Paranoia is an anxious pattern of thinking where you believe you are under threat in some way, even though there's no proof. It can range in severity from general mild feelings of uneasiness to intense and highly-distressing premonitions.
Mild paranoid thoughts can be quite common in the general population (in 2008, psychologist Dr Daniel Freeman, a paranoia expert at the Institute of Psychiatry at King's College, said that nearly one in four Londoners regularly have paranoid thoughts) and are usually short-lived and harmless. People with clinical paranoia believe that others are trying to harm them or are 'out to get them'.
These anxious thoughts and feelings can be intense and distressing for those who experience them. We spoke to Dr Elena Touroni, consultant psychologist and co-founder of The Chelsea Psychology Clinic, and GP Dr Roger Henderson about paranoia types, potential causes and available treatment options:
How severe your paranoia is depends on how much you:
Believe the paranoid thoughts
Think about the paranoid thoughts
Feel upset by the paranoid thoughts
Can function due to the paranoid thoughts
'With non-clinical paranoia, there will be a strong sense of distrust – a tendency to scrutinise other people's behaviour and question their intentions,' Dr Tourini explains. 'Clinical paranoia happens when the level of severity is such that a person loses touch with reality. There will be a belief in things which are very clearly untrue, rather than just feeling suspicious.' People with clinical paranoia are more likely to need treatment.
What causes paranoia?
Paranoid behaviour usually occurs due to mental health conditions, including depression, anxiety, or bipolar, but it's important to distinguish that paranoia is not a diagnosis in itself. The symptom is most commonly associated with three psychiatric disorders:
Paranoid personality disorder
'Paranoid personality disorder is considered the mildest type and is typically a long standing picture of problematic feelings, thoughts and behaviour,' says Dr Henderson. 'Despite this, most people with paranoid personality disorder function well. This usually improves with age and many people recover by the time they are in their fifties.'
'People with this delusional disorder have one delusion – a fixed, false belief – without any other signs of mental illness,' says Dr Henderson. 'People with delusional disorder may also have other unusual beliefs – being convinced they have a terrible illness, despite a lack of evidence – or they may practice behaviour such as stalking.'
'The most severe type, and a form of psychosis, paranoid schizophrenia is characterised by delusions and sometimes hallucinations,' says Dr Henderson. 'A person with paranoid schizophrenia often finds the world confusing and functions poorly without treatment.'
Not everyone who experiences paranoia has a mental health disorder. It may be that a number of genetic and environmental factors are working in combination. Recreational drug use – such as cannabis, amphetamine and cocaine – dementia, traumatic life events, insomnia, and severe stress are all associated with the onset of paranoia.
The symptoms of paranoia range from mild to severe, and depend on the cause. However, they typically involve:
Being easily offended and quick to anger
Finding it difficult to trust others
Being thin-skinned and unable to be receive criticism
Assigning harmful meanings to others' remarks
Believing your actions or thoughts are being interfered with by other people
Being defensive, argumentative and unable to compromise
Being unable to 'forgive and forget'
Thinking people are secretly threatening you
Thinking people are trying to make you look bad or exclude you
Being overly suspicious of others in general
Feeling threatened and persecuted by the world
Believing you are at risk of being harmed or killed
Thinking people are deliberately trying to upset or annoy you
Believing in conspiracy theories
Believing you are being controlled or that the government is targeting you
Believing people are trying to take your money or possessions
Thinking you are being talked about or watched by people or organisations
'In order to understand if you are suffering from paranoia, it's important to consult a psychologist,' says Dr Touroni. 'If you're suffering from clear delusions, then this indicates it is more of a psychiatric condition. In this case, it's important to get help via the NHS as these conditions require being on some form of medication.'
How is paranoia diagnosed?
Getting to the root cause of paranoia can be difficult, because it's characterised by a mistrust of other people. 'People with paranoia may avoid doctors, hospitals and other medical settings for fear of being harmed,' says Dr Henderson.
Since it's common across many mental illnesses, a wide range of disorders could be behind the symptom. 'Paranoia isn't diagnosed as a condition unless someone is suffering from a psychotic disorder,' says Dr Touroni. 'It can also be part of an anxiety disorder, in its less severe form.'
To ascertain why someone is experiencing paranoid thoughts, a doctor may need to do a physical examination – which may include blood tests or scans – to rule out underlying physical causes, Dr Henderson says, as well as psychological tests.
'The first point of call would be to discuss with your GP who can signpost you in the right direction,' says Dr Touroni. 'People who actively seek out support are likely to be suffering from a less severe form of paranoia, because they are able to recognise that there is a problem. In the more severe cases, it is usually a family member or close friend who recognises that something is wrong.
Treatments for paranoia
Treatment of paranoia depends on the underlying cause. 'Sometimes, simply stopping alcohol or recreational drugs cures the problem altogether,' says Dr Henderson. 'However, many people with paranoia can have difficulty in accepting treatment, and so it can take a long time for recovery to occur.
For schizophrenia and delusional disorder, medication is the mainstay. 'Treatment depends on the type and severity of the condition, but may include medications, such as anti-anxiety drugs or antipsychotic drugs,' Dr Henderson continues. 'A person with paranoia may often refuse to take medication because they're afraid it'll harm them.'
Psychotherapy, such as cognitive behaviour therapy (CBT), is also an effective treatment. 'It can help a person to cope with their symptoms and may improve their ability to function,' says Dr Henderson. 'This can be especially helpful in people with mild paranoia or paranoid personality disorder.'
More generally, coping skills can be taught – for example, relaxation therapy and anxiety reduction techniques, Dr Henderson adds. If the paranoia is especially severe and puts the individual or people close to them in immediate danger, 'they may need to be hospitalised until the condition causing the paranoia stabilises,' he says.
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