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Understanding
paranoia
Paranoia
Understanding paranoia
This booklet describes the feelings and
experiences associated with paranoia. It
explores possible causes, steps you can take to
recognise when fears might be exaggerated
and suggests techniques to help you change
the way you react to suspicious thoughts. It
also discusses professional treatment, and how
friends and family can help.
Contents
What is paranoia?...................................................................... 4
What are the different types of paranoia?.................................. 5
What causes paranoid thoughts?............................................... 8
How can I help myself?.............................................................. 9
What treatments are available?................................................ 13
What can family and friends do to help?.................................. 16
Useful contacts........................................................................ 18
3
Understanding paranoia
What is paranoia?
It is common to have suspicious thoughts or worries about other people
from time to time. These fears are described as paranoid when they are
exaggerated and not based in fact. There are three key features of paranoid
thoughts:
• you fear that something bad will happen
• you think that others are responsible
• your belief is exaggerated or unfounded.
However, the central thought which is present with paranoia is a sense of
threat.
There are different types of threat or harm that you may feel paranoid about;
for example:
• psychological or emotional harm – bullying, spreading rumours about you
• physical harm – trying to physically hurt or injure you, or even trying to
kill you
• financial harm – stealing from you, damaging your property or tricking
you into giving away your money.
You might feel threatened by one person, a group of people, an
organisation, an event or an object.
Depending on what your paranoid thoughts are, they can bring up a wide
range of emotions. You may feel:
• anxious and stressed
• scared/terrified
• mistrustful of other people and organisations
• victimised or persecuted
• isolated
• tired - from worrying all the time.
4
What are the different types of paranoia?
What are the different types of paranoia?
Certain types of paranoid thought are believed to be common in the
population and are closely related to anxiety. These thoughts can be
distressing and leave you feeling under threat, but will not normally stop you
from living your normal life.
More severe paranoid thoughts are less common, but have a more significant
impact on day-to-day life. They are likely to be very alarming, and leave you
feeling terrified, isolated and exhausted.
This pyramid diagram shows some of the levels of threat you might feel – the
more personal the threat, the higher the level of paranoia. The thoughts at the
bottom of the triangle are experienced by more people than those at the top.
Feeling
under
severe
personal threat
e.g. MI5 are using
the TV to control
my thoughts
Feeling under moderate
personal threat e.g. I think
someone is tracking my phone calls and
emails to use the information against me.
Feeling under mild personal threat
e.g. the person on the bus is
tapping their foot in order to annoy me
Having suspicious thoughts e.g. my work
colleagues are talking about me behind my back
General feelings of vulnerability e.g. Terrorists blew
up a bus yesterday; what if there’s a bomb on my bus too?
Based on a model created by Freeman D et al. ‘Psychological investigation of
the structure of paranoia in a non-clinical population’ BJP 2005;186:427-435
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Understanding paranoia
In the examples in the diagram, thoughts are divided into distinct levels of
threat; however, in reality, you are likely to find that your thoughts move
between levels at different times. You might also find the ‘lower level’
concerns cause significant distress if they last for a long period of time. Also,
the sense of threat you experience can develop and get stronger over time.
I have always been afraid of the dark. As I got older it has
progressed. It isn’t as much the dark that I’m afraid of now,
it’s the feeling of what may be in the room that I cannot see. I
always feel like someone is there, and is going to either kidnap,
rape, or kill me.
Paranoid Thoughts website
If you experience mild paranoia over a short time period, you will probably
have some insight into your thoughts and realise that although they are
worrying, your suspicions might be groundless or exaggerated. It can be
difficult to share these thoughts with others, as you might worry that they
will judge you.
If your thoughts are more extreme, or have been present for a long time, it
will feel that your fears are real. This can be very isolating, as other people
are unlikely to share your views. Having to cope with your own feelings of
alarm and not being believed can be very distressing.
Paranoia and mental health problems
As outlined in the previous sections, paranoid thoughts can be very
distressing, and can lead to problems such as anxiety and depression;
however, the measures that doctors use to diagnose mental health problems
do not currently recognise paranoia as a diagnosis in its own right. More
severe paranoid thoughts are likely to be seen as symptoms or indicators of
some of the less common mental health diagnoses.
6
What are the different types of paranoia?
Paranoid schizophrenia
Paranoid schizophrenia is a particular type of schizophrenia that features
extreme paranoid thoughts. If you experience paranoid schizophrenia, then
you may also hear voices, which might confirm your paranoid feelings and
cause you further distress by mocking or threatening you. You might also feel
that you are an important or powerful person, such as a religious figure or
royalty, which is why you are being persecuted.
