Paranoid Thoughts in Adults: Early Warning Signs and Therapy Options

Daniel Hoadley
Published: 11/22/2025 | Updated: 12/30/2025
Authored by: Daniel Hoadley, B.S. Psychology
Edited by: Jemma Strain, B.S. Psychology
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We’ve all experienced moments when we pause and wonder what someone’s intentions are. Maybe a friend’s expression shifted during a conversation, or you thought two colleagues were talking about you. Most people can let these thoughts fade once they think about the situation logically. But for some, these ideas may grow, creating a level of uncertainty that doesn’t match what’s actually happening. This type of thinking is referred to as “paranoid thoughts,” and if you’ve noticed this pattern in yourself, it may be worth looking a little deeper. 

If suspicious or paranoid thinking is affecting your relationships and well-being, a mental health professional can help you get to the root of the issue and suggest ways to cope. This page can also help you understand the paranoid thoughts anxiety can create by discussing:

  • What paranoid thoughts are
  • The psychiatric conditions linked to paranoid thoughts
  • How paranoid thoughts can affect someone’s life
  • The paranoia treatment options available
  • Where to find professional support

But, most importantly, we guide you on where and how you can reach out for the help you deserve

If you or a loved one is experiencing deep paranoid thoughts that could put you or others in danger, reach out for mental health crisis support. You can do this by contacting 911 or visiting your local emergency department.

Woman in distress with her hands clutching her head due to paranoid thoughts in adults

What Are Paranoid Thoughts?

Paranoid thoughts are ideas or beliefs that make you feel as though you’re unsafe or mistrusted by others.1 These types of thoughts can range from mild worries, like thinking people are whispering about you, to stronger, more intrusive concerns that others are plotting to cause harm.2 

This means that paranoid thoughts could be split into two different categories: sub-clinical paranoid thoughts and clinical paranoid thoughts. The following sections discuss the definitions of both of these thought forms. 

Sub-Clinical Paranoid Thoughts

Subclinical paranoid thoughts are the kinds of ideas most people experience during stressful, but everyday moments.3 These thoughts may come as quick worries, like wondering if someone is judging you or talking about you. While they can feel uncomfortable, there’s usually an awareness that they’re probably irrational.

A large survey of over 10,000 adults found that 19.6% of respondents described themselves as generally mistrustful of other people.4 This indicates that these types of feelings aren’t rare in the general population.

Clinical Paranoid Thoughts

Clinical paranoid thoughts sit at the opposite end of the spectrum from sub-clinical ones and manifest as persistent and rigid thoughts, which may reach a delusional level.5 

When paranoia becomes clinical, the person may firmly believe that others have intentions to harm or surveil them, without any concrete evidence. This conviction stays in place even when there is clear evidence that the belief cannot be true. 

What Psychiatric Conditions Are Linked to Paranoid Thoughts?

Paranoid thoughts can surface for all kinds of reasons, but when they become deeply held or start coloring everyday life, they’re usually strongly linked to something happening beneath the surface. In the sections ahead, we’ll look at the psychiatric disorders most commonly connected to paranoid thinking.

Paranoid Personality Disorder

People with PPD often believe that others are trying to deceive or harm them, even when there is no real reason to think this.6 These people do not experience hallucinations, so they aren’t classed as having a psychotic disorder, but the level of suspicion they feel is still intense and long-standing.

At the center of PPD are the paranoid thoughts themselves, which take the form of firm and irrational beliefs about other people’s motives.7 For example, a person with PPD might assume that a simple comment from a friend contains a hidden insult. These ideas can grow quickly because the person focuses on anything that feels threatening, even when no harm was intended.

