teen girl looking paranoid

My Teen Shows Signs of Paranoia: Should I Be Worried?

As your teen grows and matures, they develop their own personalities, complete with idiosyncrasies and quirks like all of us – but when your teen has thoughts that seem to you like classic paranoia, or their behavior seems unnecessarily suspicious or paranoid, you’re right to be worried. Or, as we like to say instead of worried, it’s okay to be proactively concerned.

Examples of behavior or thoughts in teens that may indicate the presence of paranoia. Your teen may think:

  • People are following them
  • Everyone is against them
  • People – friends, family, teachers – talk about them behind their back
  • Mysterious figures are following them
  • External forces are reading/guiding their thoughts

These thoughts and/or associated behaviors may be obvious and in the open. For instance, your teenager may make a claim they’re being followed by spies with no evidence. Or, they may mutter things under their breath, such as “…you’re against me just like everyone else.”

In either case, these thoughts and behaviors lead you to the following questions:

Does my teen have paranoia? And what is paranoia, really? What’s the official definition?

We’ll help you answer those questions now, starting with the official definition.

What is Paranoia? A Clinical Definition

It’s important to remember the word paranoia has meaning outside of its clinical context. Most of us use it when we think someone is suspicious of something or someone with no reason to support their suspicion. When they worry about government conspiracies, we say something like “You’re just being paranoid.” Or, when they think someone at work is undermining them intentionally, we may say something like “Sounds like paranoia to me.”

That common understanding of the word is not far from this official definition of paranoia, provided by the American Journal of Psychiatry:

“Paranoia is the pervasive and unwarranted mistrust of others.”

However, when this pervasive mistrust of others is demonstrably untrue or unfounded, these thoughts cross from typical paranoia to what we call delusions, which are a type of symptom associated with serious, complex mental health disorders. The National Alliance on Mental Illness (NAMI) defines delusions as:


“Thoughts or beliefs held by a person that are objectively and demonstrably false or untrue.”

That brings us to a preliminary answer to the question we pose in the title of this article. If the thoughts and ideas your teen voices, expresses, or experiences are provably false or untrue – and they insist they believe them anyway – then yes, it’s time to recognize that your proactive concern, i.e. your worry, is well-founded, and you may need to arrange a full psychiatric evaluation for your teen, administered by a mental health professional experienced in treating adolescents.

Teen Paranoia and Mental Health: Warning Signs and Symptoms

If you think your teen is showing signs of paranoia, compare what you observe or what they tell you to the items on the list below. These are all indications of the presence of paranoid thoughts and/or paranoid patterns of thought. Watch your teen for any of the following signs:

  • Extreme, irrational mistrust of the people in their lives
  • Intense/extreme suspicion of the people in their lives
  • Persistent fear of typical situations
  • Recurring anger, with no clear cause
  • Recurring feelings of betrayal
  • Hypervigilance: on the watch for/fearful of a negative outcome in any situation
  • Problems understanding the intentions of others
  • Difficulty accepting apologies/difficulty forgiving pother people
  • Extremely defensive with no apparent cause
  • Hypersensitivity to any type criticism
  • Preoccupation with the idea others are out to get them
  • Uncharacteristic aggression
  • Constantly arguing or disputing basic facts
  • Difficulty calming down/difficulty relaxing
  • Pronounced, pervasive fear others will lie to or deceive them
  • Pronounced, pervasive fear others will take advantage of them

If you see any of these behaviors, they may indicate the presence of a complex mental health disorder, as we mention above. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) identifies paranoia as a symptom common to several different mental health disorders, including:

Paranoid Personality Disorder (PPD)

This disorder is defined by a distrust and suspicion of others. People with PPD persistently believe other people have negative intentions and consistently interpret their actions as harmful/hostile. To meet receive a diagnosis for paranoid personality disorder, an individual must show these symptoms before early adulthood.

Delusional Disorder

This disorder is defined by the presence of delusions, i.e. ideas or thoughts that are provably false, that center around feeling exploited, being suspicious of friends, reading negative/sinister meanings into harmless remarks by others, holding grudges, and extreme defensiveness in response to any perceived slights. To meet the criteria for diagnosis, a qualified physician must evaluate the patient and rule out any other cause of the delusions, such as a substance use disorder or another mental health disorder with paranoid symptoms.


