A person with schizophrenia may experience delusional thinking, including paranoid thoughts. It may not be possible for the person to distinguish between this and regular thinking.

Schizophrenia affects a person’s perception and can involve hallucinations and delusions. When these happen, it can be hard to know what is real and what is not.

Paranoid delusions can cause a person to fear that others are watching them or trying to harm them. Also, a person experiencing a delusion may believe that media, such as the television or the internet, are sending them special messages.

These feelings and beliefs can cause severe fear and anxiety, disrupt daily life, and limit a person’s ability to participate in work and relationships, including those with family.

Studies suggest that nearly 50% of people with schizophrenia experience paranoia.

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Schizophrenia is a spectrum disorder, meaning that it encompasses several linked conditions, symptoms, and traits.

Before 2013, healthcare professionals considered paranoid schizophrenia to be a distinct type of the disorder. However, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), which provides expert guidelines, dropped that classification in 2016. It now classifies paranoia as a symptom, rather than a subtype, of the disorder.

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Schizophrenia is a lifelong mental health condition. Symptoms often emerge when a person is in their late teens to early 30s.

It can affect a person’s:

  • thought processes
  • perceptions and feelings
  • sleep patterns
  • ability to communicate and relate to others
  • ability to focus and complete tasks

Symptoms of schizophrenia can include:

  • a lack of motivation
  • changes in sleep patterns
  • a lack of self-care
  • disordered thinking
  • changes in body language and emotions
  • withdrawing from family, friends, and activities
  • psychotic symptoms, such as hallucinations and delusions

A delusion is something a person believes to be true, even when strong evidence suggests it is false. For example, a person may believe that someone is planning to harm them.

A hallucination is when a person hears, sees, smells, tastes, or feels things that are not there. A common hallucination for a person with schizophrenia is hearing voices that are not there.

People with paranoia may experience a combination of the following:

  • feeling upset, anxious, angry, and confused
  • being suspicious of those around them
  • believing that someone is persecuting them
  • fearing that someone is following, chasing, poisoning, or otherwise plotting against them
  • feeling as if someone else is controlling their thoughts and actions
  • feeling as if their thoughts are disappearing or being taken away from them

The person may also engage in self-harm or attempt suicide, but this can happen with many conditions.

If a person experiences any of the above, they should receive immediate medical care.

Find out more about disorganized thinking, a symptom of schizophrenia.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

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Schizophrenia is a neuropsychiatric disorder. The exact causes are unclear, but they likely involve a combination of genetic factors and environmental triggers.

Risk factors may be:

  • Genetic: Those with a family history may have a higher risk.
  • Medical: These may include poor nutrition before birth and some viruses.
  • Biological: Features of the brain’s structure or the activity of neurotransmitters, such as dopamine, may contribute.
  • Environmental: Stress, past trauma, and abuse may trigger symptoms in people already at risk.

One study suggests that people with schizophrenia and paranoia may have social cognitive impairments that make it harder for them, for example, to recognize people’s emotions or trust others. However, drawing conclusions about this will require more research.

Use of drugs

Some recreational drugs that affect the mental processes, such as amphetamines, cocaine, cannabis, and LSD, may trigger psychosis or schizophrenia in people with a susceptibility.

Experts say that the use of drugs is more common among people with schizophrenia, but it is not clear whether the drugs trigger the disorder or whether having schizophrenia increases the likelihood of using drugs to cope with symptoms.

Various substances can also interfere with treatment. Anyone with concerns about the link between schizophrenia and substance use should speak with a doctor.

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If a person seeks help for symptoms that may indicate schizophrenia, a doctor will consider their personal and family medical histories and physical health, as well as the symptoms.

They may also request diagnostic tests, such as blood tests, to rule out other possible causes of the symptoms.

Diagnostic criteria

For a doctor to diagnose schizophrenia, a person must continuously exhibit signs of the disorder for at least 6 months. This may involve:

  • delusions
  • hallucinations
  • disorganized speech
  • social and occupational dysfunction
  • highly disorganized or catatonic behavior
  • emotional flatness or a lack of pleasure in everyday life

A doctor can only diagnose schizophrenia if any other health issue cannot explain these signs, such as drug or alcohol misuse or a mood disorder.

