Anxiety vs Paranoia: Understanding the Difference

Anxiety and paranoia are not light matters. 31.1% of American adults, including millions of older adults and veterans, experience an anxiety disorder at some point in their lives. Anxiety and paranoia can cause issues like interpersonal strife and self-harm. 

However, many people don’t get the treatment they need because they confuse anxiety with paranoia. If you’re concerned about your mental health, you must figure out anxiety vs. paranoia. Here’s what you should know about these two conditions.

The Basics of Anxiety

According to the American Psychological Association, anxiety is “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” Some people have anxiety occasionally, while others develop chronic anxiety disorders that require treatment. 

Anxiety disorders can create recurring and intrusive thoughts, including thoughts of violence toward others. They can lead people to avoid situations out of worry, sometimes without a logical reason. Many people with anxiety disorders experience physical symptoms like heart palpitations, dizziness, and sweating.

Many people confuse anxiety with fear, but they are two different emotions. Fear is a response to a present and specific danger, like a storm or a home intruder. Fear may be intense and contribute to similar symptoms as anxiety, but it passes quickly. Anxiety is long-term and future-oriented without any basis in a specific danger. 

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The Basics of Paranoia

Mental Health America states paranoia “involves intense anxious or fearful feelings and thoughts often related to persecution, threat, or conspiracy.” Paranoia can occur independently of a psychiatric disorder, but it is most present in psychotic disorders. Psychotic disorders are conditions that create strange thinking, changes in perceptions, and emotional swings. 

Paranoia can create delusions, which are false beliefs about reality. Someone may think that the government is tracking them or another person is stalking them. A person may believe their delusions so strongly that no information can change their mind, leading to significant complications. 

Paranoia and delusions may not cause any physical symptoms. Someone may not have changes in perception, seeing or hearing things that are not there. Some people maintain jobs and families while living with paranoia, while others cannot function or perform tasks like grocery shopping.

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Symptoms

Anxiety and paranoia can seem similar, but they cause very different effects on the body. Anxiety can cause emotional, physical, and behavioral symptoms. Emotional symptoms of anxiety include intense feelings of panic, having uncontrollable thoughts, and having nightmares. Physical symptoms include difficulty breathing and heart palpitations. Nighttime anxiety can be more severe than daytime anxiety, sometimes for no apparent reason.

Many people with anxiety will take action based on their emotional and physical symptoms. If they associate their anxiety with an object or place, they may avoid it. They may engage in ritualistic behaviors that help them calm down, like washing their hands. Some people use drugs or alcohol to cope with their symptoms, worsening anxiety. 

Paranoia can create emotional symptoms like fear, but it is more behavioral. A paranoid person may become hyperaware of small details and read hidden meanings into normal things. They may overthink and over-analyze, jumping to unsound or bizarre conclusions. Many paranoid people are stubborn, refusing to admit that they are wrong. 

A paranoid person may struggle to open up to people, making it hard for them to find friends or romantic partners. They also may find it hard to compromise or accept criticism, which can hurt their job prospects. 

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Causes

Many people associate anxiety with stressful life events like divorces or getting fired. Someone can develop anxiety after a stressful event, but other causes of anxiety disorders exist. Anxiety has genetic components, though doctors are still determining how exactly genetics can contribute to anxiety. A 2022 study found that people with neurotic or introverted personalities are more likely to develop anxiety than extroverted people. 

Scientists are uncertain about why paranoia occurs, though it’s likely a combination of factors. A person is more likely to develop paranoia when they have an unusual experience that is difficult to explain, like a car accident. People who come to conclusions quickly or develop strong opinions are more likely to become paranoid than other people. Dementia and neurological disorders can cause paranoid thinking, including Alzheimer’s disease. 

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Treatments

A doctor can diagnose anxiety vs. paranoia by conducting a physical exam to rule out illnesses that could be causing physical symptoms. They can also take a personal history and run tests to determine if a person meets the definition of anxiety or paranoia. 

Doctors treat anxiety disorders with psychotherapy and medication. Cognitive behavioral therapy (CBT) helps people identify the thoughts contributing to their anxiety. They work with a psychotherapist over time to challenge their thoughts and replace them with positive ones. Exposure therapy introduces people to events and situations they avoid due to anxiety. It can help them confront situations that lead to anxiety attacks and overcome them. 

Medication does not cure anxiety but can help someone manage their symptoms, including physical sensations. Common medications include Xanax and Valium, which can help with generalized and social anxiety disorders. 

CBT can also help with paranoia, though someone may need additional psychotherapy to help them. Someone who struggles to open up to people may take therapy to improve their communication and relaxation skills. Psychodynamic therapy can help someone understand how their subconscious and unconscious feelings contribute to paranoia. People with paranoia can take antipsychotic medications like Loxitane and Prolixin that moderate psychotic thoughts and delusional episodes. 

Related: 5 Ways to Alleviate Anxiety