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What is Paranoid Psychosis?

Mary McMahon
Updated Mar 03, 2024
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Paranoid psychosis is a break with reality that includes extreme fear and anxiety associated with delusions. Paranoia is a common feature of many delusions, especially in cases like persecutory delusions where people become convinced that they are under attack or someone is out to get them. A number of psychiatric conditions can contribute to the development of paranoid psychosis, and it can also develop in response to neurological disorders, certain medications, and some other causes. There are treatments available to help the patient address the delusions and associated paranoia.

Paranoia itself is fear and anxiety at an unreasonable level that may be exaggerated, and is often rooted in something not very believable. Informally, the term is often used to describe quite reasonable cautions, like being alert for police cars while speeding. In psychiatry, this would not be considered paranoia, but believing that the police were tracking a driver with a device mounted in the vehicle would be.

People in a state of psychosis can experience hallucinations, sensory experiences of things that are not actually there, along with delusions, beliefs about things that are not really happening. In paranoid psychosis, the hallucinations and delusions are accompanied by intense fear. This can cause the patient to behave suspiciously and to view anyone trying to help with extreme suspicion; a doctor may become an enemy agent, for example, or a family member may be possessed by aliens.

While in a state of paranoid psychosis, people genuinely believe that there is a credible threat and they may take steps to protect themselves. This can make interacting with and treating patients challenging. Treatments can include medications as well as psychotherapy. Medication to treat delusions and hallucinations may not be readily accepted by the patient while an episode of paranoid psychosis is occurring. Performing medical evaluations like imaging studies of the brain can be challenging with a paranoid patient, as the patient may not want to undergo medical tests.

If someone begins behaving erratically or unusually and appears to be experiencing a disconnect from reality, it can be a sign of psychosis. Some psychiatric conditions like schizophrenia do not onset until later in life and can appear in people who were previously healthy and emotionally balanced. It is important for people to receive treatment, as early intervention can help improve patient outcomes. People should try to remember that the patient's reality is real to the patient, and while it may seem irrational or ludicrous, it should be taken seriously. Expert psychiatric care may be needed.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Mary McMahon
By Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a The Health Board researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Discussion Comments
By anon1005168 — On Jul 04, 2021

The feeling of “eyes upon you” is something that anyone who hasn't had psychosis will not fully understand. It's a result of often multiple occasions of coincidences in real life that happen whilst the person is experiencing their psychosis. The person then forms a habit of often being on high alert to prove/disprove to him/herself whether or not he/she is correct. There comes a time when even on days where everything is fine, the individual is somewhat on alert, semi listening out for something out of the ordinary. It can get to a stage where an individual feels almost constantly watched or spied on and as if someone is invading their privacy.

It might not sound like much as an outsider might say, "Well distract yourself with something," but it actually scares and annoys you at the same time. “Why would someone want to invade my privacy like this? It's not fair. What have I done?” are maybe thoughts that run through your mind and that belief that you cannot do anything without it being seen is exhausting, consuming and actually lowers your self confidence.

In my case, if I also heard voices, I would deliberately try doing the opposite of what they were commenting on so as to try catch them out, but also to try to lessen the control that was being held over me.

By anon945515 — On Apr 13, 2014

@anon945406: You know, there's an old saying that goes, "Being paranoid doesn't necessarily mean people *aren't* out to get you." In other words, people who have anxiety and depression may indeed be more sensitive, but that doesn't mean they're "crazy."

I think you're right: you're living with a psycho. Psychopaths can present themselves to be very charming, interesting people, and then they stick the knife in. The fact that he claims to have the same kinds of items owned by serial killers is a huge warning bell, to me. That's not healthy.

Your partner is not the target of any of this behavior, so he isn't apt to think anything is wrong. I don't think you're crazy at all. I think that's what this guy *wants* you to think. Watch the movie "Gaslight" and see if it rings any bells. He obviously has issues with women, but psychopaths don't really need a reason to do anything they do-- that's what makes them so dangerous.

I don't think you're losing your grip on reality; I think you're seeing things very clearly, in fact. I think you need to get out of that situation for a while and once you've been gone for a few days, see your therapist. Don't worry that he/she will think you're crazy or whatever. Lay out the facts, his behavior and what he says and does and see what your therapist feels is going on. And don't eat anything he cooks for you -- ever. Take your plate, go to another room and throw the food away. Or "accidentally" drop it on the floor and see how he reacts. That might tell you something.