Delusional or paranoid disorder
If you experience delusional disorder you are likely to develop one particular
dominating, paranoid idea, of great complexity, that puts you in conflict with
those around you. You are more likely to contact the police or a lawyer than
a psychiatrist for help, as you will feel your persecution is real.
Paranoid personality disorder
Paranoid personality disorder is another diagnosis which is usually considered
if your paranoid feelings have been around for some time, perhaps since
adolescence. If you have received this diagnosis, you are likely to feel very
suspicious and find it difficult to trust other people. You might feel that
people are plotting against you, and will find it difficult to accept that these
feelings might be exaggerated or unfounded.
Other diagnoses
Other diagnoses that may include paranoid feelings are bipolar disorder,
schizoaffective disorder, severe anxiety or depression, and postnatal
psychosis. See Mind’s website or Understanding booklets for more
information about all of these diagnoses.
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Understanding paranoia
What causes paranoid thoughts?
Paranoia is a complex blend of thoughts and feelings, so it’s unlikely to have
one simple cause. A combination of factors is likely to play a role.
Life events
A sudden increase in stress can be very significant. If you have lost a job or
a relationship has ended, this can make you feel very isolated and might
mean that you turn inwards and feel insecure and under threat. Life events
that involve a betrayal or emotional pain for example, if you are bullied in
your workplace, or your home is burgled can also form the root of suspicious
thoughts that then develop into paranoia.
External environment
Some research has suggested that paranoid thoughts are more common if
you live in an urban environment or a community where you feel isolated
rather than connected. Media reports of crime, terrorism, violence and other
social issues might also play a role in triggering paranoid feelings. High levels
of stress associated with modern lifestyles might also put you at greater risk.
Anxiety and depression
Anxiety and depression can act as triggers for paranoid thoughts in some
people. If you’re anxious you are likely to be on edge and more fearful than
normal. Depression can lower your self-esteem, and make you more likely to
misinterpret other people’s intentions towards you.
Poor sleep
If you have trouble sleeping this can also have a big impact on paranoia.
Fears and worries can develop late at night when you are alone with your
thoughts, and feeling constantly tired can trigger feelings of insecurity.
The effects of drugs and alcohol
Chemicals can sometimes be a factor. Drugs such as cocaine, cannabis,
alcohol, ecstasy, LSD and amphetamine can all trigger paranoia. So do
certain steroids taken by some athletes and weightlifters. Certain insecticides,
fuel and paint have also been associated with symptoms. (See Understanding
the mental health effects of street drugs.)
8
How can I help myself?
Childhood influences
What happens in your childhood might play a part. If you were brought
up to believe that the world is a very unsafe place and that people are
untrustworthy, this might affect the way you think as an adult. If your
childhood was abusive or neglectful you are also likely to feel mistrustful and
suspicious of others.
Physical causes
Paranoia, as a symptom, is linked with certain physical illnesses, such as
Huntington’s disease, Parkinson’s disease, strokes, Alzheimer’s disease and
other forms of dementia. Hearing loss can also trigger paranoid thoughts for
some people.
How can I help myself?
Taking steps to change paranoid thoughts can seem like a daunting task,
especially if you feel that there are good reasons for you feeling suspicious
and fearful. However, there are strategies which can make a difference to the
way you respond to your fears, and help you to recognise and avoid triggers.
Using these strategies does not mean that you need to handle everything
on your own – they can be used in combination with other treatments and
support from friends, family and professionals.
Lifestyle
Some of the possible causes or triggers for paranoid thoughts explored in the
last section are connected to lifestyle. If you are able to improve your overall
wellbeing, you are likely to feel more grounded, and will be better able to
cope with your fears if they arise.
Sleep well
Lack of sleep can be a major trigger in the development of paranoid
thoughts. Try to prioritise a regular sleep pattern over other activities.
Relaxing with a bath or a good book before bed can help, and making sure
you have had enough exercise during the day to physically tire you out can
help you to sleep more easily. See How to cope with sleep problems for more
information.
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Understanding paranoia
Avoid drugs and alcohol
There are clear links between drugs and alcohol and paranoid feelings.
Stopping or reducing your use of them will help you feel more in
control of your thoughts, and make it easier to rationalise your feelings.
See Understanding the mental health effects of street drugs for more
information.