Overall, it can take some time to reach a diagnosis.

According to the National Alliance on Mental Illness (NAMI), Black and Latinx people in the United States are more likely than others to receive an incorrect diagnosis of schizophrenia. This may be due to clinical bias, difficulty accessing suitable healthcare, or both.

Learn about schizoaffective disorder, which involves schizophrenia and a mood disorder.

Schizophrenia is a lifelong condition, but treatment can help relieve the symptoms. If a person stops the treatment at any point, their symptoms may return.

It can take time to find the best approach, which may be a combination of treatments. The right combination depends on factors such as which symptoms are present, how severe they are, and the person’s age.

It helps if the person and their doctor are able to work together to develop and tweak the treatment plan, NAMI reports.


Drugs called antipsychotics can reduce the occurrence of disturbing thoughts, hallucinations, and delusions.

Drug options include the following:

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Maintenance drugs may have the same ingredients as an initial SGA, but their effects last longer as the body releases them slowly after the injection. The effects can last several weeks.

However, it can take time to find a suitable option. In addition, around 30% of people do not have a good reaction to antipsychotic drugs. In around 7% of cases, the drugs are ineffective.

If the person’s symptoms do not respond to at least two antipsychotics, the doctor may prescribe clozapine (Clozaril). This is not the first choice due to the risk of adverse effects.

Learn more about SGAs and other antipsychotics for schizophrenia.

Psychotherapy and social support

Counseling and other types of therapy can help a person with schizophrenia live independently.

Some options include:

Also, social support can help a person find work and housing and improve their communication skills and overall well-being. This may involve a peer support group.

Caregivers and loved ones can help by learning about schizophrenia and encouraging the person to follow their treatment plan.

One study has suggested that people with schizophrenia and paranoia benefit from support and treatment that specifically tailor to these issues.

Complementary medicines

According to NAMI, the following may play a role in a wider treatment plan:

While these may help, they cannot replace traditional treatment. It is important that people with schizophrenia discuss any complementary treatments with their doctors.

Without treatment, schizophrenia can significantly disrupt a person’s life, including their ability to work, study, and care for themselves.

Some helpful strategies include:

  • following the treatment plan carefully, including taking medications as prescribed
  • bringing up any concerns about treatment with a healthcare professional
  • making use of available support, which may involve friends, crisis services, and specialized healthcare facilities
  • making healthy choices regarding diet, exercise, and the use of drugs, alcohol, and tobacco
  • talking about the experience of schizophrenia with friends, family members, healthcare professionals, and supportive peers

Loved ones can help by:

  • listening to the person
  • educating themselves about schizophrenia
  • learning to spot the signs of a relapse
  • understanding what to do if a relapse happens

Here are some questions people often ask about schizophrenia-related paranoia.

What is paranoid schizophrenia like?

Experts no longer consider paranoid schizophrenia a type of schizophrenia, but paranoia can be a symptom of schizophrenia. A person may believe people are watching, harassing, or persecuting them. This can give rise to anxiety and fear.

What triggers paranoia in a person with schizophrenia?

Paranoia is a symptom that affects some people with schizophrenia. Doctors do not know precisely what causes schizophrenia, but it probably stems from a combination of genetic and environmental factors.

It is a complex condition, but experts have suggested risk factors may include birthing complications, health issues in the birthing parent during pregnancy, a family history of psychosis, childhood trauma, social isolation, living in an urban environment, and cannabis use.

A person who is undergoing treatment for schizophrenia may experience symptoms if they stop using medication.

What are some warning signs of schizophrenia?

The first episode of schizophrenia usually happens during adolescence or early adulthood. Changes are often gradual. A person may not be aware of changes in themselves, but others may notice the following:

  • social withdrawal and depressed mood
  • apparent personality changes
  • unusual behavior and speech
  • lack of self-care
  • self-harm or suicide attempts
  • extreme reactions to criticism
  • calling the emergency services about perceived but delusional symptoms
  • getting into trouble with authorities such as crime enforcement agencies

Schizophrenia is a severe mental health condition that can involve delusions and paranoia.

A person with paranoia may fear that other people are pursuing and intending to harm them. This can have a severe impact on their safety and overall well-being.

Treatment can often help a person manage their symptoms and live a full life. It is important to receive ongoing support.