Understanding and Managing Paranoia

Medically Reviewed by Smitha Bhandari, MD on May 10, 2022
6 min read

Paranoia is a symptom of several mental health conditions. It can be found in paranoid personality disorder (PPD), one of the “cluster A” or eccentric personality disorders. Paranoia often happens to people with psychotic disorders, like schizophrenia.

Paranoia is when you constantly think or believe that everyone is threatening you, even when there’s proof that it’s not true. You become very suspicious of other people and their motives. You may even have delusions about attacks or plots against you.

Paranoia is a chronic condition that often starts in childhood or your early teens.

We don’t know exactly what causes paranoia. It can run in families, so your genes may play a role. Physical or emotional traumas in early childhood may also trigger paranoia in some people. Drug abuse may also trigger paranoid thoughts.

Paranoia causes uncontrollable feelings of fear, mistrust, and suspicion about other people’s intentions toward you, even when there’s no proof of malice. Paranoia can harm your relationships, because you’re unable to trust anyone.

Paranoia may cause you to become:

  • Suspicious about everyone in your life, thinking that they’re working against you behind your back or scheming to take advantage of you
  • Secretive, because you believe others will use your personal information or thoughts to undermine you
  • Unable to relax or rest from your nonstop fear and worry
  • Extremely sensitive to criticism, even misreading mild comments or looks as insults
  • Cold, distant, mistrustful, controlling, and jealous

When you’re paranoid, you may be angry and argue all the time, because you feel that you’re right and others are just out to get you. You hold grudges for a long time.

Paranoia isn’t just fear or mistrust of people you know, but of the wider world. You see the world as dangerous. You may believe in conspiracy theories or hold negative views about people of other races or nationalities.

To diagnose paranoia, your doctor can examine you and do a complete medical history to rule out any physical causes of your symptoms, like hearing loss or substance abuse. If they think you may have paranoid personality disorder, they’ll refer you to a psychiatrist or psychologist for a thorough mental health evaluation.

Because people with paranoia deeply mistrust or fear others, they often don’t see a mental health specialist for diagnosis or treatment. They may not accept that they have a problem, or trust that any psychologist or counselor truly wants to help.

If a person with paranoia is willing to seek treatment and trust their doctor, psychotherapy and medications can help them manage their symptoms.

Psychotherapy or counseling is the main treatment for managing paranoia. In counseling, you’ll learn how to cope with your feelings, including how to trust others. You’ll learn how to develop empathy, good self-esteem, and communication skills. Counseling takes time to work, so you and your family must be patient.

You may have psychotherapy or counseling alone or with your family.

Cognitive behavioral therapy (CBT) is an effective way to treat and manage your paranoia. CBT uses techniques to help you adjust your disordered beliefs about others and develop healthy coping skills. CBT can lower your anxiety and worry.

You’ll work with your therapist to take a closer look at your thoughts, suspicions, and fears. You’ll talk about what proof there is that others are out to get you, and then learn to view others’ motives in a less harmful way.

Medications. For paranoia symptoms, or if you also have anxiety or depression, your doctor may prescribe anti-psychotic, anti-anxiety, or antidepressant drugs.

Hospital care. People with very severe paranoia symptoms, like attempting suicide, making threats, or having delusions, may have a mental health crisis. This may require a hospital stay for treatment until they’re stable again.

While you’re in the hospital, a psychiatrist will evaluate your condition. They may prescribe tranquilizers, psychotherapy, or electroconvulsive therapy (ECT, or shock treatments) to help you relax and stabilize you.

Seek support. If you have a friend or family member you trust, talk with them about your paranoid feelings or thoughts. Turn to them when you need someone to listen or help you work through your reactions to stressful situations.

If you’re isolated and lonely, your paranoia can get worse. Peer support groups may also help you manage your paranoid thoughts and reactions.

Challenge your suspicions. You can also try to question your paranoid thoughts or feelings. Look harder for evidence of attacks against you or conspiracies. Think about how others may react to your fear or beliefs before you let these thoughts take over.

Self-care can help you manage your paranoia day to day in a healthy, positive way. Talk to your therapist about how to take better care of yourself.

Get enough restful sleep. Paranoia can ruin your sleep. You stay up worrying or panicking. Poor sleep also triggers paranoia attacks and makes your symptoms worse. When you get enough restful, deep sleep, your brain can work better to process thoughts and emotions in a healthy way.

Diet and exercise. Eat regular meals to keep your blood sugar stable. Get regular physical activity to ease stress and anxiety.

Avoid drugs and alcohol. You may drink or use drugs as a way to numb your feelings, but these habits can make your paranoia worse. You’re also more likely to develop a substance abuse problem if you have paranoia. Talk with your therapist if you need help to quit drinking and using drugs.

Watch out for “folie á deux.” You may have a close family member or friend who also has paranoid delusions. Both people (and sometimes, multiple people) can reinforce paranoid thoughts in each other. Therapy can help you avoid this “folie á deux” (a shared delusion) or deal with these situations. Your doctor may prescribe anticonvulsants like aripiprazole (Abilify) or quetiapine (Seroquel) to ease your delusions.

Mindfulness practice. Similar to meditation, you can learn and practice skills to be more self-aware and in control of your thoughts. Mindfulness practice teaches you how to calm down, de-stress, and cope with your negative emotions or beliefs. You learn how to recognize your body’s signs of worry and stress, like a pounding heartbeat or tense muscles, and relax them. Mindfulness practice training may be paired with CBT.

There’s research that shows that people with paranoia who learn mindfulness-based practice can significantly reduce their symptoms. You can learn mindfulness from your therapist or through online training programs.

Focused breathing. Use your own breathing to calm down and de-stress. Take a few minutes to focus on your breathing. Inhale through your nose and exhale through your mouth. While you breathe, relax your shoulders. Place your hand on your tummy, feeling each breath go in and out. Breathe slowly, deeply, and calmly. Count to four or five in your mind as you breathe.

Journaling. Keep a diary or journal of your paranoia symptoms, thoughts, and how you react to them physically or emotionally. Look for anything that seems to trigger your paranoia. You can also download a diary app on your phone, so it’s always handy.

Herbal remedies. There’s some evidence that herbal or natural treatments like ginkgo biloba, vitamin B6, Chinese and ayurvedic herbs, glycine, sarcosine, or N-acetylcysteine may help manage paranoid or psychotic symptoms. Talk to your doctor before you try any herbal or natural treatment.