Paranoid Ideation

Paranoid Ideation. Psychology Fanatic. Feature Image

The haunting, anxiety ridden thoughts that the world is conspiring against you, maybe part of a diagnosable illness, such as borderline personality disorder (BPD), or post traumatic stress disorder (PTSD). Or, perhaps, just a harmful thinking practice that is disrupting your life. Paranoid ideation can differ in duration and severity. For some, on the lesser side of the scale, may be habitual worriers, and part of their worries maybe classified as paranoid ideation. Others, on the far side of the scale, may suffer from paranoid thoughts along with several other symptoms belonging to a psychotic disorder.

​Paranoid ideation can be measured on a continuum, from mild and subclinical levels to severe life inhibiting fears. Mild paranoia is experienced through “transient and uncertain ideas about negative rumors circulating around the self.” As the severity of paranoid ideation continues, the impact moves from common feelings of shame and worry to “stable and convincing beliefs that others are deliberately trying to cause significant harm”  (Saarinen, Granö, & Lehtimäki, 2020). ​

Characteristics of Paranoid Ideation

“The spectrum of paranoid ideation goes from mild distrust and suspiciousness to full-blown persecutory delusions” (Bianchi & Janin, 2019). As many as one in three people may regularly engage in some level of paranoid ideation.

​Paranoia can be defined as “a relatively stable mode of thinking that can be observed in non-clinical populations.” Non-clinical paranoid ideation is “characterized by suspiciousness, feelings of ill will or resentment and beliefs of external control or influence” (Fabris et al. 2020).

Paranoid ideation may include:

  • Inability to Trust
  • Feelings of being exploited
  • Feeling like a victim
  • Feeling persecuted by others
  • Interpreting benign body language, words, and glances as hostile
  • Suspicion of being watched or spied on

Impact of Paranoid Ideation on Wellness


Jealousy quickly slips from healthy caring to paranoid ideation in relationships. Paranoia is often expressed through jealousy.

Carrie Manner explains, “normal jealousy is a pang that comes on in an instant, one which we can usually dismiss on our own. Unhealthy jealous behavior happens when we indulge that feeling and act impulsively from a place of suspicion and insecurity. When insecurity in our relationships run rampant, jealousy can rapidly grow into paranoia and obsession and threaten to destroy the very relationship we’re most afraid to lose” (2018).

Healthy jealousy is a normal emotions to protect something personally beneficial, like a relationship. We  can react to these healthy motivational pushes in healthy ways. Emotionally intelligent people may simply regulate the emotion, understanding the emotion may spring from unsupported worry. Dr. Gary and Barb Rosberg wrote,  “on the other hand, unhealthy jealousy manifests itself through lies, threats, self-pity, and feelings of inadequacy, inferiority and insecurity” (2006).

Many atrocities begin with the paranoid thinking which is displayed through blind jealousy, and acted upon in rage. The paranoid ideation rips apart hopes of intimacy, love and security. A shameful cycle of emotionally driven action that destroys the very thing (the relationship) it is striving to protect.

Anger and Violence

​González-Prendes and Jozefowicz-Simbeni explain in there research that the “paranoid stance is characterized by an exaggerated egocentric outlook that often leads the angry person to formulate erroneous conclusions as to the intent and motives of others.” Furthermore, The authors continue, ” Individuals with a paranoid outlook manifest a pervasive attitude of suspiciousness and distrust, along with a the tendency to ascribe malevolent intent to the actions of others” (2009).

While anger is a healthy response to violation of our rights, those inflicted with excessive paranoid ideations subjectively define benign behaviors of others as violations, personalizing the behaviors and even thoughts (that we believe they may have) as malevolent and disrespectful.

Paranoia and anger walk hand in hand.

Negative Affect

Whether overwhelming emotions motivate paranoid ideation, or contrarily, if the reverse order, paranoid ideation ignites overwhelming emotions is difficult to determine. Yet, the two are associated. Research has found that increases in negative affect is associated with increases in paranoid ideation in the general population (Wittkamp, Krkovic, & Lincoln, 2020).

Research has discovered, however, that emotional regulation skills help to mediate symptoms of paranoia, intervening before the thoughts destructively express themselves. We can partially control negative experiences through healthy action. However, life is difficult, and not completely controllable. Sometimes bad things happen and they hurt. Having resources to down regulate distressing emotions helps limit negative ideation.

