Traumatised clients and the difference between paranoia and anxiety

PTSD treatment

Knowing the difference between anxiety and paranoia is important for best client care. The challenge for clinicians is to clarify whether beliefs and protective behaviours to keep one safe from potential and unknown threats are different from the beliefs and behaviours that are driven by, and driving paranoia.

Many clients who have experienced trauma describe symptoms of hypervigilance. They may be wary of their surroundings, alert to potential dangers from others and be ready to respond at the drop of a hat. They might repeatedly check for perceived dangers, and engage in behaviours which they believe will mitigate these dangers, such as attempting to control the actions of others. Some clients describe themselves as paranoid, sometimes this term is also used by their family and friends to describe them.

However, when lay people and professionals use the term paranoia there should be a difference. Treatments, for paranoia and anxiety are different. Risk is considered differently for paranoia. Prognosis may be different. Within the field of mental health, the term paranoia describes an aspect of psychotic disorders or a personality type, characterised by fear, distrust, and suspicion. Someone who is paranoid will more than likely present as anxious, however someone who is anxious may not be paranoid.

For anxious or paranoid clients, sometimes behaviour might be consistent with the fears they describe. Often, they express an awareness of this behaviour being compelled by fear or anxiety and they may even describe meta beliefs such as, ‘if I don’t have this fear then something bad will happen to me’.

Identifying the Difference Between Paranoia and Anxiety
Paranoid ideation involves misperception of oneself as the target of another’s thoughts or actions. Someone with paranoid ideation will express beliefs that others are taking special notice of them or that another’s behaviour is targeted toward them. Someone who is anxious might express more generalised beliefs, the danger to themselves and others. For example, a client with PTSD who is anxious in crowds might notice the potential dangers of someone attacking them while in a crowd. They would also be able to acknowledge this exists for others. They may even express their worry for others. In contrast, someone who is paranoid, would believe that the danger was specific to them.

Fenigstein, A., & Vanable, P. A. (1992). Paranoia and self-consciousness. Journal of Personality and Social Psychology, 62(1), 129-138.

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