Paranoia vs Anxiety: Causes and Symptoms

Katelyn Hagerty

Reviewed by Katelyn Hagerty, FNP

Written by Geoffrey C. Whittaker

Published 08/28/2022

Updated 08/29/2022

Are you anxious about being paranoid? Paranoid that your anxiety is getting out of control? Or are you just uncertain about the differences between paranoia vs anxiety and how they’re impacting your life?

Uncertainty is a common element for both paranoia and anxiety sufferers — a symptomatic building block for what makes paranoia and anxiety affect your quality of life. 

And yet, it’s not something most people fully understand. 

The problem may be with our society itself. Both paranoia and anxiety get incomplete portraits in modern culture, and the way TV, movies and other media portray anxiety and paranoia isn’t really an accurate depiction of the subtleties, behaviors and limitations that paranoia and anxiety impose on the people who suffer with them.

Whether you’re anxious, paranoid, both or not sure if you qualify for either of them, there are some telltale signs that you should look for. 

Let’s start at the ground level — what are paranoia and anxiety and how are they related?

Paranoia is essentially a disordered version of suspicion. It’s very normal to be suspicious of someone holding a black sharpie and telling you to close your eyes — paranoia is much different. 

In the case of paranoia, you’re suspicious of nearly everyone and everything, for any number of reasons.

People with paranoia tend to look for evidence to back up their paranoia rather than try to determine if it’s really valid. They also tend to avoid the people they’re suspicious of, which can lead to isolation, reduced social interaction, hostility and detachment from reality and society.

There are many theories on why people develop psychotic disorders like paranoia, but research points to a combination of factors, including a genetic link, emotional neglect in childhood and other risk factors that lead to problems in adolescence and adulthood.

Anxiety, similarly, can cause avoidant, antisocial symptoms in the form of social anxiety disorder and can cause issues with things like sleep.

Interestingly, like with anxiety, paranoia may also be a function of an unaffected person’s brain to a certain extent. 

Some researchers believe that a little bit of paranoia is in all of us, and that it’s healthy and may have some benefits. 

The same could be said of mild, useful bits of anxiety — like the worry about getting struck by a car that reminds us to look both ways, or the way all of us would feel compelled to check for spiders while visiting Australia.

It’s easiest to think about anxiety in terms of time and bears. Stick with us on this.

Anxiety is primarily concerned with fears that exist in the future. Seeing a bear on your front porch is an immediate fear, but the fear that the bear will return at some unspecified date in the future is really what anxiety is about: you don’t know that it will return and you’re concerned with the hypothetical.

Anxiety disorders are essentially a state in which your fear about the bear returning is so strong that you avoid leaving your home, watch your front door at all hours of the day and surrender your pets to the shelter, lest they be eaten. 

In other words, it’s an irrational reaction to a not-yet-real fear — one that might never be real. In other words, it can consume our daily lives.

Paranoia could arguably fit into the definition of anxiety in some cases, but in reality, they’re two different mental illnesses. 

Whereas anxiety can result from any sort of irrational fear, paranoia tends to have a specifically narrow focus on the ill intent of others. 

This can manifest as resentment or anxiety or fear, but it often presents in the form of disordered thinking: paranoid beliefs that someone’s after you or has malicious intent. 

Paranoid delusions are essentially misinterpretations of reality that forge a certain viewpoint, often with no logical connection. In many cases, delusional disorders can cause a false belief to remain even after being confronted with reality and facts.

The lines between delusional anxiety and paranoia can get a bit murky. We’re pretty sure that someone who’s convinced they’re being stalked by a man in a bear costume checks all the boxes, though.

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There are a variety of psychological factors, environmental factors and biological factors associated with anxiety risk, and it’s possible that chronic stress due to paranoia might fit these criteria.

Anxiety is caused by fear — fear centered around danger from future, unknown sources. Excessive paranoia can obviously cause anxiety.

But anxiety disorders come from repeated stress that causes a pattern of anxiety symptoms, so you’d need a pattern of paranoia-induced anxiety to meet the criteria for something like generalized anxiety disorder. 

If that happens, you’ll have a lot to work through — and working through it requires an effective, tailored treatment plan.

Both paranoia and anxiety are very good reasons to start a conversation with a health care professional or mental health provider because they may be the best-qualified people on the planet to help you.

Unfortunately, the typical paranoid person won’t have much luck getting help from a professional because of paranoia. 

In many cases, people with paranoid personality disorder are suspicious of healthcare professionals and don’t often accept treatment. If you’re reading this and feel paranoid, you might have just enough self-awareness to push past those fears and ask for help — and we encourage you to do so. 

As for anxiety (and paranoia, in some cases), treatment can take one of three formats: therapy, medication and lifestyle changes. 

Medications like antidepressants — selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs), for example — can benefit people with anxiety by helping regulate the same neurotransmitters that may contribute to things like depression and other mood disorders and mental disorders.

Therapy, especially in the form of cognitive behavioral therapy, can be a great boon for people dealing with anxious thoughts, intrusive thoughts and other mental symptoms of anxiety. 

CBT, as it’s sometimes called, can help an anxious person frame negative thoughts as positive ones, eventually helping them master anxiety’s effects altogether.

Finally, caring for your physical health is associated with better mental health, and better mental health is associated with good diet, exercise and sleep habits. Your mind and body are more connected than you might think.

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People struggling with an anxiety- or paranoia-related medical condition can benefit from the support of a mental health professional, but taking that step can be very hard in both cases. 

If you’re in need of some professional assistance, we can help. Our resources include online therapy and mental health services, anxiety medications and plenty more reading material on our mental health blog. 

Take your time seeking out answers to any questions you have. Just know that therapy and professional care are the next step in getting better.

4 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Chand SP, Marwaha R. Anxiety. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  2. U.S. National Library of Medicine. (n.d.). Paranoid personality disorder: Medlineplus medical encyclopedia. MedlinePlus. Retrieved July 12, 2022, from
  3. Paranoid personality disorder (PPD): Symptoms & treatment. Cleveland Clinic. (n.d.). Retrieved July 13, 2022, from
  4. Raihani NJ, Bell V. An evolutionary perspective on paranoia. Nat Hum Behav. 2019 Feb;3(2):114-121. doi: 10.1038/s41562-018-0495-0. Epub 2018 Dec 17.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Katelyn Hagerty, FNP

Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.

She received her undergraduate degree in nursing from the University of Delaware and her master's degree from Thomas Jefferson University. You can find Katelyn on Doximity for more information.

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