Eat well
Although it is unlikely that any foods cause paranoid thoughts, if you eat
regular healthy meals it can make a big difference to your overall sense of
wellbeing. The links between food and the way you feel are explored further
on the Mental Health Foundation’s website at www.mentalhealth.org.uk
Clear your mind
If your paranoia is triggered by anxiety, stress and worry then you might
find the techniques of mindfulness or meditation can help you to calm your
feelings and stop you becoming overwhelmed by them. See ‘Be mindful’ in
‘Useful contacts’ for more information.
It’s definitely worse when I’m tired. Therefore plenty of rest,
no alcohol or stimulants in the evening which may interrupt
sleep…Meditation taught me to relax, which of course is handy
anyway. But also I learnt to picture my mind as a big blue sky,
and any thought as a drifting cloud… I can just let it drift on by.
Paranoid thoughts website
Practical techniques
Three key features of paranoia which can make understanding and
communication with other people difficult are: feelings of alarm, the content
of your thoughts, and your fear of sharing your thoughts. Reflecting on these
areas can help you to understand your experiences more deeply.
Techniques associated with cognitive behaviour therapy (see p. 13) can help
you to take a step back from your immediate situation, and begin to analyse
your thoughts.
10
How can I help myself?
Keep a diary
You might find it helpful to track your thoughts and feelings for a short time.
At the end of each day, or every few days, take some time to write down the
thought or thoughts that have been troubling you most of all and make a
note of how many times a day they worry you.
Rate your worries
Try and look for patterns in the thoughts you have recorded. It might be
helpful to give them a numerical rating, from 1-10, showing how strongly
you believe them, and how distressing you find them. Carrying a notepad to
‘let the thought out’ can feel positive and give you something to reflect on
later.
Look for triggers
As you build up a picture of how your thoughts are affecting you, you can
start to think about things that might be acting as triggers; for example, if
you have had an argument with someone or if you slept badly.
Consider your reactions
It might be helpful to take a few different situations and try to write down
how the paranoia developed.
For example:
• My sister said she would call on Saturday.
• By 5pm she hadn’t called.
• She must be ignoring me.
• By 8.30pm there was still no call, she must hate me.
• My whole family hate me, none of them have called today.
• I phoned a friend and they didn’t answer.
• Convinced everyone hates me.
• Worried that they are plotting together to make me upset.
• Read old emails and started to see double meanings in them.
• Became increasingly scared and suspicious.
• Stayed awake most of the night.
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Understanding paranoia
Begin to assess evidence
The steps just outlined will help you to get some distance from your
thoughts, which can make it easier to consider whether they could be
exaggerated. Once you have built this awareness, you can start to challenge
your thinking. It can help to make a list of what you feel the ‘evidence for
the thought’ is, and then compare it to a list of what the ‘evidence against
the thought’ is.
In the example outlined, your list might look like this.
I feel that everyone hates me and they are conspiring to make me miserable
Evidence For
Evidence Against
Sister didn’t call me.
My sister called on Sunday – she was
really sorry she missed my call and had
been asked to work at the last minute
on Saturday.
My sister and other family members
have missed calls from me before.
Mother called later to ask if I wanted
to go for dinner next week.
I don’t receive many phone calls
or emails.
My friend has emailed to invite me
to his birthday next week.
My friend didn’t answer her phone.
I don’t send many emails or make many
phone calls, so perhaps it is not surprising
that I don’t receive many back.
I am just one part of other people’s
lives. It is normal for people to be
busy and not answer their phones.
I have not answered calls before and
it hasn’t meant I hate the person.
I know that my family and friends
don’t know each other and couldn’t
be plotting together.
As you build the evidence against your paranoid thoughts, it might be
helpful to keep some of the most helpful statements on a piece of paper in
your wallet, or as a note on your phone so you can refer to them if you start
to feel anxious about your thoughts; for example, ’I have not answered calls
before and it doesn’t mean that I hate the person calling’.
12
What treatments are available?
Sharing your thoughts
As well as reflecting on your own feelings and thoughts it might be helpful
to consider how you disclose your thoughts to other people. You have the
right to choose who you talk to, and how much you wish to tell them.
If you are experiencing particularly severe thoughts you might not have much
control over what you say. If you have disclosed things that you feel unhappy
about at a later point, you might find it helpful to discuss how you now feel,
and agree what you are now comfortable talking about.
This section has given a short outline of some techniques that might help
you to understand and challenge distressing thoughts and feelings. For more
examples of ways people have managed their thoughts see ‘Coping Tips’ on
the Paranoid Thoughts website (see ‘Useful contacts’).
What treatments are available?
The first point of contact for professional help in the UK is usually your GP,
who may refer you to a psychiatrist, clinical psychologist or a counsellor.
