What Clinical Paranoia Looks Like in Teens

Your teenage son mutters about people following him. He says everyone is against him.

Your teenage daughter is suspicious about friends and family. She insists people spy on her.

Are they clinically paranoid? Do they have schizophrenia? Is it severe anxiety? Or is it nothing to worry about?

To answer these questions, let’s talk about what these terms actually mean.

Paranoia

The American Journal of Psychiatry describes paranoia as a “pervasive and unwarranted mistrust of others.” Paranoid thinking stems from anxiety and fear. Teens with paranoia are often nervous around other people, which is why some researchers believe social anxiety is a mild form of paranoia. Teens with paranoia attribute negative intent to the actions of friends and family members. They believe everyone is out to get them.
There are three levels of paranoia:

• Paranoid personality disorder
• Delusional (paranoid) disorder
• Paranoid schizophrenia

Let’s go through these one by one.

Paranoid Personality Disorder (PPD)

The first and mildest level of clinical paranoia, paranoid personality disorder, is simply a pervasive suspicion of everyone. This is the most common type of paranoia. Teens with this disorder are consistently paranoid, all the time. Their suspicion is more than a solitary psychotic incident. Paranoia is prevalent in their thinking 24/7.

In addition to being generally distrustful of others, teens with PPD are often:

• Highly sensitive to criticism
• Rigid
• Hypervigilant
• Secretive
• Evasive
• Aggressive
• Extremely independent

Additionally, they often…

• Seem offended
• Are defensive
• Believe that others are criticizing them behind their back
• Are suspicious of being lied to or cheated in some way

Teens with PPD often have a hard time with close relationships. They may isolate themselves from others and appear angry at the world. They often resist treatment because they think the mental health provider is against them as well.

Take a look at this case study, published in the American Journal of Psychiatry about an older patient with paranoid personality disorder:

Upon initial contact with the emergency department psychiatrist, the patient reported feeling that the staff at the hospital were against him…He did not fully cooperate with the interview, was guarded and evasive, and often said, “You don’t need to know.” … He was suspicious and mistrustful of the treatment providers… [His relative] described incidents in the past in which he had held beliefs about others “being against” him, resulting in isolation from friends and family. She described him as someone who “often held grudges and for a long time.”

That could very well describe a teenager with PPD. Their experience of the world is that they can’t trust their friends, family, or anyone. That means they’re unlikely to trust a therapist, counselor, or psychiatrist as well, which can complicate the treatment process.

Delusional Disorder

Paranoid thinking can often reach the point of delusional thinking or beliefs. Delusions are irrational, illusionary thoughts that are false or disconnected from reality.

The delusions may center around a certain theme, for example, persecutions. Teens might tell you they receive death threats, that the CIA conspires against them, their phones are tapped, or that someone is tracking them(see note below). These are called persecutory delusions.

There are other types of delusions, too. A person may believe that a deceased person, a celebrity, or another inaccessible person is in love with them (erotomania). Or someone may think they have a magical superpower, or that they are extremely famous (grandiose delusions).

If someone has delusions that last for at least a month, they may have delusional disorder. Before 2014, delusional disorder was called paranoid disorder.

However, delusional disorder is more common in older adults. A teen with delusional thoughts and beliefs typically have early-onset schizophrenia rather than delusional disorder.

Schizophrenia

Often, paranoid delusions are accompanied by visual or auditory hallucinations. For example, teens with persecutory delusions may hear sounds of guns and bombs. They may have visions of demons, aliens, or soldiers surrounding them. When delusions are accompanied by hallucinations, dysfunctional behavior, and disorganized speech, the teen who experiences them may have schizophrenia. The age of onset for schizophrenia is typically early adulthood – age 18-25 for males and age 25-35 for females, but people as young as 14 years old can develop schizophrenia, as well. When it appears before are 18, it’s called early-onset schizophrenia. In the rare cases when schizophrenia develops before the age of 12, it’s called childhood onset schizophrenia.

Here are the warning signs of schizophrenia, otherwise known as the prodromal symptoms of schizophrenia:

• Paranoia
• Change in eating and sleeping patterns
• Decline in self-care or hygiene
• Loss of interest in once-pleasurable activities
• Loss of motivation
• Changes in grades
• Difficulty focusing and keeping up a conversation
• Becoming wary of others
• Withdrawal from others
• Worrisome moods
• Confusion between dreams and reality
• Visual and auditory hallucinations

If your teen exhibits the above signs, and they’re beginning to lose touch with reality, we advise arranging an assessment with a mental health professional. A teen who shows those symptoms may be in the beginning (prodromal) stages of schizophrenia.

