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paranoia
Paranoia
Understanding paranoia
This booklet describes the feelings and
experiences associated with paranoia. It
explores possible causes, steps you can take to
recognise when fears might be exaggerated
and suggests techniques to help you change
the way you react to suspicious thoughts. It
also discusses professional treatment, and how
friends and family can help.
Contents
What is paranoia?...................................................................... 4
Useful contacts........................................................................ 18
3
Understanding paranoia
What is paranoia?
It is common to have suspicious thoughts or worries about other people
from time to time. These fears are described as paranoid when they are
exaggerated and not based in fact. There are three key features of paranoid
thoughts:
There are different types of threat or harm that you may feel paranoid about;
for example:
• p
sychological or emotional harm – bullying, spreading rumours about you
• physical harm – trying to physically hurt or injure you, or even trying to
kill you
• financial harm – stealing from you, damaging your property or tricking
you into giving away your money.
Depending on what your paranoid thoughts are, they can bring up a wide
range of emotions. You may feel:
4
What are the different types of paranoia?
More severe paranoid thoughts are less common, but have a more significant
impact on day-to-day life. They are likely to be very alarming, and leave you
feeling terrified, isolated and exhausted.
This pyramid diagram shows some of the levels of threat you might feel – the
more personal the threat, the higher the level of paranoia. The thoughts at the
bottom of the triangle are experienced by more people than those at the top.
Feeling
under
severe
personal threat
e.g. MI5 are using
the TV to control
my thoughts
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Understanding paranoia
In the examples in the diagram, thoughts are divided into distinct levels of
threat; however, in reality, you are likely to find that your thoughts move
between levels at different times. You might also find the ‘lower level’
concerns cause significant distress if they last for a long period of time. Also,
the sense of threat you experience can develop and get stronger over time.
If your thoughts are more extreme, or have been present for a long time, it
will feel that your fears are real. This can be very isolating, as other people
are unlikely to share your views. Having to cope with your own feelings of
alarm and not being believed can be very distressing.
6
What are the different types of paranoia?
Paranoid schizophrenia
Paranoid schizophrenia is a particular type of schizophrenia that features
extreme paranoid thoughts. If you experience paranoid schizophrenia, then
you may also hear voices, which might confirm your paranoid feelings and
cause you further distress by mocking or threatening you. You might also feel
that you are an important or powerful person, such as a religious figure or
royalty, which is why you are being persecuted.
Other diagnoses
Other diagnoses that may include paranoid feelings are bipolar disorder,
schizoaffective disorder, severe anxiety or depression, and postnatal
psychosis. See Mind’s website or Understanding booklets for more
information about all of these diagnoses.
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Understanding paranoia
Life events
A sudden increase in stress can be very significant. If you have lost a job or
a relationship has ended, this can make you feel very isolated and might
mean that you turn inwards and feel insecure and under threat. Life events
that involve a betrayal or emotional pain for example, if you are bullied in
your workplace, or your home is burgled can also form the root of suspicious
thoughts that then develop into paranoia.
External environment
Some research has suggested that paranoid thoughts are more common if
you live in an urban environment or a community where you feel isolated
rather than connected. Media reports of crime, terrorism, violence and other
social issues might also play a role in triggering paranoid feelings. High levels
of stress associated with modern lifestyles might also put you at greater risk.
Poor sleep
If you have trouble sleeping this can also have a big impact on paranoia.
Fears and worries can develop late at night when you are alone with your
thoughts, and feeling constantly tired can trigger feelings of insecurity.
8
How can I help myself?
Childhood influences
What happens in your childhood might play a part. If you were brought
up to believe that the world is a very unsafe place and that people are
untrustworthy, this might affect the way you think as an adult. If your
childhood was abusive or neglectful you are also likely to feel mistrustful and
suspicious of others.
Physical causes
Paranoia, as a symptom, is linked with certain physical illnesses, such as
Huntington’s disease, Parkinson’s disease, strokes, Alzheimer’s disease and
other forms of dementia. Hearing loss can also trigger paranoid thoughts for
some people.
Lifestyle
Some of the possible causes or triggers for paranoid thoughts explored in the
last section are connected to lifestyle. If you are able to improve your overall
wellbeing, you are likely to feel more grounded, and will be better able to
cope with your fears if they arise.
