Paranoia and anxiety are two separate conditions. Both can cause changes in thinking patterns. Doctors no longer use the term paranoia, referring to the illness as delusional disorder.

Symptoms of delusional disorder include hallucinations and mood disturbances, such as feelings of extreme sadness or distress. Delusional thinking patterns can center around extreme jealousy and persecution.

People with anxiety present with symptoms of intense worry and sometimes panic, depending on the type.

A person can have delusional disorder and anxiety at the same time. Doctors treat both conditions with a mixture of psychotherapy and medication.

Keep reading to learn more about the symptoms, causes, and treatment options for anxiety and delusional disorder.

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Delusional disorder and anxiety are distinct conditions with different symptoms.

Delusional disorder

Delusional disorder does not impact behavior or well-being unless the person is experiencing or talking about something related to their delusion.

For example, an individual living with hypochondriacal psychosis, a delusion where they believe they have symptoms of a serious health condition, may feel extremely anxious when discussing anything about their health.

Generally, people with delusional disorder tend to feel socially isolated. They may also experience:

Changes in thinking patterns

Changes to a person’s thought patterns involving false beliefs are the most telling symptom of a delusion. Someone may feel persecuted and believe that certain organizations or people intend to cause them harm, or they may become fixated on the idea that their spouse is having an affair.

People with delusional disorder can experience a mixture of delusions with no common theme.

Mood disturbances

A person’s mood may change when they are experiencing a delusion. They may feel more anxious, irritable, or depressed.

Changes in perception

Some people experience auditory hallucinations as part of a delusion. During an auditory hallucination, an individual may hear sounds, such as voices, that are not really there.


Everybody feels anxious from time to time, and it is not unusual to worry before taking a test or starting a new job. However, when anxiety begins to take over a person’s routine and impact their quality of life, it is important they seek help.

There are several types of anxiety. Generalized anxiety disorder (GAD) is one of the most common, alongside social anxiety and phobias.

Symptoms of GAD include:

Many biological and psychological factors contribute to the development of delusional disorder and anxiety.

Delusional disorder

Researchers are unsure of the exact cause of delusional disorder. They know that biological triggers, such as substance use and some neurological conditions, can bring on delusions.

Psychological triggers of delusional disorder include social isolation, low self-esteem, and envy. When these states of psychological distress reach a high level, a person may develop a delusion to explain why they are feeling a particular way.


Many biological and psychological factors also contribute to anxiety.

Some people may be genetically predisposed to developing anxiety disorders, which can run in families.

Psychological factors that contribute to anxiety include trauma, such as the death of a loved one or an abusive relationship. A person may also experience symptoms if they are living with a prolonged illness or chronic stress.

Social and cultural factors can play a part in anxiety. For example, a 2015 review found a strong link between the experience of racism and the development of mental health difficulties including anxiety and depression. Research indicates that socioeconomic factors such as poverty experienced in childhood can also lead to mental illness.

Learn more about the causes of anxiety disorders here.

Doctors use a combination of lab tests and psychological assessments to diagnose delusional disorder and anxiety.

Delusional disorder

If a doctor thinks substances may be triggering a person’s delusions, they will order a urine test. They may also request an MRI scan or other form of imaging to rule out any other biological causes.

If there is no biological explanation, a doctor will begin a series of psychological assessments. They may also try to ascertain when the delusions started and if any life events triggered them.


A doctor may diagnose an anxiety disorder if a person presents with excessive worrying, sleep disturbance, and restlessness.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) states that these symptoms should be present for 6 months or more in cases of GAD. However, a doctor may make a diagnosis sooner than this. They will refer to the DSM-5 to rule out other psychological conditions.

A doctor may also consider other factors, such as a family history of anxiety. If a person is experiencing physical symptoms like fatigue, a doctor may do a blood test to eliminate any underlying conditions, such as an underactive thyroid.

The most effective treatment plan for both delusional disorder and anxiety is usually a combination of therapy and medication.

Delusional disorder

When treating delusional disorder, a doctor will likely begin with psychotherapy. They may then introduce antipsychotic medication as a trial for 6 weeks, adjusting the dose over time if needed.

If antipsychotic medication is not effective, lithium, valproic acid, and carbamazepine are alternative drug options.


GAD’s two main treatment options are cognitive behavioral therapy and medication, especially antidepressants.

To treat GAD, doctors generally prescribe antidepressants called selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Both these medications affect the levels of certain chemicals in a person’s brain.

If an individual is experiencing delusions and GAD, they will likely also take antipsychotics.

A person can have both delusional disorder and anxiety at the same time. Naturally, if an individual’s delusions center around their health, or if they are convinced certain groups of people are plotting against them, they will feel some form of anxiety and nervousness.

It is possible that those with health-related anxiety might experience COVID-19-related delusions, which may present with physical symptoms such as a runny nose. One 2021 case report observed that COVID-19-related delusions only ceased in one person after they took trifluoperazine (an antipsychotic medication) for 5 months.

People can have delusional disorder and anxiety at the same time. Anxiety creates feelings of intense worry. Delusional disorder symptoms revolve around false beliefs or inaccurate interpretations of real-life situations.

These interpretations persist even when the person encounters evidence that disproves the belief. For example, it is possible for someone with health anxiety to develop symptom delusions, despite testing negative for the presence of an infection.

A mixture of psychological and biological factors can bring on delusions and anxiety. A doctor will request a series of lab tests and conduct several psychological assessments to make a diagnosis.

Doctors treat both conditions with a mixture of therapy and medication.