Can PTSD Cause Paranoia?

Post-traumatic stress disorder,¹ commonly referred to as PTSD, is a psychiatric condition provoked by a traumatic event. Such an event could include war, sexual violence, abuse, torture, or neglect, all of which can be experienced directly or indirectly (i.e., witnessing it happening to someone else or learning that it happened to someone else).

While these traumatic events naturally produce fear and stress, people often recover from these symptoms naturally. However, someone experiencing PTSD continues to experience symptoms after the event, even years into the future.

To be diagnosed with PTSD, an individual must experience the symptoms for at least one month after the traumatic event occurred and experience significant distress or impairment. PTSD can affect anyone, independent of age, ethnicity, or culture.

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What are the symptoms of PTSD?

The symptoms of PTSD can be grouped into four categories:

  • Intrusion

  • Avoidance

  • Negative alterations in cognition and mood

  • Alterations in arousal and reactivity

Every person with PTSD will present differently, but symptoms typically include:

Intrusion

  • Flashbacks (dissociative reactions)

  • Nightmares related to the event

  • Involuntary and distressing memories of the event

  • Intense psychological and physiological distress in response to triggers² of the event (e.g., certain smells or noises)

Avoidance

  • Avoiding triggers that prompt distressing memories or feelings of the event (e.g., external reminders of the trauma)

  • Avoiding thinking about the event or feelings related to it

Negative alterations in cognition and mood

  • Memory loss related to the event

  • Reduced pleasure in once-enjoyed activities

  • Increased negative emotional state

  • Negative beliefs about yourself, other people, and the world in general

  • Distorted thoughts about situations surrounding the event

  • Persistent feeling of a low emotional state or constantly in a bad mood

Alterations in arousal and reactivity

  • Easily startled

  • Issues with concentration

  • Recklessness

  • Irritability

  • Sleep disturbance

  • Hypervigilance

Some symptoms are more obvious than others, but all tend to cause significant problems.

Paranoia and PTSD

While paranoia is not a symptom of PTSD according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), it may be exacerbated by other PTSD symptoms.

As mentioned above, hypervigilance is a common symptom of PTSD. Some use the words "paranoia" and "hypervigilance" interchangeably, but they have different definitions.

Hypervigilance³ tends to refer to being very aware of your surroundings, sometimes referred to as “always on guard.” Hypervigilant people are in a constant fight-or-flight state and startle easily.

Paranoia,⁴ however, refers to a mental state in which people are irrationally suspicious of others. They tend to have negative thoughts and delusions about others, as though other people are out to get them.

Another key distinction between the two is that hypervigilant people are often aware of their symptoms but a paranoid person may not be.

While the concepts of hypervigilance and paranoia are different, the two may be related.⁵ The state of constantly being aware of your surroundings can mean that hypervigilant people feel suspicious of those around them. This can prompt paranoia because they’re constantly on the lookout for betrayal.

Other symptoms of PTSD may bring on paranoid symptoms, including sleep disturbance.

One particular study⁶ demonstrated that veterans with PTSD were more likely to struggle with sleep disturbance and paranoid ideation than non-PTSD veterans. Reduced sleep quality has been extensively shown⁷ to promote psychotic-like symptoms, mostly paranoia.

Some researchers have even suggested a new diagnosis⁸ for PTSD that occurs with psychotic symptoms, including paranoia. These people often have far more severe symptoms of PTSD and tend to experience more serious impairments in well-being and overall functioning.

Causes of paranoia and PTSD

Some studies⁹ suggest that, while paranoia and PTSD are different and distinguishable conditions, they are positively correlated. In other words, they can be predicted by similar factors, which include:

  • Self-blame

  • Worry

  • An altered information-processing style during a traumatic event

  • Feelings of mental defeat

Studies¹⁰ concerning gang membership also note an increased prevalence of PTSD and paranoia compared to non-gang members.

Additional studies¹¹ have also revealed that negative thoughts about one’s self and others tend to be associated with the relationship between traumatic experiences and paranoia.

What other disorders are related to paranoia?

Paranoia is a common symptom in other disorders, and paranoid feelings are present in many conditions, including:

  • Paranoid schizophrenia¹²

  • Dementia¹³

  • Psychosis¹⁴

  • Paranoid personality disorder¹⁵

Paranoid thoughts and symptoms may also be prompted by the use of certain drugs such as cannabis, MDMA, and high doses of methamphetamine.

