Paranoia

Paranoia can be defined as an unfounded belief or fear that something bad is going to happen. Often, an individual experiencing paranoia will be suspicious of another person or group, believing that other person or group will be responsible for the negative occurrence. A sense of threat and the exaggerated nature of an individual's beliefs are what set paranoia apart from typical fear and worry.

When paranoia impairs functioning or leads an individual to develop other conditions, such as anxiety, a mental health professional can provide help and support. 

• Understanding Paranoia
• Conditions Associated with Paranoia
• Paranoid Personality Disorder
• Paranoid Schizophrenia
• Therapy and Treatment for Paranoia
• The Effects of Paranoia
• Case Example

Understanding Paranoia 

Though paranoia or paranoid thoughts may be experienced by individuals as a symptom of a mental health condition, paranoia itself is not considered to be a diagnostic condition. When paranoia is severe, it may indicate the presence of a mental health condition, but paranoia can be experienced on its own and for many reasons. Even though individuals such as veterans and other military personnel who have survived trauma may be more likely to experience paranoia than those who have not been a victim of trauma, paranoia can affect anyone.

The suspicion and mistrust that characterizes the condition might be directed toward strangers, public figures, organizations, or family and friends. An individual experiencing paranoia might feel the need for increased caution or be extremely suspicious of unknown individuals. A person might also experience delusions or become distanced from reality.

Mild or moderate paranoia can become more severe over time. More severe paranoid thoughts, or those that lead an individual to believe in the presence of a moderate to extreme personal threat, can also be isolating because they are typically more extreme than general worry and are less likely to be experienced by other members of the population. People who experience higher levels of paranoia may experience these thoughts over a long period of time, which can often make the threat seem more real.

Paranoia often develops as a result of multiple factors rather than one single factor. Stressful life events—especially those that involve betrayal, trauma, or other emotional distress; an isolated or dangerous living environment; certain types of physical illness; lack of sleep; mental health conditions such as anxiety or depression; or chemical influences—might have an effect on an individual's risk of developing paranoia or paranoid thoughts.

Conditions Associated with Paranoia

Paranoia may be a symptom of neurological conditions such as dementia, Parkinson's disease, stroke, brain injuries, or Huntington's disease, and treatment of these concerns may help resolve an individual's paranoid thoughts. Childhood circumstances may also lead an individual to develop paranoia, as childhood neglect or abuse may be a factor in paranoid thinking in adulthood. Further, if an individual's parents experience paranoid thinking or believe an outside entity poses a threat, this is likely to have an effect on the way that individual thinks in adulthood. Paranoia also might occur when an individual goes through substance withdrawal or experiences insomnia or hearing loss.

The Diagnostic and Statistical Manual lists paranoia as a symptom of several conditions, such as paranoid personality disorder, schizophrenia, postpartum psychosis, and posttraumatic stress. Treating the conditions is likely to help resolve the paranoia.

Paranoid Personality Disorder

A primary symptom of PPD is extreme suspicion of others, but many of those who have diagnosable PPD are unaware of the fact that their mistrust is likely to be considered irrational by other people. PPD may cause individuals to be argumentative, defensive, sensitive to criticism, and make it difficult to relax or realize problems or areas of concern in their lives. Individuals who develop this condition may believe innocent remarks or events to be personal attacks or some other type of threat.

This condition typically develops by early adulthood, and it often makes it difficult for individuals to maintain close relationships or even get along with others, due in part to the mistrust of others that characterizes the condition and in part to the tendency of holding grudges, another characteristic of PPD. 

The symptoms and diagnostic criteria of PPD may be similar to the paranoia that occurs with schizophrenia, but the conditions are diagnosed separately, though they may be comorbid. PPD is diagnosed more frequently in males than in females, and it may appear as early as childhood. 

There is no cure for PPD. Treatment generally includes therapy and sometimes medication when symptoms are severe. Though treatment is often successful at reducing paranoid thoughts and feelings and helping an individual become better able to cope with the condition and develop social and communication skills, many individuals with this condition may resist treatment and experience diminished function in life as a result. For example, it may be difficult for an individual with PPD to interact with others in a positive way or maintain employment.

Paranoid Schizophrenia

Paranoid schizophrenia, the most common subtype of schizophrenia, is characterized by paranoid delusions that are generally stable and frequent. Other symptoms include auditory hallucinations, disturbances in perception, anger, aggression, and suicidal ideation. People diagnosed with paranoid schizophrenia generally have fewer memory, emotion, or concentration issues than those with other types of schizophrenia do and therefore are less likely to have disorganized speech or behavior. However, they are far more likely to be challenged by the belief that others are plotting against them or otherwise trying to harm them. As a result, they may spend a great deal of time addressing these "threats" and planning ways to protect themselves from those they believe are attempting to hurt them.

Treatment—therapy, combined with medication in some cases—is often effective at treating this condition. When paranoid schizophrenia goes untreated, depression, substance abuse or addiction, or suicidal ideation may be the result.

Therapy and Treatment for Paranoia 

Treating paranoia with therapy can often be challenging because it may be difficult for the individual experiencing paranoia to seek out help or trust a therapist enough to relay symptoms or share fears. In some cases, an individual experiencing paranoia may believe the therapist is part of the threat; in other cases an individual may not realize the extent to which paranoia has an effect on daily life, both of which may also be barriers to treatment.

