Paranoia

Joseph Gary, M.D., Lisa N. Richey, Anne Leonpacher Walsh, M.D.

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