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.

“I have lived in fear for so many years. I always expect someone to knock on my door and when I open it, [that] they [will] attack me. And when I go out, I think I will be beaten up by people.”

Many people experience mild paranoid thoughts at some point in their lives, for example, thinking that people are looking at them or talking about them behind their backs. These types of thought are relatively common and are closely related to anxiety.

“I have a female friend who is often suspicious and untrusting of people… In her case, it seems as if the problem is based on heightened anxiety.”

“Our relative often assumed that the general conversation was aimed at him when it was about someone entirely different. [Or that] someone in a different room was talking about him when it was actually the neighbour’s TV.”

More severe paranoid thoughts are not as common, but have a more significant impact on your day-to-day life. You are likely to feel alarmed, and possibly terrified, isolated and exhausted. Severe paranoid thoughts are sometimes called persecutory delusions, because the person experiencing them feels they are being persecuted.

“I experienced paranoia as part of transient episodes of psychosis… These involved very cosmic thoughts, for example that the world was about to end, or that international war was imminent.”

“[My friend] says he is sometimes aware of the thoughts of some previous neighbours of his (some years ago and over three miles away) who have a continuing negative attitude to him. He won’t accept this is anything to do with his schizophrenia, a diagnosis he accepts, but believes [it] is controlled by his medication.”

It is possible to recover fully from paranoia. This might mean that you no longer have any paranoid thoughts. Or it may mean that you still experience them, but learn coping strategies so they no longer disrupt your life or cause you distress.

“I struggled with paranoia for a long time and it was very distressing. But with time and the help of my therapist, I have learned to deal with it and life is a lot brighter now.”

What is a paranoid thought?

It is difficult to identify what a paranoid thought is. Sometimes your thoughts and beliefs may seem irrational, but that does not mean you have paranoia.

Many people have certain cultural or unusual beliefs, such as believing in witchcraft, aliens or conspiracy theories, that are not shared by the general population. However, unless such beliefs cause you to feel threatened and scared, they would not be considered to be paranoia.

Similarly, what may be a paranoid thought for one person may be a rational reaction for another. This largely depends on the context of the thought, and your own life experience. For example, if someone has a loving and supportive family, feeling that a family member wants to hurt them may be considered irrational and paranoid.

However, if someone has difficult relationships with their family and has been threatened by a relative in the past, feeling that a family member wants to hurt them may be a rational reaction to a difficult situation. Similarly, if someone feels that they are being spied on by the government, this may seem irrational and paranoid to the people around them. However, if that person is a political refugee who has come to this country after being persecuted by their government, it may be understandable that they feel they are being watched.


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

 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.

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

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.

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.

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 disanorder is other 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 disorderschizoaffective disordersevere anxiety or depression, and postnatal psychosis.


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