Paranoia can be a common symptom of bipolar disorder, but therapy and medication may reduce the frequency and severity of the experience.

Bipolar disorder is a mental health condition that causes mood extremes with depressive lows and manic highs. Some people also experience psychotic symptoms, including paranoia.

If you’re experiencing paranoia, it may feel as if others are plotting against you, as if you’re being followed, or like there’s a constant threat in your life. Treatments usually involve therapy, medication, and support groups to help relieve this symptom.

Paranoia can be a symptom of bipolar disorder. It’s one of several symptoms of psychosis that people with bipolar disorder can experience.

Other psychosis symptoms include hallucinations, delusions, and difficulty telling the difference between real and imagined sensations. Paranoia is sometimes classified as a type of delusion.

People with bipolar disorder paranoia can develop frightening beliefs. They might believe that they’re being followed or watched, or that others are plotting against them.

About 40–50% of people with bipolar disorder experience paranoia.

What triggers paranoia in someone with bipolar disorder?

The triggers for paranoia can vary. Each person’s triggers will depend on the individual.

Common paranoia triggers may include:

  • insomnia
  • disrupted sleep patterns
  • pregnancy
  • hormonal changes
  • death of a loved one
  • divorce or breakup of a long-term relationship
  • job loss
  • trauma such as a car accident or natural disaster
  • a reaction to certain medications, including antidepressants and corticosteroids
  • caffeine and certain stimulating substances

Sometimes, there isn’t a known trigger for paranoia. People with bipolar disorder might experience paranoia without a triggering event or underlying cause.

Keeping a symptoms journal may help you determine what your triggers are or help you notice patterns.

Paranoia can cause thoughts that are irrational — but they feel very real to the person experiencing them.

People with bipolar disorder may have paranoia that is intense and fixed. They can hold onto these beliefs even when presented with arguments and evidence that they’re false.

This may cause symptoms such as:

  • hypervigilance
  • mistrust of others
  • anger
  • anxiety
  • an inability to relax
  • feeling as if you’re being tricked
  • feeling like you’re being watched
  • perceiving harmless events as threats
  • defensiveness
  • feeling as if others have betrayed you
  • difficulty forgiving others
  • believing others have hidden motivations
  • believing others are conspiring against you
  • self-isolation
  • hostility

There are many treatment options available for bipolar disorder and for paranoia. The right treatment option depends on the person, their other symptoms, and the severity of those symptoms.

Common treatment options include:

  • Psychotherapy: Psychotherapy includes treatments such as cognitive behavioral therapy (CBT) that can help people with bipolar disorder examine, understand, and manage their thoughts and beliefs. Learn more about therapy options for bipolar disorder.
  • Medications: There are a few medications that can help manage bipolar disorder symptoms. Antipsychotic medications can help reduce paranoia and other delusions, while medications such as mood stabilizers and antidepressants can help manage mood symptoms.
  • Support groups: Group therapy, support groups, and other social supports allow many people with bipolar disorder to manage their symptoms with the help of people who understand their experience. There are online and in-person options available.
  • Hospitalization: Sometimes, in-patient mental health treatment in a hospital can help manage severe paranoia and other bipolar disorder symptoms. During a hospital stay, doctors, therapists, and other care team members can find treatments that help relieve paranoia.

Be empathetic when talking with anyone experiencing paranoia. You can be supportive without confirming any false beliefs by taking steps, such as:

  • Validating feelings: You can acknowledge and validate that someone is feeling afraid, angry, and anxious without agreeing with the perceived threat or other paranoia.
  • Assessing the source of beliefs: Some fears and paranoia stem from very real places and experiences.
  • Keeping communication open: An open discussion can help reduce feelings of isolation and stress. This can help the person express their feelings more openly.
  • Being emotionally supportive: Sometimes, it’s best to focus on the person’s emotions rather than the content of their statements. You can start by assuring them of your support.
  • Encouraging professional help: Gently encouraging a loved one to seek support from a therapist or other professional can be a great step. However, remember that it’s always their choice. You cannot push someone to seek treatment.
  • Supporting choices: Respect the choices a person makes. You can suggest treatment and other supportive options, but the final decision is up to the person experiencing paranoia.

When to seek professional help

Bipolar disorder paranoia can be incredibly frightening for people who experience it. The fear, anxiety, and stress are real for them. As a result, some might feel as if they need to take actions that are dangerous to themselves or to others.

If someone is making statements or doing things that make you believe they might harm themselves or others, it’s important to seek professional help. You can call the Substance Abuse and Mental Health Services (SAMHSA) Helpline at 800-662-4357 to get connected to mental health resources in your area. The helpline is free and available 24/7.

If you need urgent help, call 911 or 988 or drive to the nearest emergency room.

Bipolar disorder can cause a range of symptoms, including mood symptoms and symptoms of psychosis. Paranoia is a psychotic symptom of bipolar disorder.

People experiencing this symptom can feel like they’re being followed, plotted against, watched, or harmed by others. Treatments such as CBT and medication can help.