Paranoia
DEFINITION
- Paranoia is a pattern of thought involving perceived threats, which is strongly influenced by anxiety and fear, and exists on a continuum of normal, reality-based experience to delusional beliefs.
- Paranoia can negatively impact an individual’s mood and ability to engage in daily life.
- Paranoid individuals may have trouble maintaining social connections due to doubting the loyalty and trustworthiness of others.
- Of all delusion types, persecutory delusions are most strongly linked to negative affect and functional impairment.[1]
- Paranoid symptoms exist on a spectrum of severity:[2]
- Social evaluative concerns that are subclinical in nature (e.g., a person feels fear of rejection, or anxiety about vulnerabilities)
- Passive ideas of reference (e.g., a person has suspicious beliefs that they are being talked about or watched)
- Persecutory threats toward oneself (e.g., a person feels that others have malicious intent to actively inflict harm, deceive, exploit, or condemn them)
- Paranoid delusions that are fixed, false, and idiosyncratic (e.g. a person may believe with certainty that a government agency has implanted a chip in their brain, despite clear contradictory evidence).
- The themes of paranoid thought vary widely and may be supported by little or no objective evidence.
- Individuals may find hidden meanings or associations between things, ideas, or events that support their beliefs.
- Paranoia can be a symptom of psychosis. In the context of a psychotic episode, delusional paranoid thoughts may be accompanied by related hallucinations.
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Last updated: October 3, 2025
Citation
Gary, Joseph, et al. "Paranoia." Johns Hopkins Psychiatry Guide, The Johns Hopkins University, 2025. Johns Hopkins Guides, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787376/3/Paranoia.
Gary J, Richey LN, Walsh AL. Paranoia. Johns Hopkins Psychiatry Guide. The Johns Hopkins University; 2025. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787376/3/Paranoia. Accessed October 8, 2025.
Gary, J., Richey, L. N., & Walsh, A. L. (2025). Paranoia. In Johns Hopkins Psychiatry Guide. The Johns Hopkins University. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787376/3/Paranoia
Gary J, Richey LN, Walsh AL. Paranoia [Internet]. In: Johns Hopkins Psychiatry Guide. The Johns Hopkins University; 2025. [cited 2025 October 08]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787376/3/Paranoia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Paranoia
ID - 787376
A1 - Gary,Joseph,M.D.
AU - Richey,Lisa,
AU - Walsh,Anne,M.D.
Y1 - 2025/10/03/
BT - Johns Hopkins Psychiatry Guide
UR - https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787376/3/Paranoia
PB - The Johns Hopkins University
DB - Johns Hopkins Guides
DP - Unbound Medicine
ER -