Paranoia

Last reviewed Saturday, October 24, 2026

Paranoia is a strong sense, without good evidence, that others are trying to harm, cheat, watch or humiliate you. It runs along a scale. Passing suspicious thoughts are common, especially under stress or after poor sleep. At the far end, a fixed belief that nothing can shake is a sign of psychosis and needs prompt help.

Also called: paranoid thoughts; paranoid ideation; suspiciousness. A paranoid belief held with certainty despite the evidence is a persecutory delusion. Paranoid personality disorder is a separate, long-standing pattern of distrust.

Signs and symptoms

Believing people are against you, talking about you or planning to hurt you
Reading hidden meanings into looks, jokes, messages or chance events
Feeling watched or followed
Mistrusting friends, family or a partner, sometimes with fixed ideas that a partner is unfaithful
Staying on guard, checking, and avoiding people or places
Anxiety, worry and poor sleep

Paranoid thoughts are common. In a survey in England, nearly 1 in 5 adults had felt in the past year that people were against them, while about 2 in 100 believed others were plotting to seriously harm them.

Causes

Paranoia usually builds from ordinary worries and fears, and several things make it more likely:

Stress and anxiety: worry, money troubles, pressure at work and feeling alone.
Poor sleep: insomnia is closely linked with paranoid thoughts.
Drugs and alcohol: cannabis, heavy drinking, and stimulants such as methamphetamine, which can cause psychosis that lasts after use stops.
Trauma: past abuse or violence can leave the world feeling unsafe.
Mental health conditions: schizophrenia, delusional disorder, bipolar disorder, severe depression and psychosis after childbirth.
Physical illness: high fever, malaria, dementia and delirium can all bring on suspicious, frightened thinking.

Treatment

Treatment depends on the cause. Talking therapy based on CBT helps you notice and test suspicious thoughts, worry less and feel safer around people. In a UK trial of 130 people whose persecutory beliefs had lasted months, a CBT-based programme reduced how strongly they held them more than friendly support did. Treating sleep matters too: in a trial of 3,755 students with insomnia, online CBT for sleep also eased paranoid thoughts a little.

When paranoia is part of psychosis, a psychiatrist may prescribe antipsychotic medicine, alongside talking therapy and family support. Cutting down cannabis, alcohol and other drugs helps whatever the cause.

If someone you love is paranoid, arguing them out of the belief rarely works. Stay calm, take their fear seriously without agreeing with the belief, and encourage them to see a doctor.

In Nigeria

Caution is often realistic here. Kidnapping and robbery are real risks, and being careful about them isn’t paranoia.

Beliefs your community shares, such as spiritual attack or “village people”, aren’t delusions in themselves. Clinicians look at whether a belief is fixed against all evidence, out of step with the people around you, and taking over your life. The effect matters too: someone who stops eating because they’re sure their food is poisoned, can’t sleep for fear, or acts on the belief needs help, whatever the explanation.

Stigma is heavy, and in Nigerian hospital studies many people with psychosis had seen a traditional or faith healer first. Faith can support recovery alongside medical care. The National Mental Health Act 2021 bans chaining, including at faith and traditional healing centres.

Everyday suspicion vs paranoid thoughts vs psychosis

Everyday suspicion is based on something real, fits the situation, and fades when the facts change.
Paranoid thoughts go beyond the evidence and cause distress, but you can still question them: “maybe I’m reading too much into this”.
A delusion is an unshakeable belief in something untrue. It’s part of psychosis, can come with hearing or seeing things, and the person often can’t see that it isn’t real. It occurs in schizophrenia and delusional disorder.
Paranoid personality disorder is long-standing distrust across life, without psychosis.

When to get help

If someone is very frightened, acting on their beliefs, or talking about harming themselves or anyone else, get help now: call 112 (or 767 in Lagos), or Safe Place Nigeria on 0800 800 2000. The full list is on our helplines page. The Federal Neuro-Psychiatric Hospital in Yaba runs a 24-hour emergency unit.

See a doctor if suspicious thoughts are frequent, upsetting or affecting your sleep, work or relationships. New paranoia with confusion, fever or drug use needs a medical check first. Alongside medical care, you can book a licensed therapist on Mytherapist.ng who works with psychotic disorders, or with anxiety if your thoughts are milder.

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