Some people with bipolar disorder experience paranoia when they are in a manic phase. They may feel that people are out to get them, which can cause intense emotions, including fear, anxiety, and panic.
Bipolar disorder is a mental health condition that causes extreme shifts in mood and energy, including very high moods (mania) and very low moods (hypomania).
However, with a treatment plan involving medications, therapy, and lifestyle changes, people with bipolar disorder can often manage the condition and any paranoia it causes.
Not everyone with bipolar disorder will have paranoia. Researchers in a 2022 review suggest that about one-third of people with bipolar disorder experience paranoia, or what they sometimes call persecutory delusions, at some point in their lifetime.
During a manic episode, some people experience paranoia as intense and irrational beliefs that other people are trying to harm, deceive, or manipulate them, even when there is no evidence to support this. These feelings can cause the person to distrust loved ones, friends, and strangers.
Along with paranoia, other symptoms of a manic episode with psychotic characteristics may include:
- Grandiose delusions: Having exaggerated beliefs about one’s importance, power, or identity.
- Auditory hallucinations: Hearing voices or sounds that are not real.
- Visual hallucinations: Seeing things that are not real.
Having paranoia during a bipolar manic episode can feel very isolating and frightening. It is not merely a feeling of suspicion, but rather, it is a deep conviction that something or someone is out to get the person.
During a manic episode, it is
Paranoia may lead them to misinterpret events and create elaborate explanations to justify their beliefs.
Paranoia can cause a person to feel constant fear and suspicion of everyone. Everyday interactions may feel threatening, and the person may question everyone’s motives.
The person may isolate themselves and have trouble relaxing and sleeping. The feelings are very real to the person experiencing them, even if they seem irrational to others.
Researchers are still investigating why paranoia may affect people with bipolar disorder during a manic episode. However, they understand several factors that may increase a person’s risk of experiencing a manic episode if they have bipolar disorder.
A 2023 review highlights several possible triggers, including:
- using antidepressants without using a mood stabilizer
- energy drinks
- acetyl-l-carnitine
- St. John’s wort
- seasonal changes
- hormonal changes.
- viral infections
Other common factors may include insufficient sleep or high stress levels.
Addressing paranoia due to bipolar disorder requires treating the underlying condition. A treatment plan
- Medications: Mood stabilizers such as lithium (Eskalith) or valproate (Depakene), antipsychotic medications, and sometimes antidepressants help manage bipolar disorder.
- Therapy: Cognitive behavioral therapy and family-focused therapy can help manage bipolar disorder.
- Other approaches: Some treatments, such as electroconvulsive therapy, repetitive transcranial magnetic stimulation, and light therapy, have also demonstrated benefits for managing bipolar disorder.
Beyond typical treatments, there are several lifestyle modifications a person with bipolar disorder can make to help reduce their risk of entering mania. This includes:
- Getting good sleep: Maintaining a consistent sleep schedule is important for managing bipolar disorder. Research suggests that not getting enough sleep may trigger mania.
- Managing stress: Experiencing stressful events or putting the body under stress, such as fasting, may also trigger mania. Learning to manage stress through stress-reducing activities may help to regulate a person’s mood and reduce the risk of mania.
- Having a routine: Having a routine of regular eating times, exercise, and sleep may help with managing bipolar disorder symptoms.
Bipolar disorder resources
Visit our dedicated hub for more research-backed information and in-depth resources on bipolar disorder.
If someone believes a loved one is experiencing paranoia related to bipolar disorder, it is important to seek professional help for them as soon as possible.
If a person believes they have symptoms of bipolar disorder or paranoia, they should seek help from a healthcare professional.
Highly concerning symptoms that require professional help include:
- severe or persistent paranoia
- risk of harm to self or others
- worsening symptoms
- ineffective treatment
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
- Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you’re not in the same household, stay on the phone with them until help arrives.
While paranoia is not a formal symptom of bipolar disorder, some people with bipolar disorder experience paranoia during a manic phase.
They may have intense distrust and suspicion of others and misinterpret events to fit their thoughts. Paranoia can cause them to feel fear and anxiety, which can lead to social isolation, sleep deprivation, and difficulty relaxing.
Lifestyle factors such as not getting enough sleep or extreme stress may trigger mania. Other triggers may include energy drinks, hormonal changes, and some supplements.
Treatments such as medications and therapy can help a person manage bipolar disorder and reduce their risk of going into a manic phase.
