Paranoia: Is it Anxiety, OCD, or Psychosis?

Recently someone asked me a question regarding the relationship between anxiety and paranoia. They reported feeling paranoid and were wondering if treatment for anxiety would help them feel better. Being paranoid means very different things to people with anxiety, Obsessive-Compulsive Disorder (OCD), or psychosis and it’s helpful to know the difference.

What does paranoia mean?

Sometimes people use the word paranoia to mean someone is worried, preoccupied, or fearful of something happening. Other times paranoia is used to describe a mental illness where someone has lost touch with reality.

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Let’s get a few definitions out of the way thanks to the Merriam-Webster dictionary.

Paranoia:

1. Mental illness characterized by systematized delusions of persecution or grandeur usually without hallucinations

2. A tendency on the part of an individual or group toward excessive or irrational suspiciousness and distrustfulness of others

Delusion:

1. Something that is falsely or delusively believed or propagated

2. A persistent false psychotic belief regarding the self or persons or objects outside the self that is maintained despite indisputable evidence to the contrary

Compulsion:

An irresistible persistent impulse to perform an act (such as excessive hand washing)

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If you know someone who is paranoid or are curious about the best ways to provide support, download this free PDF guide: 21 Guidelines on how to help someone with psychosis

Anxiety and paranoia

People with anxiety can be worried and fearful. They may feel paranoid that something bad is going to happen but they are not psychotic. Their anxious response may be out of proportion to the risk of the feared event but that doesn’t mean they are delusional.

A person with anxiety has worries that are grounded in reality. This means that what they are worried about COULD happen even though it may be unlikely (or even highly unlikely) to happen.

Examples of paranoia: Anxiety and paranoia

• “I don’t want to leave the house because I’m paranoid that I may need a bathroom. I won’t be able to find one and will have an accident.”
• “I’m paranoid I have germs and I’m going to spread them. I have to wash my hands before and after I touch anything.”
• “I’m so paranoid about losing the keys I’ve hidden copies all around.”
• “I installed an alarm system, video camera, and deadbolt on my front door because I’m paranoid about being robbed.”
• “I’m paranoid that if I go to that party everyone will stare at me and no one will talk to me. I will stand there alone looking dumb and humiliate myself.”
• “I’m paranoid that if I get on a train I will have a panic attack and not be able to get off.”

For people with anxiety, paranoia and fear can lead to avoidance and isolation. Anxiety can take over and control peoples lives if it isn’t treated. For more information about how to manage and control anxiety read these posts:

5 Ways to Stop a Panic Attack,

Do What You are Afraid Of: Stop Letting Anxiety Control You,

Anxiety: The Best Websites, Books, and Apps to Treat It.

OCD and paranoia

This can get a bit more complicated when someone has anxiety associated with Obsessive Compulsive Disorder (OCD). With OCD, people can have fears about a bad thing happening if they don’t do a particular action (ie. their compulsion). The link between the two events may be illogical and not reality-based but the person is not psychotic. A person with OCD has not lost touch with reality even if the things they worry about aren’t always rational.

Someone with OCD knows that following a regimented routine to wash dishes will not really prevent a loved one from getting in a car accident. They know it makes no sense but the anxiety is too intense for them to easily stop their ritual.

OCD is a “disease of doubt” where people feel they can’t quite trust their brains. They often think “What if I didn’t actually check it correctly? What if I thought I did but I looked at the wrong knob?”

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It doesn’t matter if they already rechecked it 10 or 20 times, some people with OCD will continue to feel anxious they left a stove on, the door unlocked, or the car running.

Despite the strength of these worries, people with OCD know that the obsessions and compulsions are irrational. However, just knowing they aren’t real doesn’t mean a person can stop them without getting treatment.

Examples of paranoia: OCD and paranoia

• They may convince themselves they ran over someone on the way to work and retrace their drive for hours. Unable to eliminate the worry, they may later scour the news for any reports of a hit and run or even call the police to ask if anyone was hit.
• “If I don’t tap this object 4 times and start walking with my left foot first something bad may happen. A train may crash.”
• “If I don’t look at that sculpture first when I walk in the room and cross myself 3 times, someone in my family may get cancer and it will be my fault.”

Psychosis and paranoia

Psychotic paranoia is a worry that is not grounded in reality. The thoughts are delusional and cannot possibly happen. The reasoning may be bizarre and illogical.

A person with psychotic paranoia isn’t aware their thoughts are not real. It is not helpful to tell them they don’t make sense or argue with them that it cannot happen.

Psychosis can be terrifying. Some people with paranoia feel constantly under attack and scrutiny. Everything feels unsafe. They may feel close family members have been replaced with imposters, or even their own bodies are being controlled by outside entities.

It can be difficult to know the best way to support someone who is in the midst of psychosis. I put together a list of 21 recommendations to keep communication lines open and increase the chance to be helpful.

Get your free PDF: 21 Guidelines on how to help someone with psychosis

Examples of paranoia: Psychosis and paranoia

• “There are people breaking into my house every night and sprinkling dust all over my house to poison me.”
• “My skin is being peeled off in my sleep by aliens and replaced by other peoples skin.”
• “The government is trying to capture and kill me. They have implanted me with tracking devices so I cannot escape. Everywhere I go there is someone following me. They are listening to us right now.”
• “The wiring in my house is set to a particular frequency that causes my food to spoil.”
• “My body was replaced by someone else’s body that I don’t recognize.”

Paranoia, Fear, and Worry

Paranoia can be upsetting and scary regardless if the source is anxiety, OCD, or psychosis. If you are struggling to overcome paranoia, fear, and worry; seek help from your psychiatric physician. Together you can come up with a treatment plan, find a way to help feel more at peace, and free yourself from the limitations set on your life because of the fear.

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Looking for additional mental health resources? Visit the Mental Health Bookstore to see a list of doctor-recommended books on many different health topics.

A version of this article was first published here, on the blog of Dr. Melissa Welby

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