The beliefs that come from paranoia are referred to as “persecutory delusions” — that is, beliefs that other people are talking about you, plotting against you, following you, or in some other way literally persecuting you. Paranoia is not inevitable for people with bipolar disorder. Many people with bipolar disorder experience a wide range of mood swings and other disruptions in their life, but never experience the severe highs or lows that can lead to psychosis and paranoia. Paranoia is unlikely to be the only symptom affecting a person with psychosis and bipolar disorder. Other symptoms of bipolar psychosis may include:
Disrupted, disorganized, or hard-to-understand speech or thought patternsHallucinationsUnrealistic beliefsDifficulty managing daily activitiesDifficulty knowing what is real and what is not
As with many bipolar symptoms, the mechanism behind paranoia is not easily understood. There is some evidence that interrupted sleep — especially insomnia or a prolonged period of getting less sleep than normal — can trigger paranoia. Interrupted sleep is a hallmark of bipolar disorder, particularly when people enter the manic phase and sleep less than usual or not at all. “Antipsychotic medications can be useful in reducing paranoia,” says psychiatrist Michael Peterson, MD, PhD, an assistant professor in the department of psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison. Antipsychotic medications can be used temporarily or may be used over a long period to stabilize thoughts and emotions. With true psychosis, patients may not be able to question whether their paranoid beliefs are real. Often, their paranoid beliefs are unshakable. In these cases, medical management may be the only way to reduce the strength of these beliefs. However, according to Dr. Peterson, there are many people whose paranoia is not as fixed. “When people have some insight into these fears and thoughts, cognitive approaches can be useful, too,” he says. In these situations, options for management include:
Therapy. Going to therapy and learning how to work with paranoid thoughts may help lessen the paranoia. “An example of this might be rationalizing why the fears may not be real or ways of testing how real these might be,” Peterson explains. Look for a professional trained in cognitive-behavioral therapy or who specializes in working with people with bipolar disorder.Social support. “Reviewing these fears with a loved one or trusted friend, in addition to health care providers, can also be useful,” says Peterson. Trust is the key, of course. Paranoia has the unfortunate side effect of eroding even the closest relationships if it is not controlled.Support groups. Look for a suitable support group through a local community mental health center, National Alliance on Mental Illness chapter, or another dedicated bipolar or schizophrenia support group. Remember that it is okay to try out a few support groups until you find one that you are comfortable with.
Paranoia is a distinctly unpleasant experience for people with bipolar disorder. However, it can be controlled, managed, and reduced so that it has less impact on your daily life.