Decision Making

According to the duel process theory, we make decisions from a duel process, involving experiential and rational thought (or intuitive and reflective). Experiential reasoning is closely tied to affect. Experiential decision making draws considerably from emotional feelings as a key motivational source (Freeman, Evans, & Lister, 2012).

In another irony of life, paranoid ideation impacts experiential decision making, and those decision increase paranoid ideation (2012).

Many unscrupulous politicians lean on this phenomenon to gather support. They feed the paranoia to motivate support. However, once elected, they continue to feed the fear, leading to a growing mass of followers that abandon rational reasoning in favor of a fear feeding frenzy, which further stimulate the fear.

We cannot rationally think when fear dominates our internal emotional landscape.

Depression, Anxiety, Substance Abuse

Patterns of paranoid thinking has some unwelcomed companions. “Paranoid ideation is related to substantial comorbidity with, for example, depression, anxiety, post-traumatic stress disorder, substance abuse, and even suicidality”(Saarinen, Granö, & Lehtimäki, 2020). 

So, far beyond, simple expressions of negativity and fear, paranoid ideation can severely impact our wellness. Unfortunately, paranoid ideation is also linked to low symptom awareness, hindering victims from seeking help.

Causes of Paranoid Ideation

Like many disorders or personality characteristics, practices of paranoid ideation has many causes both from biological traits, and experience. Our personalities are shaped through a constant interaction between innate characteristics and environmental stimuluses. Albert bandura referred to this as reciprocal determinism.

In an awe inspiring display of adaptation, cells transform, DNA molds to experience, and we become a complex example of our internal and external worlds unifying through the magic of epigenetics.


Many paranoid ideations come to life from living in a dangerous world. We can’t dismiss the impact of tragedy. The diathesis model of stress suggests when stress exceeds our capability to process, the stress impacts psychological and physical wellness. 

A life time of an inordinate amount of stress impacts security. Subsequently, the world becomes a dangerous place.

​In an article on bullying, the authors explain, “bullying helps to determine schematic beliefs about a dangerous world and vulnerable self, and it is therefore involved n the onset of paranoid ideation” (Fabris, et al. 2020).

Chemical Imbalances in the Brain

​”Any chemical imbalance in the brain can also alter emotions and judgment causing one to develop paranoia or paranoid ideation” (2021). Biological side of the equation is a powerful but also often ignored cause.

Chemicals flow, create negative feeling affects and we follow with coherent narrative to explain the feeling. If fear and anxiety dominate brain functions, we likely will match he feelings with a little paranoid worries over relationships, money and futures.

Negative Affect

Negative affect, whether from brain functions, environments, or subjective evaluations, invite paranoid ideation. In longitude studies, elevated levels of negative affect has been found to predict paranoid ideation (Wittkamp, Krkovic, & Lincoln, 2020). Negative affect probably serves both as a cause and a feeling affect of paranoid ideation. 

Learned Behavior (Thought) Patterns

Many patterns of thought are learned. Often early in development we discover little behaviors and thoughts that serve some purpose. Protective paranoid predictions may prevent surprises or disappointments in chaotic environments. Accordingly, a young child may integrate rude forms of paranoia over the future as an immature defense mechanism. As the child develops so does the maladaptive thinking.

While the maladaptive thinking may have served an earlier purpose, in adulthood the paranoid thoughts often become destructive, warning of dangers, curtailing motivation, and limiting futures; but the thought practice continues.


Stress is an ever-present condition of living. Problems arise from excessive stress. When stress exceeds our threshold of tolerance, there are physiological and psychological consequences. 

According to the diathesis stress model Predispositions interact with stressful experiences. When life stresses disrupt our psychological equilibrium (or homeostasis), the stressful event may catalyze predispositions for physical and psychological disorders (Murphy, 2021).

There is growing evidence that even smaller doses of stress may trigger paranoid thoughts. We must manage stress (Bianchi & Janin, 2019).

Treatment and Cure for Paranoid Ideation


Medication may be necessary. If our brain is firing in uncontrollable ways, we can’t adopt new learning until the red hot neurons are cooled. Importantly, a physician may help identify the problem and prescribe proper medication to get you or a client back into a more normal state.

