20 Most Common Paranoia Symptoms

Medically reviewed by Laura Angers Maddox, NCC, LPC
Updated June 5, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that include suicide which could be triggering to the reader. If you or someone you love is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Paranoia can be present in certain mental health disorders. Schizophrenia is perhaps the most well-known disorder that commonly has paranoia and paranoid thoughts as a symptom. However, paranoia can also be present in personality disorders where there is a psychotic element, including bipolar disorder or even severe depression.

When paranoia is frequent, and multiple symptoms occur simultaneously, it can be a sign of a mental health condition or personality disorder that needs attention.

While not all the following symptoms of paranoia mean the presence of a mental health disorder, if symptoms are severe enough and there are multiple symptoms, it may be worth checking in with a professional psychiatrist or psychologist.

What does it mean to be experiencing paranoia?

Low self-esteem

While low self-esteem does not necessarily mean one has paranoia, it can be a precursor to paranoia. Studies have found that low self-esteem is linked to paranoia symptoms. However, there is some debate about this within the psychiatric community. If low self-esteem is present, along with a combination of other symptoms, it can be a contributing factor.


Studies have shown that insomnia can be a paranoia symptom. When someone is paranoid, they may have a difficult time calming their mind enough to be able to fall asleep. If they do sleep, dreams may often be disturbing and extremely vivid, so they don't sleep long. The lack of sleep can, in turn, exacerbate symptoms.

Of course, many people have insomnia without having other paranoia symptoms. If you don't have any other symptoms of paranoia, there are many natural remedies for insomnia that you can try. You can also speak with a medical provider if your insomnia is causing disruptions to your daily life.

Seeing accidents as meaningful

People living with paranoia tend to see accidents as being meaningful. To someone who is paranoid, everything happens for a reason and accidents are rarely accidents. If someone were to trip and fall right in front of them, they might assume that the person was trying to attack them or was put in their path for some purpose.


Many people who are paranoid tend to be isolated. They may feel unable to trust anyone, and because of this, they cut themselves off from other people. They are often so worried about what others think of them that they choose not to interact with others at all.

This isolation typically goes far beyond simply being an introvert or feeling shy. The isolation that occurs with paranoia is absolute. It is isolation not just from social situations, but things as simple as going to the grocery store or going to work. People who are paranoid might have difficulty being around almost anyone.

Feeling powerless

Many people with paranoia may feel completely powerless about their situation and everything in their lives. For example, they may feel powerless when it comes to situations where they must interact with other people. They often perceive that other people have complete control over them or the situation and that they are powerless to stop it.

They might also feel that they are unable to change their situation. People experiencing paranoia frequently stay stuck in a rut, taking little to no action whatsoever, similar to procrastination. They often cannot be productive because they feel that they have no power to do anything to better themselves or their lives.


Again, depression alone does not mean that someone is paranoid. An individual may have symptoms of depression and not paranoia. However, studies have shown that depression can be a precursor to paranoia symptoms and episodes of delusion.

People who are paranoid can become depressed during an episode. They may feel so powerless and persecuted all the time that they begin to feel despair that it will never be better. They can lose all hope and fall into a deep depression, which can, in turn, increase paranoid symptoms.

Problems forming relationships

People who experience paranoia often have issues with forming and keeping relationships. They can have a very hard time trusting others, often feeling that people are "out to get them." Because of this, their circle tends to be very small, or perhaps nonexistent.

People with paranoia symptoms also have trouble forming relationships because they have low self-esteem and feel that they are unworthy of the attention of others. They cut themselves off from other people because they recognize that they are different, and they may be so afraid of what others think of them that they don't take the chance to get to know someone.

Irrational mistrust

People who are paranoid generally have an irrational mistrust of nearly everyone and everything. Every person they see is a suspect. They usually don't believe the things that people say, including the media, doctors, or friends and family.


This mistrust can be so severe that they don't trust what is in their food and therefore don't eat. They may not trust the mailman or the grocery store clerk. They often don't trust banks or other financial institutions and have trouble trusting in situations where they have little control.

Unfounded suspicion

People with paranoia symptoms are also very suspicious, usually without cause. They may suspect most everyone of wrongdoing. If a stranger looks in their direction on the train or along the sidewalk, they may automatically assume that the person wishes them ill will.

This unfounded suspicion can become so severe that they may become suspicious of everyone and everything. This often makes it very challenging to function in and out of society.

Hypersensitivity to criticism

One of the most common symptoms of paranoia is hypersensitivity to criticism. When someone who is paranoid receives criticism about their work, their speech, or their behavior, they often become defensive. They do not look at criticism as constructive or a learning experience, but rather as a personal attack.

When someone living with paranoia receives criticism of any kind, they feel that the person giving the criticism either wants something from them or means them harm. They become immediately suspicious of their motives, and they are likely to mistrust their opinion entirely.

Hypersensitivity to perceived persecution

Persecution involves hostility and negative treatment toward individuals or groups based on political or religious beliefs. This is different from perceived persecution, which is the belief that someone is being persecuted (when they may not be).

When an individual is hypersensitive to perceived persecution, this becomes a symptom of paranoia. This hypersensitivity could cause them to believe that everyone they meet is going to persecute them as the object of their obsession. Again, this means that nearly everyone is met with immediate and severe suspicion.


