Is There a Difference Between Paranoia and Delusional Disorders?

Paranoia and delusional disorder are similar conditions in many ways, and they can be easily mixed up. They are not, however, the same mental health condition, as they have fundamental differences.

In this article, you’ll learn what paranoia and delusional disorders are, how they relate to addiction, and treatment options for these disorders.

What Is Paranoia?

Paranoia and delusional disorder kind of similar but they have fundamental differences

When a person believes others are “out to get” them; trying to harm or stalk them; or watching, hunting, spying, or paying excessive attention to them for no reason, they may be experiencing paranoia.

This condition can be a symptom or side effect of several mental illnesses, as well as intoxication or drug misuse.

What Are the Symptoms of Paranoia?

When a person experiences paranoia, they may display symptoms such as:1

  • Difficulty believing or trusting others
  • Becoming easily offended
  • Being unable to understand or cope with criticism
  • Believing remarks are intended differently, especially harmfully
  • Attempting to find underlying meaning or messages in a conversation or a look
  • Acting defensively
  • Inability to compromise
  • Inability to let go of past transgressions even after an apology
  • Assuming that people around them dislike them, even if they say or do things to the contrary
  • Believing others are lying to them or scheming against them
  • Finding relationships difficult to maintain due to problems developing trust
  • Constantly feeling threatened by strangers and/or loved ones
  • Feeling persecuted when bad things happen, no matter how large or small
  • Believing in conspiracy theories

What Is a Delusional Disorder?

Delusional disorder is a condition in which a person experiences non-schizophrenic delusions about the people in their lives and the world around them.2 For example, a person may believe that a famous individual is on love with them, or that they are being spied on by a coworker.

Typically, a person with delusional disorder acts normal and can function in everyday life, although they may also, at times, display paranoia or other symptoms related to their delusion.

What Are the Different Types of Delusions?

Different types of delusions show different symptoms. The five types of delusions experienced by people with this disorder as well as the symptoms displayed are outlined below.3

  1. Erotomanic: This is the belief that a person with higher social or financial standing, such as a famous movie star, is in love with the individual. This can lead to stalking and obsession with the object of the delusion.
  2. Grandiose: This involves the false belief that the individual has a special power, ability, relationship, or feature not shared with anyone else. For example, the individual might believe they have the power of flight or that they have excessive luck.
  3. Jealous: This is the belief that a lover or former lover is unfaithful or intentionally harmful. Paranoia about the loved one’s words and actions can be a symptom of jealous delusions.
  4. Persecutory: This is a delusion in which a person believes they are being threatened, mistreated, or will be harmed in the future. The common sense of the paranoia is that someone or something is “out to get” the individual.
  5. Somatic: This is a paranoid delusion in which a person believes they have an illness, disability, or physical defect.

A person with delusional disorder may experience one type of delusion or a few simultaneously. For example, a person may believe that a spouse is slowly poisoning them.

What Causes Paranoia & Delusional Disorders?


Paranoia is a persistent feeling that is a symptom of some conditions, including intoxication on drugs like cocaine, LSD, bath salts, or marijuana.4 There are other mental health issues that are the primary causes of paranoia and defined largely by the consistent display and experience of paranoia. These are:

  1. Paranoid personality disorder: Defined as the mildest form of paranoia, an individual with this condition may distrust the world around them, but they are still able to function in relationships, maintain employment, and participate in social activities.
  2. Delusional (paranoid) disorder: A person with this condition holds one major false belief, or delusion, typically without any other signs of mental illness. For example, a person with persecution delusions will believe that others are talking about them behind their back, spying on them, and actively plotting to harm them. People with hypochondria believe they suffer from a mysterious illness or illnesses and need immediate medical attention.
  3. Paranoid schizophrenia: This is the most severe type of paranoia, and it involves strange, baseless delusions, such as the belief that thoughts are being spied on by a government agency. Hallucinations are common with this form of schizophrenia. People struggling with this condition do not function well in society and need consistent treatment.

Risk factors that may contribute to the development of paranoia include:

  • Genetics.
  • Brain damage from an illness, injury, or substance misuse.
  • Traumatic events in life, such as experiencing conflict in war or childhood sexual trauma.

Delusional Disorder

The causes of delusional disorder may be:

  • Genetic.
  • Biological.
  • Environmental.
  • Psychological.

People with close family members who experience similar disorders are at a higher risk for delusional disorder; an injury to the brain may lead to delusional disorder; substance abuse or addiction may trigger delusional disorder; or people who are socially isolated may develop this condition.

How Are Delusional Disorders & Paranoia Diagnosed?

Both delusional disorders and paranoia can only be diagnosed by a doctor or other licensed professional.

 Causes of delusional disorder either biological or psychological that also can occur from family members

Paranoia Diagnosis

To diagnose paranoia, a physician will take a medical history, conduct a physical examination, and perform psychological tests or refer the individual to a psychologist for a questionnaire or interview appointment.

It is important to find the cause of the paranoia, such as a physical condition or other mental health issue, so the condition can be treated appropriately.

Multiple sclerosis, Alzheimer’s disease, and other underlying medical conditions can cause paranoia and should be treated differently than a mental illness.

Delusional Disorder Diagnosis

In order to receive a diagnosis of delusional disorder, a person must experience symptoms for at least one month, with no other, prior mental health issue (such as schizophrenia) as the cause.5

The person experiencing delusions will also undergo a physical exam and blood tests to rule out other underlying causes. If there are no chronic illnesses or infections causing the delusions, the person will be referred to a psychologist for an interview appointment or another professional who has experience understanding and diagnosing delusional disorder.

Delusional Disorders & Substance Use Disorder

Many individuals who have mental health disorders are also diagnosed with substance use disorders, and vice versa.6 In some people, delusional disorders and substance use disorders co-occur. When a person has both a mental health disorder and a substance use disorder, they are called co-occurring disorders or a dual diagnosis.7

There is a bidirectional relationship between mental health disorders and SUDs and each disorder can impact the outcome and severity of the other.8 Integrated treatment for co-occurring disorders has been found superior to treating each disorder separately.9

Treatment for Paranoia & Delusional Disorders

At Sunrise House we specialize in treating co-occurring disorders. We employ integrated treatment that involves the use of evidence-based behavioral therapies to effectively treat both paranoia or delusional disorders and co-occurring substance use disorders.

Our inpatient rehab in New Jersey offers multiple levels of addiction treatment, including medical detox and residential rehab. Each patient receives personalized treatment to ensure their individual needs are met throughout their recovery journey.

We are in-network with many of the major insurance providers. Simply complete our confidential to verify your insurance coverage for rehab.

In addition to health insurance, there are many other ways of paying for addiction treatment. Reach out to our helpful admissions navigators to find the best payment method for you. They are available 24/7 to answer any questions you may have and walk you through the admissions process. Get admitted today by calling .


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