Imagine living every day with the knowledge that there are mean spirited spies watching your every move. No matter where you go or what you do, you are tailed, bugged and being stalked so that at the right moment these malevolent forces can take you down.

That would be a pretty frightening existence wracked with constant worry and fear. For some individuals, this worry is the result of a legitimate threat to their well-being, but that is not the case for everyone experiencing this kind of existence.

Paranoia is a commonly portrayed psychiatric symptom where individuals mistakenly believe that everyone is watching them or trying to ‘get them’. It is a form of delusion, which for obvious reasons can be extremely disabling.

Paranoia commonly occurs as a symptom of broader psychiatric conditions such as depression, bipolar disorder, delirium or schizophrenia – and it also frequently accompanies drug abuse.

But it’s not always just a symptom. Sometimes, paranoia can exist as a disorder in itself as in delusional disorder or paranoid personality disorder. In the former there are non-bizarre delusions involving situations that occur in real life, such as being followed, poisoned, infected, or deceived by spouse or lover. These delusions are not a symptom of another disorder but the disorder itself. In the latter there is a pervasive distrust and suspiciousness of others where other people’s motives are consistently interpreted as malevolent.

This personality disorder typically begins in early adulthood and must be accompanied by at least four trademark symptoms.

Symptoms include: suspicion without basis that others are exploiting, harming or deceiving him or her; preoccupation with unjustified doubts of the loyalty of friends; reluctance to confide in others fearing that information will be used against him or her; reading threatening meanings into common remarks or events; persistently bearing grudges; perceiving attacks against his or her character with no reason and reacting aggressively; and recurring, unjustified suspicion that spouse is unfaithful.

In addition to these symptoms, the paranoia must not occur exclusively during a psychotic episode or a mood disorder and should not be due to the direct effects of a general medical condition.

Obviously, paranoia in any form can cause serious problems for daily living and can destroy relationships as the paranoid individual is always suspicious of those around him or her. On rare occasions a second person (such as a spouse) believes the delusions of the paranoid individual. This is called “folie a deux” and then disrupts the lives of both parties.

Aside from being hard to get along with, paranoid individuals can also be quite dangerous. Aggressive behaviour often results from their belief that people are trying to harm them – and from their point of view it is understandable as they often believe they are simply trying to defend themselves.

Unfortunately, paranoia can be difficult to diagnose because it is sometimes hard to know if the person is actually delusional or is truly experiencing some form of persecution. If the physician doesn’t have another source of information and the delusions are not totally out of the question it becomes very difficult. In these cases, there must be enough things that seem sufficiently implausible for a conclusion to be obvious.

Also, although treatment is important, many paranoid individuals will not seek treatment on their own because they don’t believe their problems are medical in nature. Often, family members must bring them in or they may seek help for anxiety related to their delusions.

When a person is available for treatment, it is important to first determine whether there is a broader underlying condition. Treatment begins by treating the underlying condition. Often, this will alleviate the delusions.

If paranoia is the primary symptom, therapy can be helpful alone or in combination with an anti-psychotic medication or anti-depressant to treat suspicion and irritability.

Finally, paranoid delusions should not be ignored. If someone you love seems to be experiencing unfounded suspicions and fears, seek the help of a professional.


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