Treatment

Both PTSD and paranoia can cause significant harm and various problems in the daily life of the affected person, but many possible treatment options are available. PTSD is often treated using:

  • Cognitive behavioral therapy

  • Cognitive processing therapy

  • Cognitive therapy

  • Prolonged exposure therapy

Such interventions are strongly recommended by the American Psychiatric Association (APA) for their efficacy. Medications are also helpful and include:

  • Sertraline

  • Paroxetine

  • Venlafaxine

  • Fluoxetine

These are under conditional recommendation, meaning that they’re prescribed only when necessary. Other non-conventional treatments are also available.

For example, running and other forms of exercise can greatly reduce the symptoms of PTSD when used in combination with talk therapy.

Paranoia treatment¹⁶ may involve talk therapies such as cognitive behavioral therapy and family intervention. When paranoia is in the context of PTSD, treatment of PTSD  symptoms may relieve the feelings of paranoia.

Antipsychotics¹⁷ may also be used. Alternative therapies are available as well, including treatments using virtual reality.¹⁸ This targets negative thoughts about oneself and others by using compassionate imagery.

Trauma-focused treatment¹⁹ in PTSD patients with associated psychosis has also demonstrated significant reductions in paranoia without worsening PTSD-related symptoms.

Self-care and coping options are also helpful for paranoia. These include:

  • Keeping a diary or making notes about your thoughts

  • Trying to catch paranoid thoughts and challenge them

  • Looking for support from family or friends

  • Trying to get enough sleep, eat well, and exercise

The lowdown

While paranoia is not a symptom of PTSD according to the DSM-5, it can occur in people diagnosed with PTSD. These people experience distrust of others and often have difficulty functioning in their daily lives because of their paranoia combined with other PTSD symptoms.

Luckily, a multitude of treatment options is available for PTSD and paranoia.

  1. Post-traumatic stress disorder | NIH: National Institute of Mental Health

  2. A cognitive model of posttraumatic stress disorder (2000)

  3. The impact of hypervigilance: Evidence for a forward feedback loop (2013)

  4. Traumatised clients and the difference between paranoia and anxiety | Centre for Clinical Psychology

  5. Hypervigilance and PTSD | PTSD UK

  6. Disturbed egg sleep, paranoid cognition and somatic symptoms identify veterans with post-traumatic stress disorder (2018)

  7. Sleep quality and paranoia: The role of alexithymia, negative emotions and perceptual anomalies (2018)

  8. Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges (2018)

  9. Paranoia and post-traumatic stress disorder in the months after a physical assault: A longitudinal study examining shared and differential predictors (2013)

  10. Gang membership: Links to violence exposure, paranoia, PTSD, anxiety, and forced control of behavior in prison (2017)

  11. The association between traumatic experience, paranoia and hallucinations: A test of the predictions of psychological models (2007)

  12. Hypothesis: Grandiosity and guilt cause paranoia; Paranoid schizophrenia is a psychotic mood disorder; A review (2007)

  13. Neuropsychiatric aspects of multi-infarct dementia and dementia of the alzheimer type (1987)

  14. Paranoia and self-concepts in psychosis: A systematic review of the literature (2014)

  15. Mistrustful and misunderstood: A review of paranoid personality disorder (2017)

  16. Helping patients with paranoid and suspicious thoughts: A cognitive–behavioural approach (2018)

  17. A review of atypical antipsychotics and their utility in post-traumatic stress disorder (2013)

  18. Virtual reality clinical-experimental tests of compassion treatment techniques to reduce paranoia (2020)

  19. Trauma-focused treatment in PTSD patients with psychosis: Symptom exacerbation, adverse events, and revictimization (2015)

Other Sources:

Have you considered clinical trials for Post-traumatic stress disorder (PTSD)?

We make it easy for you to participate in a clinical trial for Post-traumatic stress disorder (PTSD), and get access to the latest treatments not yet widely available - and be a part of finding a cure.

Joining community groups and exercise programs for my condition made me feel empowered – but I want to be part of finding a cure.
Peter, 64

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