In any event, I think you need to get out of that situation as quickly as possible, at least until you can get some good counsel from your therapist. Good luck.

By anon945406 — On Apr 12, 2014

I am concerned. I am either suffering with paranoia psychosis with a side of narcissism or a guy I live with is a manipulating psychopath. Basically, I have always known I'm not all there and that I suffer from anxiety and depression. I have been addressing these issues in the past year, however. My partner of 12 years and I are very close and treat each other like equals. We are always open and honesty about everything. We consider ourselves soul mates, best friends and partners. Anyway, recently (well, it’s been about a year) we shared a rented apartment with a relative. He is kind, generous and very clean. At first he was the best housemate to live with but then he talked to me about my problems. He says I'm too aggressive (this was usually after a confrontation or when I was anxious) and I have no sympathy/empathy and I need to change. My partner has started to agree with him but others think I'm passionate, over emotional and easy to confide in. These things have plagued my mind.

I feel like I'm inadequate, like I'm not a legitimate person because of these accusations. It started to change me. I'd rather just go to bed, nod and agree and just do as he says. My partner is starting to confide in him more. In fact, my partner's attitude has seemed to change towards me.

The thing is, this guy has no trust in women, which he has admitted to. His mum left the family when he was very young and he had to take up the parent role because he was the eldest and his dad had to work. I’ve tried to talk to him about how he has affected me with these statements but he talks to me for an hour and by the end of the conversation I am ready to leave and confused.

He gloats about having items which have been used to poison or kill people by serial killers or whoever. I am starting to get frightened but am assured by my partner I'm being ridiculous. Lately he has been segregating my dinner from his and my partner's when he cooks, by calling me separately but offering both other plates as a choice for my partner. The worst thing is, I have been sick almost every time he cooks and when I went away with relatives for a week, I felt tons better. I convinced myself I was just getting paranoid, but even with this new approach, the symptoms seemed to have worsened. My partner is scared I'm going insane.

By anon349789 — On Sep 29, 2013

I'm starting to worry about myself. Ever since I was 15, when I drink a lot I start having delusions. Usually they're about someone trying to harm me. I always brushed it off because I thought I was just a drunk idiot. Two nights ago I had an episode. I thought my fiancé was trying to kill me and was plotting to take our son away from me. Although I do not remember everything, I remember that I actually believed this was happening.

The police were called and then an ambulance, I believed that the EMT was working with my fiancé and wanted to kill me to. While at the hospital in restraints, I tried escaping because I thought they were trying to hurt me. These things have only happened when I consume alcohol and the other night was the worst of all the delusions I've had. I'm very worried about myself. I plan on calling the doctor tomorrow, but could someone shed some light on what could be wrong with me?

By anon332176 — On Apr 27, 2013

My sister has been telling me people from her old church are watching her and following her wherever she goes. She is a stay at home mom and has no friends. I do not believe any of it but what is going on with her? I tell her but she says I do not understand, that God knows it all and they are evil and the devil. What can I do?

By anon310332 — On Dec 21, 2012

My dad passed away nearly four years ago and my mum is on her own for the first time in 55 years and now thinks people are in her roof.

She believes they unscrew the bolts and get in and sometimes watch through the air con vents which I might add she has ducted air conditioning. She puts covers over the vents as she thinks they are watching her.

We have been in her roof, had police, friends, electricians, etc. up in the roof and they have all told her the same thing: there's nothing there! There is no convincing her.

She is medicated which I had a hard time getting her to do, but I believe the medication is now not enough. She is very independent and is more than capable of looking after herself even though she is 78 years old. I'm wondering if anyone else has had the same experience with a family member or friend and can help me out.

By sus — On Oct 03, 2012

My brother suddenly developed psychosis about two years ago. He was age 42. If the onset came on earlier he kept it well hidden.

He believes people are after him and also hears voices. I worry about him a lot. He was admitted into the hospital once and diagnosed as being schizophrenic. I have observed patterns in his behavior. It appears he acts OK or hides things well for a few weeks and then demonstrates obvious signs of anger, paranoid behavior and facial expression changes once a month.

From my observation, it appears the bad psychotic behavior appears about once a month. I am about the only person my brother trusts. When his episodes get bad, I calm him down. I tell my family do not ever call 911 because that will push him away.