Delusional Disorder

Delusional disorder is a psychotic condition where a person holds one or more fixed false beliefs for at least a month.8 In this subtype, the paranoid thoughts are central, with someone’s delusions being firm and centered on the idea that another person or group intends to harm them. These themes can repeat themselves, such as believing they are being watched, cheated, harassed, or plotted against.8

Schizophrenia

Schizophrenia is a persistent psychotic disorder that affects how a person experiences reality and influences many parts of their behaviour. The World Health Organization explains that it involves persistent delusions, which are firm beliefs held even when there is clear evidence they are untrue, along with hallucinations and disorganised thinking.9

Paranoid ideas are common in schizophrenia and often take the form of persecutory delusions, where a person believes they are being targeted or harmed when nothing is actually happening.10

The older term, “paranoid schizophrenia,” once described cases where these beliefs and auditory hallucinations were more dominant. Although this subtype no longer appears in DSM-5, paranoia is still one of the most frequent symptoms seen in schizophrenia.

Bipolar Disorder With Psychotic Features

Bipolar disorder is a mood condition that involves episodes of depression and periods of mania or hypomania.11 Some people experience hallucinations or delusions during these mood shifts, which is described as “bipolar disorder with psychotic features.” It isn’t a separate diagnosis in DSM-5, but an added specifier that shows psychosis appears only during mood episodes.

When psychosis is present, the delusional beliefs tend to mirror the person’s emotional state. During a depressive episode, for example, someone may feel certain that others are working against them or believe they have caused harm that cannot be fixed. This mood-linked pattern helps distinguish bipolar psychosis from primary psychotic disorders, where delusional thinking is not tied to emotional changes.12

How Can Paranoid Thoughts Affect Someone's Life?

Paranoid thoughts can reach into many parts of a person’s life and affect the people close to them as well. It’s easy to think the impact stays within mental health, but these thoughts can influence much more than how someone feels. We discuss these potential impacts in the following sections.

Physical Consequences

Living with constant suspicion creates a level of stress that the body isn’t built to handle for long. When someone feels under threat, their system stays on high alert, and this heightened arousal has been linked with real physiological strain.13 

Research also shows that people with schizophrenia who experience strong paranoid beliefs have poorer physical health, partly because mistrust makes them more likely to avoid medical care or stop treatment altogether.14 

One study even found that people with persistent paranoia showed abnormal stress biomarkers, and those who started out with higher stress struggled more with social functioning over the following months.13 

This finding shows how physical stress and paranoia can interact with each other in a way that may keep a person feeling physically unwell.

Mental Health Consequences

Paranoia rarely appears on its own and is linked to other mental health issues, a pattern known as “comorbidity.” For instance, anxiety and depression are commonly found alongside paranoia,4 and the fear triggered by paranoid thoughts can loop back into even stronger anxiety.

Sleep also suffers as many people stay alert at night because they feel unsafe, which leads to significant sleep loss.14 As this continues, a person may start to feel worn down or hopeless, especially if they’re still aware that something isn’t right, but still can’t stop the thoughts. 

The emotional strain of constant paranoid thoughts can be severe, too. In a study of people with strong persecutory delusions, more than three-quarters had recent suicidal thoughts, and a small but worrying number had made an attempt in the previous month.14 

Impacts on Quality of Life

Paranoia can also change the rhythm of everyday life, as a fixed paranoid belief can be enough to damage someone’s overall quality of life. For instance, a long-term study found that people with delusional disorder had social and work functioning scores similar to those with schizophrenia.15 

Further, when researchers measured quality of life using the WHO scale, people with delusional disorder rated their overall satisfaction noticeably lower than those without mental health problems.16 The biggest impact appeared in the social domain, with far lower scores linked to loneliness and difficulty trusting others.16 

Put simply, paranoia can reach into every part of a person’s life and make general well-being much harder to maintain.

What Therapies Help With Paranoid Thoughts?

Talk therapies are widely regarded as a first-line treatment for paranoid thoughts,17 as they give people a space to explore what they’re feeling and learn healthier ways to respond. Below, we look at two commonly used forms of paranoia treatment options and how they can directly support someone dealing with paranoia.

