What Are Some Coping Skills For Paranoia?


I am under the care of a therapist and diagnosed as Paranoia. I have neighbors that are – to me – bizarre methods of ‘getting even for my smoking’. (I’ve almost stopped. Did stop for three weeks, but the problems never went away, so I went back to it. They send odors of smoke into my home somehow. One part of me says it’s not possible, the other ‘freaks out’ and I wind up with a panic attack. I have been ‘getting feisty’ lately, with loud comments to them, like "Thank You. You just made my day!" etc. I also belong to a group who meets weekly. What coping skills should I use? I just want to get back to my "old self" as soon as possible. Thank you.

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Paranoia means that a person has become inordinately suspicious of others’ motives and behaviors, interpreting them as hostile when in actuality, there is no hostile intent. By diagnosing you as paranoid, your therapist is saying that you are reading premeditated hostile intent and personal malice into events that are actually not at all intentionally designed to harm you, which may not involve you, or (if your paranoia is severe enough), which may not actually have happened. In all levels of severity of paranoia a person’s judgment has been compromised or has become systematically biased and as a consequence that person cannot rely upon their own interpersonal judgments when making decisions. There are several problems associated with paranoia. Paranoid people may attack other who don’t deserve it and thus inflict harm on innocents. They may get attacked back themselves after provoking someone. They may be subject to court proceedings or prison for their actions. They may avoid the health care system and thus not get help for conditions that could otherwise be treated. Finally, since they can’t trust anyone they tend to become intensely lonely people which is one of the more painful emotional states that anyone can experience in life.

Because paranoia is essentially a problem with judgment and thinking, the best thing paranoid people can do to help themselves is to partake in activities which will help restore their judgment or which will prevent them from acting out their paranoia in potentially destructive ways. For example, a paranoid person might come to believe that someone they know meant to insult them, and then get upset about that insult and attack that person, possibly seriously harming them. Though from the paranoid person’s point of view, the attack might seem like self-defense, in point of fact of shared social reality (e.g., the way that most other people see the world), there was no insult that occurred, and in any event the attack was well out of proportion to the crime. A jury of peers would send such a paranoid person off to jail despite the fact that he saw himself as only engaging in self-protective behaviors. Effective coping with paranoia means finding ways to 1) recognize when you’ve come to the wrong conclusion, and 2) stop yourself from acting out in ways that will cause harm to innocent other people.


Paranoia comes in different strengths. Some people are mildly paranoid and can still perhaps have some ability to recognize when their judgment is failing them. Other people become severely paranoid and completely lose their ability to question their own judgment, flawed though it may be. When you are paranoid, your judgment may be so compromised that you really can’t tell what is going on without outside help. For this reason, the best thing a paranoid person can do when trying to figure out if their judgment is okay or paranoid is to share what they are thinking with someone they trust and get a second opinion. This process is often referred to as "reality testing", and it is a very valuable thing to do. By testing your perceptions against what trusted others think, you can gain an appreciation for how far off your own judgment is from others. If you see things very differently than other people do, then you have a warning sign that your own judgment may be off.

Making a decision to give people ‘the benefit of the doubt‘ is another way for a mildly paranoid person to cope with their paranoia. Many paranoid people feel that they are being attacked or harassed by others (as you seem to feel), but it is not necessarily the case that this is actually what is happening. Deciding to give people the benefit of the doubt means that you engage in an active process of trying to figure out other ways to understand what it is that other people may be doing or intending to do besides attacking or harassing you. Someone walking around might not actually be spying on you, for instance. He or she may just be visiting a family member or friend and outside for a smoke. Your neighbors may not actually be putting smoke into your apartment. Instead, the smell you are picking up on may come from a completely different source. If you are paranoid enough, there may not even be a real smell there; it may be an olfactory (smell) hallucination that no one but yourself could ever perceive. By deciding to give people the benefit of the doubt, you are acknowledging that your first impulse to see them as attacking you may be wrong and since you can’t really tell what the truth is very easily, you have decided to hold off on doing anything in retaliation.

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Not sweating the small stuff‘ is another coping strategy that a mildly paranoid person can use. This little bit of philosophy essentially is advice to pick your battles carefully and conserve your fighting energy for only those which are truly intolerable. Paranoid people are quick to read slights and insults into comments and to see others as attacking them. They are also frequently operating under the assumption that they have to respond to all attacks and slights. This just isn’t the case. Even when people really are being attacked (and it’s not just a faulty and paranoid perception), not all attacks have to be responded to. In fact, many times, it is not worth getting worked up about small attacks and slights and insults because it is more costly in personal energy to defend against them than it is to simply brush them off and not take them seriously. If paranoid people can keep in mind that most small insults and slights aren’t worth responding to, they don’t have to feel so attacked in the first place.

People become paranoid for different reasons. Sometimes paranoia is a long standing personality style that people develop after early difficult abusive experience. They have been treated badly by people and thereafter find it inordinately difficult to trust others. Post-abuse, they are left constantly waiting to be betrayed by the next people they trust. Beyond paranoia as a personality style, there is also paranoia as a brain problem. Paranoid symptoms are characteristic of disease processes such as Schizophrenia and Schizo-Affective Disorder. They can also occur in the wake of drug abuse, particularly abuse of stimulant drugs like cocaine and methamphetamine (although plenty of other drugs can lead to paranoid symptoms). If your paranoia is caused in part due to a brain problem, you can take action to help your brain problem. If your paranoia is due to drug abuse, you can get sober from the drugs you have been using. If your paranoia is due to a disease process like Schizophrenia, you can work with a psychiatrist to see if some combination of medications can help reduce your symptoms.

I’m very glad to know that you’re working with a therapist and in a group setting to get a grip on your paranoia. The people in your group and your therapist will hopefully be in a position to help you do some reality testing, and to let you know if things seem to be getting better or worse. If you are under a doctor’s care, I encourage you to continue with that course of treatment. If you are not, it may be a good idea to get yourself evaluated by a psychiatrist so as to see if medication can be helpful for your problems (as sometimes is the case). Good luck.

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