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.

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, which provides expert guidelines, now classifies paranoia as a symptom, rather than a subtype, of the disorder.

Experts explained their choice to remove the subtypes from the classification, citing “limited diagnostic stability, low reliability, and poor validity.”

How can people manage schizophrenia during COVID-19?

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
  • ability to focus and complete tasks
  • ability to relate to others

Symptoms of schizophrenia can include:

  • a lack of motivation
  • slow movement
  • changes in sleep patterns
  • low libido, or sex drive
  • a lack of self-care
  • disorganized thinking
  • changes in body language and emotions
  • withdrawing from family, friends, and activities
  • hallucinations and delusions

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

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
  • suicidal thoughts and behavior

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

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 National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.

Click here for more links and local resources.

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.

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

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 needs to exhibit signs of the disorder continuously 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 these signs cannot be explained by any other health issue, such as drug or alcohol abuse 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 racial 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 report.


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

It can take time to find a suitable option, however. Also, 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.

Psychotherapy and social support

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

Some options include:

  • vocational training therapy
  • cognitive behavioral therapy
  • supportive psychotherapy
  • cognitive enhancement therapy

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 are specifically tailored to these issues.

Complementary medicines

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

  • acupuncture
  • meditation
  • nutritional interventions

While these may help, they cannot replace traditional treatment.

Some researchers have suggested that cannabidiol (CBD), an ingredient in cannabis, could play a role in treating schizophrenia. However, confirming this will require more research.

It is important that people with schizophrenia discuss any complementary treatments with their doctors.

Is CBD legal?The 2018 Farm Bill removed hemp from the legal definition of marijuana in the Controlled Substances Act. This made some hemp-derived CBD products with less than 0.3 percent THC federally legal. However, CBD products containing more than 0.3 percent THC still fall under the legal definition of marijuana, making them federally illegal but legal under some state laws. Be sure to check state laws, especially when traveling. Also, keep in mind that the FDA has not approved nonprescription CBD products, and some products may be inaccurately labeled.

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 provider
  • making use of available support, which may involve friends, crisis services, and specialized healthcare facilities
  • making healthful choices regarding the diet, exercise, and the use of drugs, alcohol, and tobacco
  • talking about the experience of schizophrenia with friends, family members, healthcare providers, 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

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.