Written by MaryAnn DePietro | Published on January 8, 2014
Medically Reviewed by George Krucik, MD, MBA on January 8, 2014

What Is Paranoia?

Paranoia is a thought process that causes a person to have an irrational suspicion or mistrust of others. Paranoid people may feel like they are being persecuted or that someone is out to get them. They may fear the threat of physical harm even if they are not in danger. People with dementia sometimes have paranoia. It also occurs among drug abusers. Paranoid thoughts can be a symptom of a mental illness or a personality disorder.

What Causes Paranoia?

Paranoid behavior is usually caused by personality disorders, paranoid schizophrenia, or drug abuse.

Personality disorders can cause paranoia. It is not fully understood why some people develop personality disorders or mental illness. It may be a combination of factors. These factors include genetics, stress, and brain chemistry.

People with schizophrenia may develop with a severe form of paranoia. They can lose touch with reality. They often have delusions, including severe distrust of people or organizations.

Drug abuse can also cause paranoia.  According to the Center for Substance Abuse Research, the use of methamphetamines can cause paranoid behavior and delusions. Other drugs that can also lead to paranoid thought processes are PCP and LSD.

Symptoms of Paranoia

Symptoms of paranoia vary in severity. They can interfere with all areas of life. Paranoia can cause problems with employment and personal relationships. Sometimes paranoia leads to social isolation.

People with a paranoid personality disorder may feel persecuted or like other people are plotting against them.  They may be unable to work with others. They can also be hostile or detached.

People with paranoid schizophrenia can be distrustful of others. They may be suspicious and guarded. They may also have delusions or believe that others are trying to hurt them. They may also have hallucinations.

How Is Paranoia Diagnosed?

To diagnose paranoia, a medical cause for symptoms needs to be ruled out. One such cause is dementia.

The doctor will perform a medical exam and take a complete medical history. This will rule out a physical reason for symptoms.

A psychiatrist or psychologist will do an evaluation to determine mental status. This will include clinical psychological tests.

How Is Paranoia Treated?

Treatment depends on the cause and severity of symptoms. It may include medication and psychotherapy.

Treatment for paranoid personality disorder is usually psychotherapy. This helps patients develop coping skills to improve social and communication skills.

Medication is not usually used to treat paranoid personality disorder. However, anti-anxiety medication is sometimes recommended. This is usually for patients who are often anxious or fearful.

Patients with paranoid schizophrenia usually require medication. These patients have often lost touch with reality. Initial treatment usually includes antipsychotic medication. Anti-anxiety medications and antidepressants can also be prescribed.

Additional treatment may be recommended once a person’s condition is stabilized. This can include psychotherapy as well as individual and family counseling.

When paranoia is due to drug abuse, treatment must involve a drug treatment program. Counseling and medication may also be needed.

What Is the Outlook for Paranoia?

For patients who seek and follow through with treatment, the prognosis is usually good. But getting someone to see treatment is sometimes difficult. Since they are usually distrustful of others, people with paranoia may not go for treatment. Because they perceive the paranoid thoughts as real, they may not think they have a problem.

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