I need to get him on the right meds and get my brother back. Please help! Any advice is appreciated.

By anon291108 — On Sep 12, 2012

My mom has been having many of these symptoms recently (she has been diagnosed with paranoid psychosis), although other family members have said she's had it for about 20 years.

Lately, she has been crying a lot to me, telling me she thinks there is someone following her. I want to help but it's impossible to know what to say and it usually ends in an argument if I do. She won't leave the house anymore or go anywhere. She's very suspicious of things and cars that pull up to our drive looking for my father. But she tells me things and swears me to secrecy. I usually end up telling my sisters out of concern and then they usually contact a GP. But I cannot help her. I don't know what to do.

By anon256906 — On Mar 23, 2012

I am not a doctor, don't have medical experience, but have a family member in crisis. She is psychotic, hears voices sees people, etc. She now lives alone as her two children (grown ups now) have their own homes.

She walks around her house with a butcher knife, afraid for her life. She often sees an old man and young woman in her bedroom and kitchen. She refuses so talk to anyone for fear of being committed. How do I help her with me being in a different state?

By anon255572 — On Mar 18, 2012

I was diagnosed with Paranoid Psychosis some eight years ago.

I was a total mess at the time and I was *literally* scared of shadows. I also suffered audio hallucinations - which told me to do things. Some were innocuous, others not so much. I had never been so scared in all my life, and going out in public was horrendous, with panic attacks galore.

The point is though, I got over it. You really need to take a look at yourself and see that what you believe to be true really isn't. There is no conspiracy. It's just your mind rationalising a series of unlikely events that get ever more twisted and out of control.

I haven't had a hallucination for the better part of five years now and I don't take medication.

By anon168090 — On Apr 15, 2011

I have suffered from paranoid psychosis since i was 17, but i wasn't diagnosed until i was 21. Four years later they said it was a misdiagnosis and that i suffer from paranoid psychosis.

When I'm in a psychosis, i fear for my life and i feel like everyone is conspiring to grab hold of me. I went to my aunt's house and thought she was in on it. It's the most frightening, horrible time in my life, and i wouldn't wish this illness on my worst enemy. Well, considering i think i have plenty of them i probably would, through my paranoia!

By amypollick — On Nov 21, 2010

@Anna Bella: I hate to say it, but the symptoms your mom is displaying are consistent with Sundowners Syndrome. There's an article on this web site about it.

I think you are doing the right thing by taking her to a good psychiatrist, but you might also consider having her see a neurologist, as well. If she does have early Alzheimer's Disease, there are medications that can help her and help slow the progress of the condition. The paranoia and agitation, especially at night, are consistent with Sundowners, but of course, you need to have her evaluated by a competent physician to see exactly what is going on.

Medications can also affect older people differently than younger people, so have the doctor go through her meds, as well.

I'm not a doctor, but my mom is 82, so I understand some of the issues you're facing. Good luck.

By anon129019 — On Nov 21, 2010

My mother is paranoid and thinks my dad is poisoning her, and having sex with the neighbor nightly. She locks her door, and hates my dad because she feels he cheats on her. On the other side, he is depressed and going through prostate cancer and feels she isn't supportive. He yells at my mom "you are crazy and I'm going to have to put away" and a lot of other issues.

She just has an MRI and doesn't trust him to see her results.

What medications are good for an 82 year old women with psychosis at night mostly. She must have the lights on, walks around the house etc. Dad yells at her to turn off the lights. Her neighbor is a creep and dad tells the whole street my mom is crazy and has Alzheimer's.

She has never been DX with anything yet or even seen a professional. I plan on taking her to a good psychiatrist in two weeks.

I really feel she needs meds but not too much, and maybe a sleep aid? I live in another state and can't be there all the time, just phone. But I plan on letting her live with me if needed.

Thanks again, I need to know what medications are good for elderly psychosis without causing danger of falling. She is alert and stable, but getting more frail and confused. Could it also be her blood pressure medications? Thank you again, Anne Bella

By anon128976 — On Nov 21, 2010

i was diagnosed with psychosis paranoia and i believe he was right. i am always thinking that someone is out to get me or watching me constantly. i feel bad but i can't help but to feel as if eyes are on me constantly. i stay in the house most of the time and it's not fair to my daughter.

Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a...

Learn more
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