Sleep well
Lack of sleep can be a major trigger in the development of paranoid
thoughts. Try to prioritise a regular sleep pattern over other activities.
Relaxing with a bath or a good book before bed can help, and making sure
you have had enough exercise during the day to physically tire you out can
help you to sleep more easily. See How to cope with sleep problems for more
information.
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Understanding paranoia
Eat well
Although it is unlikely that any foods cause paranoid thoughts, if you eat
regular healthy meals it can make a big difference to your overall sense of
wellbeing. The links between food and the way you feel are explored further
on the Mental Health Foundation’s website at www.mentalhealth.org.uk
Practical techniques
Three key features of paranoia which can make understanding and
communication with other people difficult are: feelings of alarm, the content
of your thoughts, and your fear of sharing your thoughts. Reflecting on these
areas can help you to understand your experiences more deeply.
Techniques associated with cognitive behaviour therapy (see p. 13) can help
you to take a step back from your immediate situation, and begin to analyse
your thoughts.
10
How can I help myself?
Keep a diary
You might find it helpful to track your thoughts and feelings for a short time.
At the end of each day, or every few days, take some time to write down the
thought or thoughts that have been troubling you most of all and make a
note of how many times a day they worry you.
For example:
• My sister said she would call on Saturday.
• By 5pm she hadn’t called.
• She must be ignoring me.
• By 8.30pm there was still no call, she must hate me.
• My whole family hate me, none of them have called today.
• I phoned a friend and they didn’t answer.
• Convinced everyone hates me.
• Worried that they are plotting together to make me upset.
• Read old emails and started to see double meanings in them.
• Became increasingly scared and suspicious.
• Stayed awake most of the night.
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Understanding paranoia
I feel that everyone hates me and they are conspiring to make me miserable
12
What treatments are available?
If you are experiencing particularly severe thoughts you might not have much
control over what you say. If you have disclosed things that you feel unhappy
about at a later point, you might find it helpful to discuss how you now feel,
and agree what you are now comfortable talking about.
This section has given a short outline of some techniques that might help
you to understand and challenge distressing thoughts and feelings. For more
examples of ways people have managed their thoughts see ‘Coping Tips’ on
the Paranoid Thoughts website (see ‘Useful contacts’).
Talking treatments
Cognitive behaviour therapy (CBT) is a type of psychological (talking) therapy that
has become popular in the UK in recent years. It involves examining your thinking
patterns and the evidence you have for your beliefs. It then aims to help you find
alternative interpretations to the ones that are distressing you. Many people find
CBT is a helpful way to cope with paranoid thoughts. It can help you to take a
step back from your thoughts, and find new ways to deal with the alarm that they
cause. (See Mind’s booklet, Making sense of cognitive behaviour therapy (CBT).
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Understanding paranoia
An important aspect of all talking treatments is finding a therapist that you trust
and feel comfortable with. If you are feeling particularly threatened or suspicious
of other people, you might find it difficult to establish a good relationship.
It might be helpful to agree with your therapist what action you will take if your
paranoia worsens; for example, pausing sessions until you feel able to engage
with the process again.
Medication
Medication is not normally prescribed to treat paranoid thoughts, but if
you are particularly anxious or depressed, your GP might recommend anti-
depressants or tranquillisers to relieve the symptoms. There are side-effects
associated with both types of drug. See Making sense of anti-depressants and
Making sense of sleeping pills and minor tranquillisers for more information.
However, not everybody finds antipsychotics helpful, and they are only expected
to lessen symptoms, not cure the problem. They can also have very serious
physical and emotion side effects, causing problems with movement, weight and
sexual function. For more information, see Making sense of antipsychotics.
If you are prescribed any medication, then you should be given an explanation
of what the medication is for, possible side effects and any alternative treatment
options by your doctor. In almost all circumstances your agreement is required
before you are given medication. The only situation where this is not the case
is if you are subject to certain parts of the Mental Capacity Act or the Mental
Health Act, (see Mind’s website for information about Consent to Treatment).
14
What treatments are available?
Complementary therapies
Some people find complementary therapies such as hypnotherapy,
massage and acupuncture help to manage anxiety and upsetting feelings
associated with paranoid thoughts. The clinical evidence for these therapies
is not always as robust as it is for other treatments. A body called the
Complementary and Natural Healthcare Council exists to provide regulation
for complementary therapists and lists details of therapists registered with
recognised professional organisations. (See ‘Useful contacts’ on p. 18).
