Paranoid Ideation

Paranoid ideation is a transient, stress-related type of paranoia in which the person baselessly feels threatened, persecuted, or conspired against. Someone experiencing paranoid ideation might feel a general suspicion regarding the motives or intentions of others.

Paranoid ideation frequently occurs in borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), and psychotic disorders such as schizophrenia.

If you have BPD, you've probably experienced transient paranoid ideation under stress. It's one of the possible diagnostic criteria, according to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Symptoms

The duration and severity of paranoid thinking vary. Some people have brief, mild paranoid ideations, whereas others have more severe, persistent thoughts. Common symptoms include:

• Anxiety and stress
• Difficulty with relationships
• Distrust
• Feeling exploited
• Feeling isolated
• Feeling like a victim
• Feeling persecuted by others
• Interpreting body language, words, and glances as hostile
• Thinking that they are being watched or spied on

Diagnosis

Paranoid ideation is one of the symptoms that might lead to a BPD diagnosis, which can be given only by a qualified mental health professional. Although there is no definitive test for the disorder, some signs and symptoms are common:

• Anger issues, such as becoming extremely angry in inappropriate situations, exploding in rage, or being unable to control your anger, perhaps followed by feeling guilty or ashamed
• A perception of yourself that changes often and affects your thoughts, behaviors, opinions, relationships, and moods
• Extreme efforts to avoid real or perceived rejection or abandonment by others
• Feelings of disconnection with your body and/or your mind and paranoid thoughts that are brought on by stress
• Intense and unstable love-hate relationships with others
• Perpetual feelings of being bored and/or empty
• Risky, impulsive behavior, such as going on shopping sprees, using illicit drugs, or engaging in risky sex
• Suicidal behavior and/or behavior that's harmful to yourself
• Times of extreme emotion that last from a few hours to a few days and involve depression, anxiety, or irritability

Causes

No one knows what causes BPD or the paranoid ideation that may accompany it. Environmental factors, genetics, and brain abnormalities may all be involved.

• Changes in the brain: There may be abnormalities in the brain that can lead to developing BPD. This is particularly true of areas of the brain that control emotions and judgment.
• Childhood trauma: Specifically, people with a history of child abuse, neglect, or other childhood trauma are more likely to have BPD.
• Family history: If you have a parent or sibling with BPD, you are more likely to develop it yourself.
• Interruptions in reasoning: People are more likely to have paranoid thoughts when their ability to reason and interpret the world around them is compromised.
• Stress: Stressful and traumatic events often play a role in triggering paranoid ideation.

Treatment

If you are having paranoid ideation due to BPD, finding qualified, professional treatment is important. Your treatment plan will likely combine medications and psychotherapy.

• Psychotherapy: Common psychotherapies used to treat BPD are dialectical behavioral therapy (DBT), psychodynamic therapy, and cognitive-behavioral therapy (CBT).
• Medication: A combination of different medications may be used to help treat your symptoms as well. Typical medications include antipsychotics, antidepressants, and mood stabilizers.

Coping

Paranoid ideation in BPD is usually triggered by stress. Finding ways to manage stress levels can be an effective way to cope with paranoid thoughts. Some strategies you might try include:

• Deep breathing: This is a common stress management technique that involves taking slow, deep breaths. It can aid in relaxation and ease feelings of anxiety. This technique is particularly useful because it can be used anywhere at any time.
• Meditation: This ancient technique has a wide range of health benefits, including easing stress and anxiety. There are a wide variety of meditative techniques, but mindfulness meditation, a strategy that involves focusing on the present, might be particularly helpful.
• Progressive muscle relaxation (PMR): This technique involves tightening and then relaxing various muscle groups throughout the body. After some practice, people can use PMR to quickly induce feelings of relaxation.
• Regular exercise: Physical exercise can be a great way to cope with feelings of stress. Research has also shown that exercise can help manage the body's reaction to anxiety. 
• Visualization: This technique involves using mental imagery to help induce a more relaxed state of mind. When you find yourself experiencing paranoid or panicked thoughts, for example, you might focus on an image that helps you feel calm and grounded.
• Yoga: This form of exercise can be a great way to combine physical activity with calming, meditative movements.