People who are paranoid are often very stubborn in their beliefs. It can be difficult to convince a paranoid person to trust you if they are experiencing irrational mistrust. Individuals in relationships with them will often also be unsuccessful in getting them to go out in public if they are certain that someone is a danger to their life.

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What does it mean to be experiencing paranoia?

These individuals may hold on very strongly to their perceptions about what is happening around them or what will happen in certain situations. They may not waver in their thoughts on these matters. Their delusions about what is real or imagined in the way of trust, suspicion, and other matters are absolute and can last for months or even years without treatment.

Delusions of control

Many people who live with paranoia have delusions of control. This means that they are certain that an outside source is controlling them. That source could be the government, aliens, ghosts, or demons. When delusions of control take hold, they feel that they cannot be held accountable for their actions. They also begin to suspect everyone of being in on the plot to control them, especially when those people deny that the control is taking place.

Delusions of grandeur

Another symptom that is common among people with paranoia is delusions of grandeur. Delusions of grandeur refer to delusions where the person believes that they have special powers, abilities, riches, or that they are a very important person. Typically, this becomes a problem when these delusions cause the individual to not be able to function properly.

For example, if someone has the delusion that they are wealthy, they may spend all of their money frivolously and then not have money for food. When the money runs out, they don't believe that they should be out of money and may immediately begin blaming whomever their mind gravitates to for the crime.

Delusions of persecution

This symptom is like hypersensitivity to persecution but is different because it means that the persecution the person fears is imaginary. Delusions of persecution occur when the individual is certain that they are being persecuted for something that either does not apply to them or is not typically a matter of persecution in society.

This also refers to the idea that everyone is "out to get them." They may have delusions that they are being persecuted by the government because they are wanted for experiments or some knowledge that they are supposed to have. Or they could imagine they are being persecuted because they think they forgot to pay the bus fare.

Delusions of reference

Delusions of reference refer to the belief that an insignificant object or situation was designed specifically for the individual. This can work either positively or negatively. They may believe that they are special because something was created just for them. Or they may feel that they are being attacked because the object or situation had a negative impact or outcome. 


Many people who experience paranoia also experience hallucinations. They may believe that someone is following them when, in reality, there is no one there. They may also believe that an unseen force is watching them.

Some people with paranoia symptoms also hear things that are not there. They may hear something that if real would put them in a state of danger. These sights and sounds can bombard them from anywhere at any time, and they fully believe that they are real. When others cannot see or hear these things, they might start to believe that those people are in on the plot.

Disorganized speech

Many people who are paranoid have disorganized speech, known as hebephrenia. This means that they can be very hard to understand. They may be talking so fast that you can only catch every other word. Or they may be talking with such poor sentence structure that you cannot understand what they are trying to say. They may start and stop sentences, or start a sentence, stop, and continue as though they finished the sentence when they didn't.

Disorganized behavior

People with paranoia symptoms also typically have behavior that appears disorganized. To them, their actions are perfectly rational and sane. However, their behavior may not make sense to the people that they come across daily.

Suicidal thoughts

Many people with paranoia symptoms have suicidal thoughts. They are so tired of being "controlled," "persecuted," or "lied to" that they simply want it to end. They become so distressed about their unchanging situation that they see no other way out. Of course, not everyone with suicidal thoughts has paranoia or vice-versa.

Online counseling with BetterHelp

If you are experiencing symptoms of paranoia in any form, online therapy can provide you with the tools to cope with your emotions. With online therapy through BetterHelp, you won’t have to worry about commuting to and from an office. Unlike traditional, in-person therapy, you’ll be able to interact with a licensed therapist from the comfort of your home. Also, you’ll be able to message your therapist outside of sessions; so, if you have questions or concerns, reach out and they will get back to you as soon as they are able. 

The efficacy of online counseling

A growing body of evidence suggests that online counseling can help individuals who are living with complicated emotions associated with paranoia. In one report published in Mindfulness, a peer-reviewed academic journal, researchers examined the effectiveness of online therapy when treating symptoms of paranoia. The study specifically utilized mindfulness techniques, with lessons and videos meant to teach users meditation and breathing exercises. Participants reported a significant decrease in feelings of paranoia after online mindfulness therapy. Researchers concluded that online therapy could reduce paranoia in people experiencing both clinical and non-clinical paranoia. This result is important because, as they state, paranoid thinking is common amongst the general population.

Counselor reviews

“Loretta has undoubtedly changed my life. In my late attempt to deal with trauma she has shown me the light at the end of the tunnel. Through various strategies and methods she has provided me, I have become less paranoid, guilt-ridden, and anxious. I am so glad I decided to start using BetterHelp and was paired with Loretta.”

“I've barely started my counseling through this website. Even though it has been 3 weeks, it has helped out. I'm able to tell her things that my paranoid delusions aren't able to use against me. I guess it is because she is at a distance. Either which way, her tools of coping are massive and highly appreciated. Adding more tools to the chest.”


Symptoms of paranoia can vary from person to person. If you or someone you love has some or all the symptoms listed throughout this article, it can be important to seek advice and treatment from a professional medical provider. These symptoms could be the result of certain mental health disorders, trauma, or stressful life situations. Only a doctor or psychiatrist can properly make a diagnosis and prescribe treatment. There are many treatments available, and inpatient services may not be required if symptoms are caught early. Connecting with an online therapist can allow you to get prompt attention and support when you need it most.
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