Arts therapies
Arts therapies are a way of using the arts – for example, music, painting, clay,
dance, voice or drama – to express yourself in a therapeutic environment
with a trained therapist. The therapist helps to make sense of what you have
created in relation to your experiences and state of mind. See Mind’s online
booklet Making sense of arts therapies, for more information.
As explored in the section on talking therapies, you might find these more
beneficial if you are able to build a relationship of trust with the therapist.
Support groups
You might find it helpful to take a break from your normal situation. There
are a growing number of support groups offering a chance to talk to people
who have had similar experiences. The National Paranoia Network is working
to develop groups for people who experience paranoid thoughts and many
local Minds also support groups for people with mental health issues (see
‘Useful contacts’). The Mind Infoline can provide further information about
local support if you find it difficult to find a group close to you.
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Understanding paranoia
If you have a high level of need, or require support from more than one
professional, you might be offered a package of care under the ‘Care
Programme Approach’. You should have one professional (your care
coordinator) who will consult with you to produce a care plan which sets out
all of the services which you need to access. This should be tailored to your
needs, and reviewed regularly. (See Mind’s website for The Mind guide to
community based mental health and social care).
If you are not willing to go into hospital as a voluntary patient but you are
assessed and felt to be a risk to yourself or others, you could be detained
under a section of the Mental Health Act 1983. (See Rights guide 1: civil
admission to hospital.)
Recovery
It is possible to recover from paranoia. This might mean that you no longer
have any paranoid thoughts, or it could be that they no longer disrupt your
life or cause you distress. After recovery you may feel inspired to continue
with or take up a new direction in life. The Scottish Recovery Network
website provides more information and resources about recovery and mental
health (see ‘Useful contacts’ on p. 18).
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What can friends and family do to help?
Be aware of feelings
Even if you don’t agree that your relative or friend is under threat or at risk,
try to understand how they are feeling. Don’t be dismissive – the feelings
that they have are real, even if the thing they fear is unfounded. Focus on
the level of distress or alarm that they are experiencing and offer reassurance
and comfort.
Be honest
If you are honest with your friend or family member about how you feel, it
will help to establish trust over time. Your point of view might be reassuring
to the person, reinforcing the possibility that what they fear may not actually
be happening. It is possible to recognise their alarm and acknowledge their
feelings without agreeing with the reason they feel this way.
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Understanding paranoia
Useful contacts
Mind Complementary and Natural
Mind Infoline: 0300 123 3393 Healthcare Council
(Monday to Friday 9am to 6pm) tel: 020 3178 2199
email: info@mind.org.uk web: www.cnhc.org.uk
web: www.mind.org.uk Maintains a register of complementary
Details of local Minds and other local healthcare practitioners
services, and Mind’s Legal Advice Line.
Carers UK
Language Line is available for talking
in a language other than English. helpline: 0808 808 7777
web: www.carersuk.org
Anxiety UK (formerly the National Information and advice on all aspects
Phobics Society) of caring
tel: 08444 775 774
web: www.anxietyuk.org.uk Hearing Voices Network
Information, counselling, helpline and web: www.hearing-voices.org
tel: 0114 271 8210
online support for those suffering
Information, support and
from anxiety disorders
understanding to people who hear
voices and those who support them
Be Mindful
web: www.bemindful.co.uk National paranoia network
Website that explains the principles web: www.nationalparanoianetwork.org
behind mindfulness, and gives detailstel: 0114 271 8210
of local courses and therapists Information, support and
understanding for people who
British Association for Behavioural experience paranoid thoughts
and Cognitive Psychotherapies
tel: 0161 705 4304 Paranoid thoughts
web: www.babcp.com web: www.iop.kcl.ac.uk/apps/
Has a list of accredited behavioural paranoidthoughts/default.aspx
and cognitive therapists Website about unfounded or
excessive fears about others.
British Association for Counselling Contains personal accounts and
and Psychotherapy (BACP) further reading
tel: 01455 88 33 00
web: www.itsgoodtotalk.org.uk Scottish Recovery Network
For details of local practitioners web: www.scottishrecovery.net
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