Although counsellors and psychologists can be approached without a GP
referral, they are likely to want a GP’s opinion first, to rule out any physical
cause for the condition.
Talking treatments
Cognitive behaviour therapy (CBT) is a type of psychological (talking) therapy that
has become popular in the UK in recent years. It involves examining your thinking
patterns and the evidence you have for your beliefs. It then aims to help you find
alternative interpretations to the ones that are distressing you. Many people find
CBT is a helpful way to cope with paranoid thoughts. It can help you to take a
step back from your thoughts, and find new ways to deal with the alarm that they
cause. (See Mind’s booklet, Making sense of cognitive behaviour therapy (CBT).
Many others forms of talking therapy are available, including psychotherapy,
family therapy and group therapy. Although they have different underlying
ideas, they generally involve talking over personal experiences, in detail, and
exploring feelings. See Understanding talking treatments, and the ‘It’s Good
to Talk’ website (under BACP In ‘Useful contacts’).
13
Understanding paranoia
An important aspect of all talking treatments is finding a therapist that you trust
and feel comfortable with. If you are feeling particularly threatened or suspicious
of other people, you might find it difficult to establish a good relationship.
It might be helpful to agree with your therapist what action you will take if your
paranoia worsens; for example, pausing sessions until you feel able to engage
with the process again.
Medication
Medication is not normally prescribed to treat paranoid thoughts, but if
you are particularly anxious or depressed, your GP might recommend antidepressants or tranquillisers to relieve the symptoms. There are side-effects
associated with both types of drug. See Making sense of anti-depressants and
Making sense of sleeping pills and minor tranquillisers for more information.
If you have received a more severe diagnosis of paranoid schizophrenia or
paranoid or delusional disorder you are likely to be offered an antipsychotic
drug. These should only be prescribed by a psychiatrist (a specialist mental health
doctor).
Antipsychotics may lessen delusions, hallucinations, incoherent speech and
thinking, and reduce confusion. The drugs can control anxiety and serious
agitation, make you feel less threatened, and also reduce violent, disruptive and
manic behaviour.
However, not everybody finds antipsychotics helpful, and they are only expected
to lessen symptoms, not cure the problem. They can also have very serious
physical and emotion side effects, causing problems with movement, weight and
sexual function. For more information, see Making sense of antipsychotics.
If you are prescribed any medication, then you should be given an explanation
of what the medication is for, possible side effects and any alternative treatment
options by your doctor. In almost all circumstances your agreement is required
before you are given medication. The only situation where this is not the case
is if you are subject to certain parts of the Mental Capacity Act or the Mental
Health Act, (see Mind’s website for information about Consent to Treatment).
14
What treatments are available?
Complementary therapies
Some people find complementary therapies such as hypnotherapy,
massage and acupuncture help to manage anxiety and upsetting feelings
associated with paranoid thoughts. The clinical evidence for these therapies
is not always as robust as it is for other treatments. A body called the
Complementary and Natural Healthcare Council exists to provide regulation
for complementary therapists and lists details of therapists registered with
recognised professional organisations. (See ‘Useful contacts’ on p. 18).
Arts therapies
Arts therapies are a way of using the arts – for example, music, painting, clay,
dance, voice or drama – to express yourself in a therapeutic environment
with a trained therapist. The therapist helps to make sense of what you have
created in relation to your experiences and state of mind. See Mind’s online
booklet Making sense of arts therapies, for more information.
As explored in the section on talking therapies, you might find these more
beneficial if you are able to build a relationship of trust with the therapist.
Support groups
You might find it helpful to take a break from your normal situation. There
are a growing number of support groups offering a chance to talk to people
who have had similar experiences. The National Paranoia Network is working
to develop groups for people who experience paranoid thoughts and many
local Minds also support groups for people with mental health issues (see
‘Useful contacts’). The Mind Infoline can provide further information about
local support if you find it difficult to find a group close to you.
Secondary care and hospital
If your paranoid thoughts are causing you significant distress and stopping
you from being able to live your normal life, then you are likely to be referred
to ‘secondary services’. Government policy is to provide as much care as
possible in the community.
15
Understanding paranoia
If you have a high level of need, or require support from more than one
professional, you might be offered a package of care under the ‘Care
Programme Approach’. You should have one professional (your care
coordinator) who will consult with you to produce a care plan which sets out
all of the services which you need to access. This should be tailored to your
needs, and reviewed regularly. (See Mind’s website for The Mind guide to
community based mental health and social care).
