Paranoia & suspicious thoughts

Noticing possible threats has always helped people stay safe. When we are stressed, tired or low, the mind can start to see danger in ordinary things, like a glance or a laugh nearby.

People describe

• Feeling people are talking about you or laughing at you
• Feeling watched or followed
• Thinking others are trying to upset or embarrass you
• Worrying that someone wants to hurt you
• Finding it hard to trust friends or family

These thoughts can bring anxiety, low mood, poor sleep and a wish to stay away from people.

A large survey found paranoia was linked with less happiness, poorer social life, less support and a wide range of other mental health struggles.

The good news is that the things that feed paranoia, like worry and poor sleep, can be worked on.

Researchers call this interpersonal sensitivity. It is the most common rung on the ladder and very ordinary, like worrying you said something silly at a party.

Mistrust is a general sense that people may not be honest or kind. It is another of the four kinds of paranoid thinking found in a large British survey.

If you have been hurt, bullied or treated unfairly before, being careful can make sense. It becomes a problem when it stops you trusting people who are safe.

Researchers call these ideas of reference: feeling that a laugh, a look or a news story is aimed at you, when it may not be.

This is the rarest and most distressing rung. In a national survey, 1.8% of adults said they had felt in the past year that there were plots to cause them serious harm.

When these fears are held very strongly and don’t shift, a clinical provider may see them as part of a health condition that deserves care.

A worrying thinking style keeps unlikely ideas in mind and adds to distress. Research shows worry predicts paranoia starting and lasting.

Feeling inferior or vulnerable makes paranoia more likely. Expecting criticism or rejection can tilt how we read other people’s actions.

Research links paranoia with jumping to conclusions and finding it harder to consider other explanations. These are habits of mind that anyone can have, and they can be practised.

In a national survey, paranoia was linked with being younger, being single, poverty, poor physical health, stress at work, less social support and less sense of community.

The authors note some of these may help cause suspicious thoughts, while others may be a result of them.

Childhood trauma and abuse are linked to psychosis, and some evidence links childhood neglect to paranoia. Researchers also note connections between PTSD and paranoia.

Urban living is linked with more psychotic experiences, and one study found that going into a busy urban area increased paranoia, anxiety and negative thoughts about oneself.

Insomnia is linked with paranoia and may predict it starting and lasting. Going a long time without sleep is a known cause of psychosis.

In a trial with 3,755 students, an online sleep programme improved sleep and led to small drops in paranoia and hallucinations. Better sleep helped explain the change.

NIDA lists anxiety, fear, distrust, panic and hallucinations among short-term effects of cannabis. These are more common with large amounts, strong products or little experience.

Cannabis can also bring on a temporary psychotic episode in some people, especially at high doses.

In a national survey, paranoia was linked with cannabis use and problem drinking. The NHS lists drug misuse and alcohol-use disorder as possible triggers for psychosis.

Physical conditions, a head injury and some brain conditions can lead to psychosis. A health check is an important first step if suspicious thoughts appear suddenly.

In Alzheimer’s disease, a person may become suspicious of people around them, such as believing things have been stolen.

NIMH lists suspiciousness or paranoid ideas among the changes that can come before psychosis, along with poor sleep, pulling away from people and trouble thinking clearly.

A large survey found paranoia was linked with anxiety, worry, phobias, post-traumatic stress, insomnia and thoughts of suicide.

Getting help for these can ease suspicious thoughts too.

A person with Alzheimer’s may become suspicious of those around them. The Alzheimer’s Association notes the situation feels very real to the person, even though it isn’t based in reality.

Tips for carers

• Don’t take offence: the illness is causing the behaviour
• Keep explanations short and simple
• Listen to the worry behind the accusation
• Offer reassurance, and gently switch to another activity

How to try it

1. Pick a set half-hour each day for worrying
2. When a worry pops up at other times, note it down for later
3. In your worry period, look at the worries and work on any real problems
4. When time is up, move on to something absorbing

Note when suspicious thoughts come up, what was happening, and how strongly you believed them. Over time you may see links with tiredness, stress or certain places.

Pick one suspicious thought and list the evidence for and against it. Ask yourself what you would say to a friend who had the same worry.

Other explanations to consider

• Could they be laughing at something else?
• Could they be busy, tired or having a bad day?
• Is this how I’d see it if I’d slept well?

Avoiding feared situations can keep paranoia going. Testing thoughts means slowly going into situations you fear, starting with easier ones, and seeing what really happens. Never put yourself in real danger.

Fighting a thought can make it louder. Instead, try noticing it with some distance, like a cloud passing, without spending time going over it.

Telling a trusted person about your fears can ease the load and help you check your thoughts against another view.

Tiredness and stress make paranoia more likely. Good-quality sleep, regular exercise and healthy eating all help.

The NHS describes CBT for psychosis as based on how people make sense of their experiences. A therapist helps you consider other ways of understanding what is happening, and work towards your own goals.

Feeling Safe is a talking therapy developed in Oxford. It works on things that keep fears of harm going, such as worry, poor sleep and low self-confidence, and helps people get back into everyday life.

In a trial with 130 people whose fears had lasted despite standard care, about half showed large benefits and about a quarter made moderate gains, over about 20 sessions.

A large trial found that a CBT-based online sleep programme reduced insomnia and led to small but real drops in paranoia.

The NHS says family intervention is an effective therapy for people with psychosis. It helps the person and their family cope together.

What helps

• Ask about their fears, and don’t argue
• Give them space, so they don’t feel trapped
• Move away from noise or crowds if you can
• Say what you’re going to do before you do it
• Tell them you want to help
• Use short, simple sentences

Talk about their fears when they are not feeling so unsafe, and make a plan for handling them when they come back. You could help them make a list of their fears.

Don’t push them to write or say things they don’t want to. Pressure can make them feel you are part of the problem.

If you are accused of something, try not to get defensive. Listen to what is worrying them, and offer calm reassurance.

If someone is threatening you, or you think anyone is in danger, call for help. In the U.S., call 911 in an emergency, or call or text 988 for crisis support.

Make time for rest and your own support. Carer support groups can be a place to swap ideas with others who understand.