What Is the Difference Between Paranoia and Reasonable Suspicion?

A man looks at a computer screen, which reflects in his glassesIn 2013, former CIA employee and government contractor Edward Snowden released classified documents revealing the broad scope of U.S. government surveillance. Suddenly, fears that once seemed paranoid were decidedly rooted in reality. Paranoia and anxiety are common. They can be part of the typical range of human experience or signs of a serious mental health diagnosis.

Drawing the line between normal fears, anxiety, and paranoia can be difficult. That’s especially true when a person’s apparently paranoid fears turn out to be true—as was the case for activists targeted by programs such as COINTELPRO, and for Ernest Hemingway, who really did have an FBI file. Knowing where to draw that line, and how to decide whether a fear is reasonable or not, can help people seek appropriate mental health care.

What Is Paranoia?

Paranoia is persistent anxiety about a specific fear. Paranoid anxieties often center around persecution, being watched, or being treated unjustly. The hallmark of paranoia is that it is rooted in a false belief. People with paranoid thoughts may also have false beliefs about their own power or importance. For example, a person who does not occupy a political position or engage in activism might believe in an international conspiracy to monitor and torture them. In some cases, exposure to trauma or severe stress can make people more likely to experience paranoia.

People experiencing paranoid thoughts are often preoccupied by these thoughts. They may be fixated on getting other people to accept their beliefs as true. They may make unusual choices designed to protect themselves from the sources of their anxiety.

Fleeting moments of paranoia are common and don’t necessarily mean a person has a mental health condition. Paranoia is also distinct from anxiety in that:

  • Paranoia is focused on a specific source of anxiety.
  • People who experience paranoia often have false beliefs about themselves, the world, or people they know.
  • A person with paranoid thoughts may experience perceptual issues. A 2008 study that compared social anxiety to paranoia found that people with unusual perceptions, including hallucinations, were more likely to experience paranoia.

Delusional vs. Reasonable Paranoia

Delusional paranoia is paranoia due to a false belief. While often a hallmark of schizophrenia, it can also be due to other mental health diagnoses. When a person’s fears are rooted in reality or reasonable, they’re not paranoid. The challenge is determining which beliefs are reasonable and which are not.

A lawyer working with detained immigrants might worry that they are being monitored by the government. A doctor working with infectious diseases may be concerned about becoming infected or spreading the disease. Even if the fear does not come to fruition, it is rooted in reality.

It’s important for mental health providers to critically examine why a person has a specific fear and how their social bubble, occupation, culture, and other factors may affect that fear. For instance, young black Americans may be fearful of the police. To someone who has never had a negative interaction with police, this fear might seem unreasonable, even paranoid. To a person exposed to police violence against young black people, the fear seems reasonable and is unlikely to be due to a mental health diagnosis. Dismissing a person’s reasonable fears can be very harmful, especially when it happens in therapy.

It’s important for mental health providers to critically examine why a person has a specific fear and how their social bubble, occupation, culture, and other factors may affect that fear.

One way to assess whether a person’s anxiety is reasonable or not is to assess how they respond to conflicting evidence. People with schizophrenia, for example, may continue to endorse false beliefs even when given evidence to the contrary. The conflicting evidence may even be viewed as a sign of a larger conspiracy, or as a reason to distrust a mental health provider. A person without schizophrenia who learns their false belief is untrue may be relieved rather than defensive.

People who think someone they love may have schizophrenia should not spend time arguing about false or paranoid beliefs. This can harm the relationship, making it difficult for the person to feel understood or loved. Arguing about false beliefs may inadvertently stigmatize the person or make them feel judged.

Schizophrenia Symptoms: The Link to Paranoia and Anxiety

A person who has paranoid thoughts may have schizophrenia or a related condition. Only a mental health professional can treat and diagnose this condition, so it’s important to seek expert insight.

Schizophrenia usually begins in adolescence or early adulthood. Someone who develops paranoid thoughts later in life might have another mental health condition, such as dementia.

Some schizophrenia symptoms to watch for include:

  • Loss of touch with reality. Schizophrenia can cause people to see or hear things that others can’t.
  • Thoughts and beliefs that others perceive as strange or unusual.
  • Changes in affect. A person with schizophrenia may have an affect that seems flat, presenting few emotions and seeming very detached.
  • Trouble with memory, especially working memory.
  • Executive function difficulties that make it difficult to concentrate or stay on task.
  • Trouble starting or sticking with new hobbies or activities.
  • Not talking much.
  • Behavior related to false beliefs. A person with schizophrenia might try to contact a celebrity to warn them of a threat or reach out to a lawyer to report government surveillance that doesn’t seem to be happening.

When to Seek Treatment for Anxiety About Being Watched

Mental health treatment can help anyone experiencing anxiety, whether their anxiety is rooted in a real source or the product of a mental health diagnosis. Activists such as lawyers or protest leaders who have reasonable fears about being monitored may find therapy helps them manage their anxiety, deal with the effects of those fears on their relationships, and separate reasonable fears from unreasonable ones.

People who have a condition linked to unreasonable paranoia may also find immense relief in therapy. Therapy can help a person understand their anxiety, confront false beliefs, and assess the effects that false beliefs have on their life. People with diagnoses linked to delusions often struggle at work, school, and in their relationships. Therapy can help with developing better communication skills and dealing with the challenges of schizophrenia and other diagnoses linked to delusions.