Inpatient care in psychiatric wards or hospitals is normally only considered if it
is felt you are unable to cope in your home. If your paranoia is this severe you
are likely to feel very scared and under considerable threat. Unfortunately,
going into hospital might make these feelings worse.
If you are not willing to go into hospital as a voluntary patient but you are
assessed and felt to be a risk to yourself or others, you could be detained
under a section of the Mental Health Act 1983. (See Rights guide 1: civil
admission to hospital.)
Recovery
It is possible to recover from paranoia. This might mean that you no longer
have any paranoid thoughts, or it could be that they no longer disrupt your
life or cause you distress. After recovery you may feel inspired to continue
with or take up a new direction in life. The Scottish Recovery Network
website provides more information and resources about recovery and mental
health (see ‘Useful contacts’ on p. 18).
What can family and friends do to help?
This section is for friends or relatives who are would like to help someone
they know with paranoid thoughts.
If you have a relative or friend who is experiencing paranoia it can be
alarming and upsetting. You might feel unsure of how to offer support,
particularly if you don’t agree with the thoughts that they are expressing.
Feeling this way is understandable and, although it might seem scary at first,
there are ways you can offer support.
16
What can friends and family do to help?
Be aware of feelings
Even if you don’t agree that your relative or friend is under threat or at risk,
try to understand how they are feeling. Don’t be dismissive – the feelings
that they have are real, even if the thing they fear is unfounded. Focus on
the level of distress or alarm that they are experiencing and offer reassurance
and comfort.
Respect privacy and boundaries
It is important to remember that your friend or relative has a right to their
own boundaries. They might choose to tell you only a small amount of detail
about their thoughts, or they might disclose a lot of their fears. The amount
that they tell you might change depending on how they are feeling. Accept
the boundaries that they feel comfortable with, and be aware that they
might feel embarrassed about things they have said when they are unwell.
Consider if there is a basis for their fears
Many paranoid thoughts will have developed from a real situation. Explore
with your friend or family member whether there is basis for their fears. This
can help both of you to understand how fears have developed, and can also
be helpful to see where ideas might seem improbable (see ‘What causes
paranoid thoughts?’ p. 8).
Be honest
If you are honest with your friend or family member about how you feel, it
will help to establish trust over time. Your point of view might be reassuring
to the person, reinforcing the possibility that what they fear may not actually
be happening. It is possible to recognise their alarm and acknowledge their
feelings without agreeing with the reason they feel this way.
Get support for yourself
It is important to look after yourself as well. It can be distressing to see
someone you care about behaving differently than usual, and putting
themselves at risk. You might find counselling or a support group can help,
giving you the opportunity to talk about what the relationship is like for you,
the feelings you have about the person and what you can do to look after
yourself.
17
Understanding paranoia
Useful contacts
Mind
Mind Infoline: 0300 123 3393
(Monday to Friday 9am to 6pm)
email: [email protected]
web: www.mind.org.uk
Details of local Minds and other local
services, and Mind’s Legal Advice Line.
Language Line is available for talking
in a language other than English.
Complementary and Natural
Healthcare Council
tel: 020 3178 2199
web: www.cnhc.org.uk
Maintains a register of complementary
healthcare practitioners
Carers UK
helpline: 0808 808 7777
web: www.carersuk.org
Anxiety UK (formerly the National Information and advice on all aspects
of caring
Phobics Society)
tel: 08444 775 774
web: www.anxietyuk.org.uk
Information, counselling, helpline and
online support for those suffering
from anxiety disorders
Be Mindful
web: www.bemindful.co.uk
Website that explains the principles
behind mindfulness, and gives details
of local courses and therapists
Hearing Voices Network
web: www.hearing-voices.org
tel: 0114 271 8210
Information, support and
understanding to people who hear
voices and those who support them
National paranoia network
web: www.nationalparanoianetwork.org
tel: 0114 271 8210
Information, support and
understanding for people who
British Association for Behavioural experience paranoid thoughts
and Cognitive Psychotherapies
tel: 0161 705 4304
Paranoid thoughts
web: www.babcp.com
web: www.iop.kcl.ac.uk/apps/
Has a list of accredited behavioural
paranoidthoughts/default.aspx
and cognitive therapists
Website about unfounded or
excessive fears about others.
British Association for Counselling Contains personal accounts and
and Psychotherapy (BACP)
further reading
tel: 01455 88 33 00
web: www.itsgoodtotalk.org.uk
Scottish Recovery Network
web: www.scottishrecovery.net
For details of local practitioners
18
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