Therapy for Paranoid Ideation

Therapy such as cognitive-behavior therapy may help learn new cognitive practices, such as cognitive reappraisal to extinguish paranoia. Research supports the effectiveness of CBT on paranoid ideation. “Cognitive-behavioral approaches helped clients learn to identify, evaluate, and restructure dysfunctional thinking as well as to correct specific skill deficits that affected the presenting problem (i.e., communication, relaxation) (González-Prendes, & Jozefowicz-Simbeni 2009). 

Emotional Regulation

Since negative affect is a common condition associate with paranoid ideation, learning methods to calm aroused systems has shown to be effective ways to combat the disruptive thoughts.

In an a 2019 article on emotional regulation I presented  Kim Gratz and Lizabeth Roemer’s four elements of emotional regulation.

Kim Gratz and Lizabeth Roemer proposed four dimensions of emotional regulation and dysregulation.

  1. Awareness of emotions
  2. Acceptance of emotions
  3. Ability to control impulsive behaviors and behave in accordance with desired goals when experiencing negative emotions
  4. Ability to use situational appropriate emotional regulation strategies flexibly to modulate emotional responses in order to meet individual goals (2004).

We need a tool box of strategies to regulate pesky, overwhelming emotions, dousing fires that are burning too hot to keep stress within a manageable threshold. With healthy emotion regulating practices, we can limit harmful paranoid ideations.

A Few Closing Remarks on Paranoid Ideation

We have built into our brains complex mechanisms for predicting and preparing for futures. It appears that paranoid ideation is a function of this system. Like many other beneficial adaptive practices, paranoid ideation may become harmful when overused.

We can mediate the destructive nature through a mindful check-in to evaluate thoughts and emotions, and then seeking solutions to get our inner lives in balance with long term goals to flourish.

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Bianchi, .R., & Janin, .L. (2019). Burnout, depression and paranoid ideation: a cluster-analytic study. Occupational Medicine, 69(1),

Fabris, M., Badenes-Ribera, L., Longobardi, C., Demuru, A., Dawid Konrad, & Settanni, M. (2020). Homophobic bullying victimization and muscle Dysmorphic concerns in men having sex with men: the mediating role of paranoid ideation. Current Psychology, OnlineFirst, 1-8.

Freeman, D., Evans, N., & Lister, R. (2012). Gut feelings, deliberative thought, and paranoid ideation: a study of experiential and rational reasoning. Psychiatry research, 197(1-2), 119–122. 

González-Prendes, A., & Jozefowicz-Simbeni, D. (2009). The Effects of Cognitive—Behavioral Therapy on Trait Anger and Paranoid Ideation. Research on Social Work Practice, 19(6), 686-693.

​Gratz, K., & Roemer, L. (2004). Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54.

Manner, Carrie (2018) Unhealthy Relationship Behaviors Series: Jealousy. Onelove. Published 4-20-2018; Accessed 3-23-2022

Mohsen Bazargan, S.L. (2001). Paranoid Ideation Among Elderly African American Persons. The Gerontologist, 41(3).

Spotlight Article:

Murphy, T. Franklin (2021) Diathesis Stress Model. Psychology Fanatic. Published 9-7-2021. Accessed 3-25-2022.

Rosberg, Gary; Rosberg, Barb (2006). Understanding healthy and unhealthy jealousy. Focus on the Family. Published 8-2006. Accessed 3-23-2022

Saarinen, A., Granö, N., & Lehtimäki, T. (2020). Self-Reported Cognitive Functions Predict the Trajectory of Paranoid Ideation Over a 15-Year Prospective Follow-Up. Cognitive Therapy and Research, 45(2), 333-342.

Salters-Pedneault, Kristalyn (2020) What is paranoid Ideation. VeryWellMind. Published 11-16-2020. Accessed 3-23-2022

Swarnakshi Sharma (2021). Paranoid Ideation: Definition, Symptoms & Treatment (Self-Coping Tips). Calm Stage. Published 11-22-2021. Accessed 3-18-2022.

Wesemann, U., Mahnke, M., Polk, S., & Willmund, G. (2020). Long-term effects of the terror attack in Berlin in 2016 on paranoid ideation in female emergency personnel. BJPsych Open, 6(5),

Wittkamp, M., Krkovic, K., & Lincoln, T. (2020). An Analysis of the Pattern of Adaptive Emotion Regulation Associated with Low Paranoid Ideation in Healthy and Clinical Samples. Cognitive Therapy and Research, 45(3), 468-479.

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