  1. Freeman, D., Gittins, M., Pugh, K., Antley, A., Slater, M., & Dunn, G. (2008). What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychological Medicine, 8(38), 1121-1132. doi: 10.1017/S0033291708003589
  2. Schizophrenia. (2016, February). Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
  3. Shakeel, M. K., & Docherty, N. M. (2015). Confabulations in schizophrenia. Cognitive Neuropsychiatry, 1(20), 1-13. doi: 10.1080/13546805.2014.940886

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  • Tonycliftontaxi

    October 5th, 2018 at 10:58 PM

    Paranoid schizophrenia is indeed a serious mental disorder characterized by a delusional state of mind leading to irrational thoughts and fear not to be confused with a schizoid personality disorder or SPO, a personality disorder characterised by a lack of interest in social relationships, a tendency towards a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment and apathy. It is possible to have a combination of both bi-polar and either of the two schizophrenic type illnessness commonly referred to as schizo-affective disorder. It is not unusual, if and when undergoing extreme stressors to experience a paranoid type thinking without developing the full blown illness but chronic stress can manifest in a variety of different complaints depending on the individuals ability to cope with it. Living in constant fear of your lifesavings being snatched away at the. simple click of a switch or a press of an unscrupulous scammers button can lead to a type of paranoia similar to that experienced by sufferers of this dreadful disorder and an extremely unpleasant way to live by anybody”s standards.

  • Jonh

    April 12th, 2020 at 4:57 AM

    Interesting article, but suggests only one way of differentiating between the heathy and unhealthy.. the most obvious.. presenting the evidence..
    What if we don’t have the evidence which is usually the case?
    Another way of aproaching this is to continue agreeing with the person and present more examples of paranoid thinking in line with their reasoning. If they don’t question any of my examples, and they turn everything to support their paranoid script then it is a good indicator of them suffering from unhealthy paranoia..

  • Jo

    March 13th, 2021 at 4:24 AM

    I was diagnosed with a personality disorder when I said that a nurse had raped me. Multiple professionals described me as “paranoid” because I was afraid of them after this. When other patients said the same thing about the same nurse, I thought they would remove the diagnosis, but instead they dug in their heels and diagnosed the others too. Some got hospitalized for this. The nurse still has his job. Who really has false beliefs about the world? I would say it was the mental health professionals who had the false beliefs.

  • Joan

    December 11th, 2021 at 3:51 PM

    I am so sorry that happened to you. I want you to know that I believe you.

  • Ellie

    January 10th, 2022 at 10:38 PM

    That’s awful indeed! My best bit of advice is don’t give up. That’s such an awful thing to happen and it can take a long time to recover from trauma like this. Try to get in touch with another of the patients that went through this. They can help you feel less alone and you can do the same for them. Keep talking to therapists lawyers and other professionals. Eventually someone will believe you. Even the staff can be a good resource. If this person raped you chances are good there’s more than that going on and another of their co-workers will probabaly side with you. Especially if you are for ex a 20 year old female and there’s a 20 yo female on staff. That is my tips for recovering. What an awful thing to happen to anyone. I hope you can someday find the healing and peace you so deserve and this criminal is brought to justice.

  • Anastacia

    April 7th, 2022 at 5:05 AM

    Holy crap, Jo! I can’t help but feel some empathy right now. 2 days ago I was in Wigan Royal Albert Edward Infirmary for 5 days, they were fully aware of my ADHD. I went in with hyperveris gravidarium as I am 6 months pregnant and going through delayed grievance of losing my poor old Kirby (West Highland terrier, rescue) on November 15th last year. He was almost 20 and was part of my life for 10 years and 4 months. The way more than half of the nurses treated me in there was diabolical! I feel mentally and emotionally battered, but with every challenge in life, I have managed to come out of the other side stronger than I was before. I may be blunt and up front, but have always chosen to see myself as a battle scarred warrior who is truly greatful for the innocent creatures in life.

  • Aiden

    July 21st, 2023 at 6:23 PM

    When someone truly gangs up on you and tries to distort the narrative to fit their agenda, then how can you try to convince someone that you are not mentally unwell at the moment to know the difference between facts and have actual evidence to support it? This is especially true when you have a mental health history and people being uneducated call you out for different diagnosis even though they are not mental health professionals. “Oh he is paranoid.” or ” She is delusional.” and they play amateur mental health care professionals for thirty seconds. Its an observation, not a diagnosis. Yet, courts look at average DOES for their thoughts on the subject of mental health illness in people without being professionals. I am not criticizing this article. Just pointing out that not everyone is mentally unwell to the extent that they are not paranoid. They are going through a really crappy time.

  • Pam

    October 29th, 2023 at 7:36 PM

    My family call me mad, sad, mental, paranoid, say I have a “wicked mind”, am inappropriate etc. if I ever get up enough courage to challenge them about the negative ways they speak to me or treat me. Dismissingme as paranoid allows them to continue to be thoughtless, inconsiderate, hurftul, even nasty at times with impunity. They can feel justified in discussing my “problems” amongst themselves behind my back, deny that they ever do or say anything wrong and continue to consider themselves nice, righteous people. There is a lot in it for them if they brand me “paranoid”.
    Not so good for me though to have my reality and sanity questioned to the extent I am googling “am I paranoid”!

  • Jack

    February 19th, 2024 at 3:31 PM

    Not all fears or concerns are irrational or unfounded. Some people have hidden agendas and are quick to paint people as being paranoid to divert suspicion away from themselves. It happens more frequently than many people think.

  • M

    June 16th, 2024 at 9:54 PM

    Something similar happened to me — I had several concerns rooted in reality that doctors I was forced to see have mischaracterized as clinical paranoia, and have tried forcing medications on me. I am certain that I am not BPD or schizo, and this has been incredibly damaging to my life. Are there honest psychiatrists on this blog who may be able to help me with a second opinion clarifying that I do not have any mental illness?

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