This disorder is defined by the presence of delusions, i.e. believing things that aren’t true, and hallucinations, i.e. seeing, hearing, feeling, smelling, or tasting things that aren’t there. For instance, an individual with schizophrenia may think other people can read their mind, believe they’re a famous celebrity, or think others are out to get them. An individual with schizophrenia may also experience hallucinations related to their delusions.

To meet criteria for diagnosis, symptoms must be present for at least six months and cause significant disruption in work, school, or relationships. In addition, the diagnosing clinician must rule out the presence of substance use, other mental health disorders, or medical conditions that can better explain the symptoms.

Borderline Personality Disorder (BPD)

This disorder is defined by a pattern of volatile mood swings, transient self-image, and extreme sensitivity to any type of rejection/abandonment. An individual with BPD often has turbulent relationships with family members and difficulty forming and maintaining relationships with peers or romantic partners. They may also repeatedly engage in non-suicidal self-injury (NSSI), suicidal ideation, or other suicidal behavior. To meet criteria for this diagnosis, a patient must show the symptoms/patterns of thought and behavior we describe above by early adulthood.

Anxiety, Mood Disorders, and Other Disorders

In some cases, people with anxiety disorders, mood disorders such as bipolar disorder and major depressive disorder, psychotic disorders, and post-traumatic stress disorder may experience paranoia. Paranoia and paranoid patterns of thought may be a primary symptom, as with psychotic disorders, or the disorder itself may increase or exacerbate symptoms associated with paranoia, as with anxiety disorders, mood disorders, and post-traumatic stress disorder.

Your Teen and Paranoia: Risk Factors

While no one know exactly what causes paranoia, researchers can identify factors that increase risk of developing paranoia, called risk factors. The primary risk factors for teen paranoia and disorders with paranoid features include:

  • Family history of mental health disorders with paranoia
  • Some diseases/illnesses, including:
    • Parkinson’s disease
    • Alzheimer’s disease
    • Dementia with Lewy bodies
  • Early/childhood trauma
  • Brain injury
  • Severe stress, acute or chronic
  • Severe alcohol/substance use disorder (AUD/SUD)
  • Chronic amphetamine use, particularly methamphetamine

Secondary risk factors for paranoia include:

  • Low self-esteem
  • Sleep deprivation
  • Recreational drug use
  • Excess contact with media related to violence, crime, terrorism

The presence of risk factors doesn’t mean a person will develop paranoia, but rather that they have elevated risk of developing paranoia or paranoid patterns of thought and behavior.

What Parents Can Do: Find Professional Support

If your teen shows signs of paranoia, and you dig deeper and confirm that what you see matches the symptoms we list above, then it’s important to arrange a full psychiatric assessment administered by a mental health professional.

This is a crucial step to take, because the symptoms you observe could be the early signs of a serious mental health disorder.

Disclaimer: this article cannot diagnose your teen or stand in for a full psychiatric assessment for paranoia. To understand what’s happening with your teen, you must consult a mental health professional.

The consequences of untreated mental health disorders with paranoia include:

  • Unstable family relationships
  • Difficulty forming and maintaining non-family relationships, including friendships and romantic interests
  • Impaired academic and vocational performance
  • Isolation and self-isolation
  • Increased risk of depression and anxiety

While symptoms like paranoia can be confusing and scary for the person experiencing them and the people around them, especially close family members, it’s possible to manage paranoia and paranoid patterns of thought and live a full and fulfilling life. Evidence-based treatments for mental health disorders that involve paranoia include:

  • Medication/medication management
  • Psychiatry, if needed
  • Psychotherapy: individual and/or group
  • Psychodynamic therapy
  • Family therapy
  • Education and workshops
  • Psychosocial support

When your teen completes an assessment, the clinician may arrive at a specific diagnosis and offer referrals for professional care. Your teen may receive a referral of outpatient treatment, intensive outpatient treatment, or another level of care: the referral they receive will depend on the diagnosis, the severity of the symptoms, and the extent to which those symptoms disrupt the basic activities of daily life, including school, work, family relationships, and the basics of self-care.

Whatever level of care you choose for your teen, please know that professional treatment can work. Spending time in a positive, therapeutic environment with a team of skilled and dedicated professionals can help you, your teen, and your family find balance and return to harmony.