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


  • Paranoia is a response to perceived threats that is heavily influenced by anxiety and fear, existing along a continuum of normal, reality-based experience to delusional beliefs.
  • Paranoid symptoms represent a spectrum with a range of severities:[1]
    • Subclinical social evaluative concerns (e.g., fear of rejection, anxiety about vulnerabilities)
    • Passive ideas of reference (e.g., a person having suspicious beliefs that they are being talked about or watched)
    • Persecutory threats toward oneself (e.g., others have malicious intent to actively inflict harm, deceive, exploit, or condemn the person for a specific reason)
  • The content of paranoid thoughts varies greatly among individuals.
    • These expectations may be supported by loosely related or no objective evidence.
    • Individuals may find hidden meanings or associations between things, ideas, or events that support their 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 tied to greatest amount of negative affect; paranoia can produce low or anxious mood and can also be triggered by these moods.[2]
  • Paranoia can be a symptom of psychosis.
    • In the context of a psychotic episode, delusional paranoid thoughts may be accompanied by related hallucinations.

There's more to see -- the rest of this topic is available only to subscribers.

Last updated: February 6, 2020