Cognitive Behavioral Therapy

CBT is a type of therapy that focuses on helping people uncover and challenge unhelpful thought processes. This can be especially useful for those with paranoia, as the vast majority of paranoid thoughts come from flaws in the thinking process that can lead to inaccurate conclusions.

The therapist will focus on creating a safe environment for the person with the hope that they lower their guard enough to speak openly about their suspicions or why they might be in danger.18 

Once the groundwork for open discussion has been set, the therapist gradually introduces cognitive restructuring. This involves examining the evidence for and against the paranoid belief and considering explanations that feel less threatening but still realistic.18 

Research shows that this kind of detailed thinking work can reduce the strength and impact of delusional beliefs by helping the person see their thoughts from new angles.19

CBT for paranoid thinking also brings in practical coping tools,19 such as grounding techniques or keeping a thought journal. These methods give the person a way to pause when paranoia increases and turn to the new thinking patterns instead of reacting out of fear. 

Clinical studies show that combining these strategies can reduce paranoid intensity by improving cognitive flexibility and strengthening day-to-day problem-solving.19

Dialectical Behavior Therapy

DBT is based on CBT but designed specifically for people who struggle with very intense emotions,20 in this case, paranoid thoughts. DBT teaches skills that supplement distress management and communication skills,20 meaning that for someone with paranoia, the core issues that may lead to suspicious thoughts are worked on.

One of the core DBT skills, mindfulness,20 is another reason why DBT may be suitable for treating paranoia. It encourages people to stay more aware of their thoughts and actions in the present, which can help them notice the early stages of a paranoid pattern. 

For example, someone who becomes aware of the thought processes that lead them to feel suspicion or danger can recognize it as a thought rather than a real threat. This awareness makes it easier to label the thought as paranoid and begin separating it from reality.

Mission Connection: Professional Support for Paranoia Mental Health Symptoms

If you or someone close to you has been dealing with paranoid thoughts and these thoughts are starting to affect daily life, reaching out for support can make all the difference. We understand how nerve-racking it can be to ask for help, but when you contact Mission Connection, you’ll be met with steady guidance and genuine understanding.

We work with people who experience persistent paranoid thoughts and the conditions linked to them, including psychosis and schizophrenia. We also recognize that paranoia can create emotional strain, and many people develop anxiety or depression alongside it. These needs are treated with the same level of care and expertise.

Mission Connection offers support across the US through outpatient care for those who need flexibility for their treatment process. We also offer residential programs for those with psychosis and would benefit from time away from their usual environment. Our licensed therapists are here to walk you through every stage of treatment, regardless of setting, and guide you to a position where you can focus solely on your own needs.

By getting in contact with Mission Connection today, you’re opening the door to a new world and the beginning of a new life. We’re ready and awaiting your call.

Woman smiling and looking at her laptop, receiving therapy for paranoid thoughts in adults

