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Paranoia and Delusional Disorders

Paranoia involves intense anxious or fearful feelings and thoughts often related to persecution, threat, or conspiracy. Paranoia can occur with many mental health conditions but is most often present in psychotic disorders. Paranoid thoughts can become delusions when irrational thoughts and beliefs become so fixed that nothing can convince a person that what they think or feel is not true. When a person has paranoia or delusions, but no other symptoms (like hearing or seeing things that aren't there), they might have what is called a delusional disorder. Because only thoughts are impacted, a person with delusional disorder can usually work and function in everyday life, however, their lives may be limited and isolated as a result of their delusions.

Delusional disorder is characterized by irrational or intense belief(s) or suspicion(s) that a person believes to be true. These beliefs may seem outlandish and impossible (bizarre) or fit within the realm of what is possible (non-bizarre). Symptoms must last for one month or longer in order for someone to be diagnosed with a delusional disorder.

Symptoms of paranoia and delusional disorders include intense and irrational mistrust or suspicion, which can bring on feelings of fear, anger, and betrayal. Some beliefs and behaviors of individuals with symptoms of paranoia include mistrust, hypervigilance (constantly looking for threats), difficulty with forgiveness, defensive attitude in response to imagined criticism, preoccupation with hidden motives, fear of being tricked or taken advantage of, trouble relaxing, or being argumentative.

While we don’t know the exact cause of paranoia, a combination of biological and environmental factors can play a role. Research has identified the following environmental and biological factors that can play a significant role:

  • Childhood emotional neglect.
  • Childhood physical neglect.
  • Childhood supervision neglect.
  • Genetic links among schizophrenia and schizotypal personality disorders (while studies show this connection may not be as strong as previously thought).

A delusion is an odd belief that a person firmly insists is true despite evidence that it is not. Cultural beliefs that may seem odd but are widely accepted are not considered to be delusions. Delusions may or may not involve paranoia. Two of the most common types of delusions are delusions of grandeur or persecutory delusions.

Delusions of grandeur are false beliefs in one's superiority or identity which contradict reality. People who experience delusions of grandeur do not just have high self-esteem, but instead believe in their own exaggerated greatness and importance. Sometimes this includes believing oneself to be a celebrity or religious figure.

Persecutory delusions are a form of paranoia where an individual believes others are out to harm them despite contrary evidence. 

Paranoia is usually treated with a combination of medication and cognitive behavioral therapy. The most important element in treating paranoia and delusional disorders is building a trusting relationship between the person experiencing the disorder and the provider to reduce the impact of irrational fearful thoughts and improve social skills. People with paranoia or delusional disorders may have trouble with the treatment process at first since symptoms often include irritability, emotionally guardedness, and possible hostility. Oftentimes, progress on paranoid delusions and especially delusional disorders is slow. Regardless of how slow the process, recovery and reconnection are possible.

American Psychiatric Association

National Institute of Mental Health


Schizophrenia is a serious disorder which affects how a person thinks, feels and acts.

What is psychosis?

Psychosis is a general term to describe a set of symptoms of mental illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions.

Psychosis (Schizophrenia) in Children and Youth

For those who might develop psychotic disorders or schizophrenia as adults (adult-onset), it is not uncommon for them to start experiencing early warning signs during puberty or adolescence.

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