Emotional Effects

Anxiety and Paranoid Ideas

Micah Abraham, BSc

Written by

Micah Abraham, BSc

Last updated October 10, 2020

Anxiety and Paranoid Ideas

Anxiety and paranoid ideation are two separate symptoms, but people who suffer from anxiety can have paranoid ideas. Indeed, anxiety is often associated with paranoid ideas.

Many people who have anxiety worry that they are paranoid, and they are often told by others that they are paranoid. What does it mean to say that someone is paranoid? Are people with anxiety disorders paranoid in the same way that people with schizophrenia are paranoid?

What Kind of Thoughts are Paranoid

First of all, in a medical context, the word paranoid is usually used to refer to delusions that are a symptom of serious mental disorder like schizophrenia or delusional disorder. So let’s make a distinction between paranoid ideation and paranoid delusions.

There is an old saying in psychiatry that the difference between neurosis and psychosis is that a neurotic person builds sand castles in the sky, but knows they are not real; whereas a psychotic person builds sand castles in the sky and thinks they are real.

The same is true of paranoid ideas and the paranoid delusions that a schizophrenic person has. When a person with an anxiety disorder has paranoid ideas, they are capable of seeing that they are not true. However, when a schizophrenic person has paranoid delusions, they are entirely incapable of entertaining the idea that their delusions are not real. Paranoid delusions are as real to the schizophrenic as the ground they stand on.

In other words, paranoid ideas and paranoid delusions are different. Their content may be the same, but they have differing degrees of reality for the person who experiences them.

Paranoid Ideas Probably Cause Anxiety

Does anxiety cause paranoid thoughts? Or do paranoid thoughts cause anxiety?

If you stop and think about it for a moment, it makes perfect sense that paranoid thoughts are associated with and perhaps even the cause of anxiety. It probably works like this. Suppose a person had an overly critical parent or parents who were impossible to please. Everything that person did as a child was met with criticism.

That person might well develop the belief that all people were just as critical as his or her parents, and attribute critical thoughts to many if not most of the people with whom he or she interacts. If you consistently think that people are critical of you, that could cause you to be scared of and anxious around people. This would be paranoid ideation.

Close your eyes for a moment to see how this might work. Think about something postive that you really want to have happen. See it happening in your mind. Then notice how you feel. You’ll find that you feel good.

Then think for awhile about something negative that happened to you recently. Then notice how you feel You’ll find that you feel you feel badly. This is how thoughts could cause fear and anxiety.

Types of Paranoid Ideas

1. Worrying About Bad Things Happening

People with anxiety often worry about worst case scenarios. For example, a child with anxiety might worry that their parents are going to get hurt in a car accident or that someone is after their parents to hurt them. Both are fairly similar.

2. Worrying that Something is Wrong With Them

During anxiety attacks, people often worry that something is wrong with their health. Some people develop health anxiety - constantly checking their symptoms online to see what's wrong with them and occasionally believing that they have a terrible disorder. They may even believe the doctor hasn't provided them with honest information.

3. Worrying That Other People Think You are Different

Finally, people with social anxiety, may fear that other people see them as being different; as being incapable of having normal social interactions. When someone with social anxiety walks into a room, they often feel like eyes are on them and that people are judging them. And this will understandably make it difficult for a person to have gratifying relationships with other people

Many forms of anxiety show some degree of this. Someone that has to wash their hands often because they're worried about germs may appear paranoid to others. Someone that jumps at loud noises because of their post-traumatic stress disorder may appear to be paranoid as well.

Are Your Paranoid Ideas are Ideas or the Sign of a More Serious Mental Disorder

Probably not, especially if you have been diagnosed with an anxiety disorder. Another helpful hint is whether or not the paranoid ideas persist. If you are scared of someone’s criticism only when you are in their presence, this is probably paranoid ideation. If you can get outside of the paranoid ideas, and question whether or not they are true, this is probably paranoid ideas.

What to Do if You Have Both Anxiety and Paranoid Ideas

The approach to disempowering and diminishing paranoid ideas that occurs with anxiety is going to be the same as it would be for anxiety alone. You want to find a way to distance yourself from the paranoid ideas and find a way to stop believing them when they appear in your mind. There are several different ways to do this::

  • Cognitive Behavioral Therapy
  • Mindfulness Training
  • Meditation
  • Thought Journals and Cognitive Restructuring

Find the one that is best for you.

Questions? Comments?

Do you have a specific question that this article didn’t answered? Send us a message and we’ll answer it for you!

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Where can I go to learn more about Jacobson’s relaxation technique and other similar methods?

– Anonymous patient


You can ask your doctor for a referral to a psychologist or other mental health professional who uses relaxation techniques to help patients. Not all psychologists or other mental health professionals are knowledgeable about these techniques, though. Therapists often add their own “twist” to the technqiues. Training varies by the type of technique that they use. Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process.

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