Although it affects around 20 million people worldwide, schizophrenia is one of the less common mental health disorders. In the U.S., about 4-7 people out of every 1,000 have schizophrenia – that’s between 0.4% and 0.7% of the population. Most teens with schizophrenia need treatment and support for the disorder. After a thorough assessment and diagnosis, mental health professionals often recommend intensive residential treatment and/or medication management to learn how to deal with their symptoms and function in everyday life.

Note: When It’s Not Paranoia

An important disclaimer:

There are times when a teen isn’t being paranoid and they are being stalked or threatened by someone. Unfortunately, stalking is quite common in the U.S. The Centers for Disease Control (CDC) indicates that more than 7 million people report being stalked every year. However, most people are stalked by someone they know. A former friend or romantic interest, for instance – not by the CIA or law enforcement.  With this in mind, parents should first ascertain that their teen is safe, and that their beliefs about being stalked, watched, or surveilled aren’t actually rooted in reality.

Paranoia and Psychosis

If you think paranoia and paranoid delusions sound a lot like psychosis, you’re correct. Paranoia is considered a primary symptom of psychosis. When someone has a psychotic experience, they often have paranoid delusions. They may also hallucinate, and see disturbing visions and/or hear voices in their head. Psychosis can be caused by schizophrenia or other mental health issues, extreme stress, sleep deprivation, drugs, a traumatic brain injury, or other factors.

PTSD and Paranoia

Something else that bears mentioning here is the link between post-traumatic stress disorder (PTSD) and paranoia. When traumatic incidents involve a threatening person/people, which they often do, victims may experience persecutory delusions. The root of this type of paranoia in the anxiety, fear, and stress experienced during the initial trauma.

For example, a teen who was violently attacked by a friend or former partner while walking home from school may become wary of friends and people in general. This can develop into paranoia. Research shows that childhood abuse is associated with paranoia later in life, and that paranoia is a common symptom associated with PTSD. Other symptoms include nightmares, psychosomatic complaints, flashbacks, angry outbursts, general irritability, and avoiding the people/places/situations that remind the victim of the event.

To determine whether your teen has PTSD, contact a licensed mental health professional and arrange a full assessment and evaluation.

Do you need to worry about your paranoid teen?

Teens with paranoia may think that their immediate family members, friends, or random strangers on the street could be dangerous. If they are hallucinating, they may hear voices telling them to attack certain people or themselves. And they may believe the voices are real.

Due to the risk that teens may act on their paranoia, parents should take paranoid thinking in their teens very seriously. In fact, studies show that violence and some criminal behavior – such as arson – are often associated with paranoid personality disorder, psychosis, or schizophrenia. When teens experience psychosis, they may be out of control and unpredictable.

That’s why, if you suspect your teen exhibits symptoms of clinical paranoia, delusions, psychosis, or schizophrenia, we advise you go to the emergency room at a mental health/psychiatric hospital as soon as possible. That may be hard to take, but it’s true that anyone – teenagers included – in the middle of a severe psychotic episode may be a danger to themselves or others.

Treatment for Paranoid Personality Disorder, Delusional Disorder, and Schizophrenia

Evidence-based treatments for psychotic disorders for which paranoia is a primary symptom, such as paranoid personality disorder (ppd), delusional disorder, and schizophrenia, include the following:

• Medication
  • Typical antipsychotics
  • Atypical antipsychotics
• Cognitive Behavioral Therapy (CBT)
  • Individual
  • Group
  • Family
• Psychosocial support
  • Simplified environment
  • Reduced stimulation
  • Structured interaction

Depending on the severity of the disorder and the outcome of a professional assessment, teens with paranoia, schizophrenia, or psychosis may need short-term residential treatment at a mental health treatment center for adolescents. In crisis situations, they may require inpatient hospitalization until the crisis pass. Consistent time spent in a safe, supportive, healing, low-stress environment will help reduce the symptoms associated with paranoid personality disorder, delusional disorder, or schizophrenia in teens.

Early intervention is vital for adolescent paranoid personality disorder, delusional disorder, or schizophrenia. Delaying treatment can result in an exacerbation of symptoms. The rule of thumb with regards to treatment for any mental health disorder – including those with psychotic features – is easy to remember: the sooner the better.

If you’re a teen wondering if you have clinical paranoia, please read our article for adolescents here.