What is paranoia?

Paranoia is a state of mind in which a person believes that others are trying to harm or deceive them. It can include a feeling of being watched, listened to, followed or monitored. It might be a belief that there is a conspiracy working against them or that someone is treating them unfairly.

People with paranoia sometimes have an increased sense of self-importance and believe that other people are taking notice of them when this is not the case.

Mild paranoid thoughts are quite common in the general population and usually go away naturally. Long-term paranoia can be a symptom of a mental illness or be caused by medicines, substance use, dementia or another health condition.

Paranoia can lead to delusional thoughts. A delusion is a fixed, false belief that someone continues to hold even when there is no evidence that the belief is true.

What causes paranoia?

There are many causes of paranoia such as:

• drug use and withdrawal from drugs such as cannabis, amphetamine, alcohol, cocaine and ecstasy
• neurological diseases such as dementia, Alzheimer’s disease, Parkinson’s disease or brain injury
• severe trauma and stress, such as abuse in childhood, domestic violence or racism
• loneliness and feeling excluded

Paranoia can also be caused by mental health disorders including:

• Paranoid personality disorder — A personality disorder where people believe that others will harm, deceive or take advantage of them. It usually improves with age and many people recover by their 40s or 50s.
• Delusional disorder — People with a delusional disorder hold a fixed, false belief without any other symptoms of mental illness. Paranoid delusions are the most common type, and make people believe that there is a conspiracy against them or that they are going to be harmed.
• Paranoid schizophrenia — This is form of psychosis that causes people to have trouble explaining reality. They may have hallucinations such as hearing voices that aren’t there, as well as delusions. They may believe that their thoughts are being broadcast over the radio or they are being persecuted by the government.
• Mood disorders such as psychotic disorder and bipolar disorder can also cause paranoia.

What are the symptoms of paranoia?

Paranoid symptoms can include:

• a general feeling of distrust
• suspicion of others
• conspiracy theories — for example about the government monitoring or spying on a person
• irrational thinking

Being paranoid can make people:

• feel angry, betrayed or afraid
• hypervigilant or unable to relax
• find it hard to forgive others
• becomes defensive when beliefs are questioned or if they are criticised
• caught up with others’ hidden motives
• afraid of being taken advantage of
• argumentative

When should I see my doctor?

It is important to seek help if you are experiencing paranoia that is causing you distress. You can speak with:

• your doctor
• a counsellor
• a psychologist
• a psychiatrist

If you know someone who frequently has paranoid thoughts and feelings and it is causing them distress in their lives, encourage them to seek professional help.

If you are worried about someone else’s paranoia, it’s best not to criticise them or tell them they are imagining things. Remember that their thoughts are real to them. Understanding and support are the best way of encouraging them to seek help from a professional.

How is paranoia diagnosed?

Paranoia can be difficult to diagnose. People with paranoia may not be able to recognise that they have a problem and may avoid doctors or hospitals due to a fear of being harmed.

A mental health assessment by a doctor can help assess the level of paranoia and rule out other medical issues. An assessment involves detailed questions about the current problems, family history, general medical history and any medicines or drug and alcohol use.

A physical examination, blood tests or scans can also help identify the cause of your symptoms.

If your doctor suspects a diagnosis of mental illness or personality disorder, they may refer you to a psychiatrist (mental health specialist).

How is paranoia treated?

Treatment for paranoia depends on the underlying cause. Treatment may include:

• psychotherapy
• cognitive behaviour therapy (CBT)
• group therapy
• antipsychotic medicine

People with paranoid thoughts may find it hard to trust a doctor or mental health professional and may have difficulty accepting treatment. Developing a positive relationship with a health provider may take time but can be an important step on the road to recovery.

Resources and support

Talking to your doctor is a good place to start if you need help. If you’d like to find out more or talk to someone else, here are some organisations that can help:

• SANE Australia (people living with a mental illness) — call 1800 187 263
• Beyond Blue (anyone feeling depressed or anxious) — call 1300 22 4636 or chat online
• Black Dog Institute (people affected by mood disorders) — online help
• Lifeline (anyone having a personal crisis) — call 13 11 14 or chat online
• Suicide Call Back Service (anyone thinking about suicide) — call 1300 659 467

Do you prefer to read in languages other than English?

• Transcultural Mental Health Centre has many resources about wellbeing and mental health in different languages.
• Beyond Blue has mental health resources in a variety of languages.

Looking for information for Aboriginal and/or Torres Strait Islander people?

• Yarn Safe and Wellmob have mental health information and resources for Aboriginal and/or Torres Strait Islander people.