References

  1. MIND. (2024). What is paranoia? Mind.org.uk. https://www.mind.org.uk/information-support/types-of-mental-health-problems/paranoia/what-is-paranoia/
  2. Cleveland Clinic. (2024, February 7). Paranoia. https://my.clevelandclinic.org/health/symptoms/paranoia
  3. Combs, D. (2004). The role of subclinical paranoia on social perception and behavior. Schizophrenia Research, 69(1), 93–104. https://doi.org/10.1016/s0920-9964(03)00051-3
  4. Freeman, D., & Loe, B. S. (2023). Explaining paranoia: cognitive and social processes in the occurrence of extreme mistrust. BMJ Mental Health, 26(1). https://doi.org/10.1136/bmjment-2023-300880
  5. So, S. H., Sun, X., Chan, G. H. K., Chan, I. H. H., Chiu, C. D., Chan, S. K. W., Wong, W. Y. E., Leung, P. W., & Chen, E. Y. H. (2020). Risk perception in paranoia and anxiety: Two investigations across clinical and non-clinical populations. Schizophrenia Research: Cognition, 21, 100176. https://doi.org/10.1016/j.scog.2020.100176
  6. MedlinePlus. (2013). Paranoid personality disorder: MedlinePlus Medical Encyclopedia. Medlineplus.gov. https://medlineplus.gov/ency/article/000938.htm
  7. Zimmerman, M. (2023, September). Paranoid Personality Disorder (PPD) – Psychiatric Disorders. Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/paranoid-personality-disorder-ppd
  8. Cleveland Clinic. (2022, May 22). Delusional disorder. https://my.clevelandclinic.org/health/diseases/9599-delusional-disorder
  9. World Health Organization. (2022). Schizophrenia. https://www.who.int/news-room/fact-sheets/detail/schizophrenia
  10. Mayo Clinic. (2024, October 16). Schizophrenia. https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
  11. National Institute of Mental Health. (2024). Bipolar Disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder
  12. Fletcher, J. (2023, September 23). Bipolar psychosis: Symptoms, treatment, and tips. Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/314450#bipolar-psychosis
  13. Hatzipanayioti, A., Walther, S., Gangl, N., Conring, F., Wüthrich, F., & Stegmayer, K. (2025). Aberrant personal space is associated with paranoia, altered stress regulation, and unfavourable outcomes at 6 months’ follow-up in schizophrenia. Molecular Psychiatry. https://doi.org/10.1038/s41380-025-02999-x
  14. Cleveland Clinic (2024, October 22). Provider Insight and Empathy Can Help Improve Outcomes, Preserve Dignity of Patients With Schizophrenia. https://consultqd.clevelandclinic.org/provider-insight-and-empathy-can-help-improve-outcomes-preserve-dignity-of-patients-with-schizophrenia
  15. Freeman, D., Bold, E., & Chadwick, E. (2019). Suicidal ideation and behaviour in patients with persecutory delusions: Prevalence, symptom associations, and psychological correlates. Comprehensive Psychiatry, 93, 41–47. https://doi.org/10.1016/j.comppsych.2019.07.001
  16. Hui, C. L. M., Chan, E. W. T., Hui, P. W. M., Tao, T. J., Ho, E. C. N., Lam, B. S. T., Wah See, S. H., Suen, Y. N., Chang, W. C., Wa, S. K., Lee, E. H. M., & Chen, E. Y. H. (2023). Functional and clinical outcomes of delusional disorder and schizophrenia patients after first episode psychosis: a 4-year follow-up study. BMC Psychiatry, 23(1), 1–10. https://doi.org/10.1186/s12888-023-05175-z
  17. Shahedul Islam, M., Mmu, A., Mm, R., Mf, A., Ck, S., Mh, R., Mn, U., & Article, R. (2021). Quality of life Among Patients With Delusional Disorder: A Cross Sectional Comparative Analytical Study Journal of Psychiatry. Journal of Psychiatry, 24, 1000–1785. https://www.walshmedicalmedia.com/open-access/quality-of-life-among-patients-with-delusional-disorder-a-cross-sectional-comparative-analytical-study.pdf
  18. Freeman, D., & Garety, P. (2018). Helping patients with paranoid and suspicious thoughts: a cognitive–behavioural approach. Advances in Psychiatric Treatment, 12(6), 404–415. https://doi.org/10.1192/apt.12.6.404
  19. Berkhof, M., van der Stouwe, E. C. D., Lestestuiver, B., van’t Hag, E., van Grunsven, R., de Jager, J., Kooijmans, E., Zandee, C. E. R., Staring, A. B. P., Pot-Kolder, R. M. C. A., Vos, M., & Veling, W. (2021). Virtual reality cognitive-behavioural therapy versus cognitive-behavioural therapy for paranoid delusions: a study protocol for a single-blind multi-Centre randomised controlled superiority trial. BMC Psychiatry, 21(1). https://doi.org/10.1186/s12888-021-03473-y
  20. Cleveland Clinic. (2022). Dialectical behavior therapy (DBT). https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt