in some people.

Just because you feel paranoid or worry about what others think about you from time to time doesn’t mean you have a psychiatric disorder. The fact that you know your thoughts don’t make sense could be a sign of good mental health. But if these paranoid feelings happen all the time or start to get in the way of your home or work life, you might want to talk to your doctor or a mental health care provider.

Drug Use

Drugs like marijuana, hallucinogens (LSD, psychotropic mushrooms), and stimulants (cocaine, methamphetamine) have chemicals that make some people paranoid for short periods. Once the chemicals leave your system, the paranoia goes away, too. Days or weeks of intense alcohol abuse also can cause short-term paranoia, and over the long term, it can lead to ongoing paranoia and even hallucinations.

If paranoid thoughts are making you anxious or if you have minor symptoms of depression, drugs can make them much worse. In some people, they can trigger a psychiatric disorder with true clinical paranoia as a symptom.

Alcohol can also worsen paranoia. Plus, it makes us less inhibited, which makes it harder to control these feelings.

Memory Loss

Alzheimer’s disease and other forms of dementia, which are more likely as you age, can change your brain in ways that make you more suspicious of others. You might notice that a loved one with dementia starts to hide things like jewelry or money, or becomes convinced that people have bad intentions toward them. This is part of the disease. Their doctor might be able to help you manage these symptoms.

If you feel that you’re losing touch with reality, a doctor or mental health professional is the best place to start. Because you can still tell that your thoughts aren’t reasonable, there are things you can do to help.

To start with, it’s important to eat a healthy balanced dietexercise, and get plenty of sleep. All these things are part of a mental balance that can help keep paranoid thoughts at bay.

After that, it can actually help to talk to yourself about paranoid thoughts. This works only while you can still tell that your thoughts are not reasonable. Keep it realistic. Instead of thinking to yourself “I’m crazy” or “I’m paranoid,” try something like: “I’m worried about something that’s highly unlikely to be true.”

Even if you don’t have a mental illness, if your paranoid or irrational thoughts get in the way of doing things you want to do, talk to a social worker, psychologist, or psychiatrist. Talk therapy or some kind of medication could help you feel better.

Often, people who feel paranoid don’t get treatment because they don’t realize their thoughts are unrealistic. If you’re worried about a friend or family member, talk to a health professional or use a resource such as the National Alliance on Mental Illness (, 800-950-NAMI) or the Substance Abuse and Mental Health Services Administration (, 800-662-HELP).