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What Is Paranoia?

Psychotic Features of Bipolar Disorder


Updated July 10, 2014


A community member voiced this question about paranoia in our forums:

"Is anyone else extremely paranoid? I always think someone is talking about me, and I think they all laugh behind my back and everyone has these elaborate schemes that are made to get me .... So my question is, does anyone else experience this, and if so, is paranoia part of being bipolar?"

Paranoia is a term that in common, everyday language is used to mean everything from feeling nervous about a person or situation to being convinced that somebody is "out to get you." In his song "Almost Cut My Hair," David Crosby expressed this common usage well when he said, "It increases my paranoia, like looking in my mirror and seeing a police car." I'll wager almost everyone feels uneasy (and watches speed, signals and everything else) when police officers are right behind them.

People may call that type of experience paranoia, but medically, the definition of paranoia is more precise. Psychiatrists use the term paranoia to describe a disordered way of thinking or an anxious state that attains the level of a delusion. For example, a person who believes the FBI is tracking her every move through the fillings in her teeth is exhibiting paranoid behavior. On the other hand, a criminal who believes the FBI is listening in on his telephone calls is not likely paranoid, because it may well be true.

The key to true paranoia is that the person exhibits an unreasonable and/or exaggerated mistrust and suspicion of others. This suspicion is not based on fact and often grows into delusions. Thus, paranoia is a symptom that can be part of several syndromes, including delusional disorder, paranoid personality disorder, psychotic and mood disorders (including bipolar disorder and schizophrenia), as well as other conditions (such as brain toxicity that may be caused by drug or alcohol abuse, mineral poisoning, etc).

The community member who asked about paranoia may be experiencing these symptoms due to bipolar disorder, but they could be indicating another condition. It is important to discuss feelings of paranoia with one's psychiatrist and work toward methods to control them, as symptoms like these are certainly unpleasant and could be disruptive.

Here are some other thoughts from community members about paranoia:

  • Tom: Before I was diagnosed with BPD, my friends and family told me that I was extremely paranoid, and I was. I hated parties, large crowds, the mall, because it felt that everyone was staring or talking about me. Through therapy and medications, this has subsided. I still have my days, but I least now I have the tools to deal with it.
  • LACME1965: I feel exactly the same way. I very often worry about what people think about me- that they are laughing about me or whispering about me behind my back. Even that they make facial gestures to each other with some kind of inside joke about me.

    It even happens when I’m with a group of good friends. I feel fine when I first get there, but as the evening/day goes on, I start to feel like I’m on the outside looking in, like I don’t belong, or fit in- and I just want to disappear. I end up slowly moving away from the group, thinking that they will not even notice I am gone. I usually get to a breaking point where I just need to leave- almost a panic attack sort of thing.

  • Mikel: Maybe they really are talking about you. I have inside jokes about people all the time and nicknames for them that they have no idea we’re talking about them. Just because your paranoid doesn’t always mean there's no one out to get you. People are often mean.

  • Jane: Mikel, you might be right. However, people who don’t have paranoia don’t experience the same feelings LACME1965 has. At least some mentally healthy people are not really bothered by the fact that someone is making fun of them behind their backs or making inside jokes about them.

    I had the same kind of problem LACME1965 described, and after taking antipsychotics, these feelings went away and I started feeling like I could finally fit in. And all of a sudden, people stopped talking about me.

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