What is Paranoid Ideation?

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Paranoid ideation, or paranoia, is having beliefs that you are being harassed or persecuted, or beliefs involving general suspiciousness about others' motives or intent.

The Difference Between Paranoid Ideation and Delusional Paranoia

Paranoid ideation is not the same thing as the delusional paranoia that can occur during psychosis. Delusional paranoia is based on false thoughts and beliefs.

For example, if you are experiencing delusional paranoia, you might believe that the government has bugged your house and car in order to keep tabs on you.

If you are experiencing paranoid ideation, you might see two people in the hallway talking and believe they are talking about you.

Paranoid Ideation in Borderline Personality Disorder

If you have borderline personality disorder (BPD), it's likely that you have experienced paranoid ideation, since it is one of the possible criteria for diagnosis according to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Stress may make these paranoid thoughts and beliefs worse.

Diagnosing BPD

In order to be diagnosed with borderline personality disorder, you must have five of these symptoms:

  • Risky, impulsive behavior, such as going on shopping sprees, using illicit drugs or engaging in unprotected sex with multiple strangers
  • Perpetual feelings of being bored and/or empty
  • Intense love-hate relationships with others 
  • Extreme efforts to avoid real or perceived rejection or abandonment by others
  • Suicidal behavior and/or behavior that's harmful to yourself
  • Anger issues, such as becoming extremely angry in inappropriate situations, exploding in rage, or being unable to control your anger, followed by feeling guilty or ashamed
  • A perception of yourself that doesn't match up with what others think and changes often, affecting your thoughts, behaviors, opinions, relationships and moods
  • A feeling of disconnection with your body and/or your mind and paranoid thoughts that are made worse by stress
  • Times of extreme emotion that last from a few hours to a few days and involve depression, anxiety or irritability

Treatment for BPD

Treatment is important if you suffer from BPD and your treatment plan will likely involve a combination of medications and psychotherapy. 

Common psychotherapies used to treat BPD are dialectical behavioral therapy (DBT), psychodynamic therapy and cognitive-behavioral therapy (CBT).

A combination of different medications may be used to help treat your symptoms as well. Typical medications used to treat BPD include antipsychotics, antidepressants and mood stabilizers.

Conditions Related to BPD

If you have BPD, you may have another illness as well. Common conditions that occur along with BPD are:

  • Depression
  • Bipolar disorder
  • Anxiety disorders
  • Eating disorders
  • Substance use disorders
  • Other personality disorders

Causes of Borderline Personality Disorder

No one knows what causes BPD, but environmental factors, genetics, and abnormalities of the brain may all be involved. Specifically, people with a history of child abuse or neglect or other childhood trauma are more likely to have BPD.

Also, if you have a parent or sibling with BPD you are five times more likely to develop it yourself.

Additionally, there may be the abnormalities in the brain that can lead to developing BPD. The areas of the brain that control emotions and judgment seem to not work together as well if you have BPD.


"Borderline Personality Disorder." National Alliance on Mental Illness (2016).

"Borderline personality disorder." Mayo Clinic (2015).

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