Depending on the severity of an individual's paranoia, medication may be prescribed along with therapy. Individuals who are dealing with paranoia typically work to develop coping and relaxation skills in therapy, along with social skills that enable them to express fears in a more relatable manner. In therapy, individuals can also explore ways to lower stress and identify and avoid triggers that provoke a response grounded in paranoid thought.

In order to achieve success in therapy, an individual challenged by paranoia must first trust the therapist to provide help, not harm. For this reason, cognitive behavioral therapy is frequently used to treat paranoia, because this type of therapy allows both the therapist and person in therapy to examine and address any behaviors associated with paranoid thinking and behavior.

Those who experience mild or moderate feelings of suspicion, fear, or vulnerability may realize their thoughts are unlikely to have much basis in reality, but this knowledge may make it difficult for them to seek help, as they may fear being labeled by others as "paranoid," "delusional," or a "worrier."

Art therapies and support groups can help address and treat paranoid thinking in some instances, and hypnotherapy, massage, and acupuncture have all been shown to have some degree of effect in the reduction of anxiety and other distressing feelings that may occur in an individual experiencing paranoia. When paranoia is accompanied by physical symptoms such as nausea, headaches, or increased heart rate, medications may help provide relief.

Individuals can work to address paranoia on their own by making certain lifestyle changes that have been shown to improve well-being. A lack of sleep and increased drug or alcohol intake have both been shown to increase the likelihood that a person will experience paranoid thoughts. Therefore, getting enough sleep and avoiding drugs and alcohol can often help an individual avoid irrational thinking. When anxiety, stress, and worry cause paranoid thinking, meditation or mindfulness practices can help a person maintain a clear mind.

It may be helpful to keep a diary that tracks the development of paranoid thoughts and feelings, and a therapist may recommend this to an individual who experiences paranoid thoughts or feelings. In the diary, an individual might list worries, rate them, identify triggers, detail the development of the paranoia, and list evidence for or against the paranoia in order to determine whether it stems from rational or irrational thought.

The Effects of Paranoia

Paranoia can affect people in a variety of ways. A real situation may have led to the extreme suspicion of others, but when this is not addressed, it can become difficult to understand or control. A person may fear or suspect only certain family members, friends, or a significant other. Conjugal paranoia, for example, typically leads an individual to experience feelings of extreme jealousy in a relationship, despite having no basis for these feelings. The individual may put significant strain on the relationship by following a partner, accusing the partner of cheating, or construing moments of no significance to be evidence of infidelity.

A person who has paranoia will often find it difficult to maintain a healthy relationship while the condition goes untreated, as untreated paranoia often leads an individual to become angry, violent, and resentful of others.

An individual who experiences hypochondriacal paranoia may believe they have developed one or more serious medical conditions. This belief is often accompanied by the suspicion that a doctor will refuse to acknowledge or treat the illness, which can lead an individual to develop stress or physical symptoms as a result of mental distress.

Case Example

• Paranoia experienced with PTSD after tour overseas: After returning from a tour of duty in Afghanistan, Patrick, 28, experiences feelings of isolation and begins to distrust those around him. He wants to tell friends and family about what he went through, but he fears they will somehow use the information against him and thus avoids talking to anyone. Patrick eventually enters therapy and tells the therapist he believes those around him are discussing him constantly: his flashbacks, the angry outbursts he sometimes has, and his use of alcohol to help relax. He reports that when he enters a room, conversation stops, and his girlfriend and parents act oddly around him, make strange phone calls, and hide messages and mail. It has become difficult to sleep, he says, because he worries people are scheming about hospitalizing him or locking him up, and although he is exhausted, he worries all night about being even more alone. The therapist listens to Patrick's concerns and allows him to express his fear and frustration, then asks him several questions about his experience in Afghanistan. Patrick finds his anxiety easing over time as he becomes more able to talk to the therapist, and after a few sessions, the therapist brings up Patrick's suspicions. As Patrick has come to trust the therapist, he considers the possibility that he may be seeing a threat where there is none and agrees to begin tracking instances that trigger his paranoid thinking. He also slowly becomes more able to discuss his experiences with his family as he continues work with the therapist: practicing relaxation techniques and becoming more aware that his suspicions are unlikely to have much basis in fact. After several sessions, Patrick is able to report his suspicious thinking has improved greatly. he is drinking less, and he has become more able to avoid reacting suddenly with anger.

References:

1.  Berger, F. (2012, March 27). Schizophrenia - paranoid type. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/000936.htm 
2. Carroll, A. Are you looking at me? Understanding and managing paranoid personality disorder. Advances in Psychiatric Treatment, 20, 40-48. Retrieved from http://apt.rcpsych.org/content/15/1/40.full
3. Martel, J. (2012, July 10). Paranoid Personality Disorder. Retrieved from http://www.healthline.com/health/paranoid-personality-disorder 
4. Murphy, B. (2012). Understanding Paranoia (1st ed.). London: Mind National Association for Mental Health. Retrieved from http://www.brentmind.org.uk/wp-content/uploads/2014/05/Paranoia.pdf
5.  Nordqvist, C. (2015, May 27). Paranoid Schizophrenia: Causes, Symptoms, and Treatment. Retrieved from http://www.medicalnewstoday.com/articles/192621.php