Paranoia in Bipolar Disorder: Symptoms, Triggers, & How to Cope


Stop the repetitive mental loops and physical tension of bipolar suspicion before they damage your friendships

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One of my close friends, David, didn’t show up for my birthday party. All of my other friends showed up, so I assumed David considered other plans more important than seeing me. Though I still had a great time at my party, I was upset he wasn’t there.

The next day, my brain started to chatter: “David lied to me in the past when he said he wanted to meet. Now I know the truth.” The day after, my chattering brain got worse and entered the realm of paranoid thinking. I started to feel a sneaking suspicion that David pretended all along and wasn’t telling me the truth about his feelings.

Distinguishing Paranoia From Intuition

Eventually, I convinced myself that his absence from my party was a sign that I was not worthy of being his friend. I was sure I was being used. This, of course, ties in with any feelings of inadequacy I have about how people feel about me, so it can often be confusing to notice these unrealistic, paranoid thoughts at first.

It’s important to differentiate between intuition — which is a “gut feeling” based on subtle, real-world cues — and paranoia. Intuition often protects us from justified mistrust, whereas paranoia in bipolar disorder typically involves a “break” from evidence, where the mind creates a narrative of persecution without proof.

Managing Bipolar Paranoia and Suspicion

Years ago, I would’ve dealt with such a situation by sending David a paranoid and accusatory email. As you can imagine, I lost quite a few friends over the years because of my paranoia! People would think I was weird because of the unfounded things I’d write, and naturally, they’d want nothing to do with me after receiving a few of these bizarre emails. I was just so filled with what seemed like real feelings that it was natural to me to let others know they were hurting me.

Lived-Experience Signals to Watch For

Recognizing when paranoia is escalating is key to preventing those “bizarre emails.” Here are a few signals I watch for:

  • The “Secret” Narrative: Feeling like you are the only one who sees “the truth” about someone’s hidden motives.
  • Repetitive Mental Loops: When the brain “chatters” the same accusatory thought for hours.
  • Physical Tension: A “sneaking suspicion” that manifests as a tight chest or hyper-vigilance.

Paranoid thoughts are bizarre because they are rarely provable when examined rationally. When a student in a dorm believes the government has wired his room in order to record his behavior and listen in on his thoughts, it’s a delusion.

When I suspect that my friend missed my birthday party because he has a secret, it’s also a delusion. Once examined, delusions have very little proof in the physical world. They are usually manufactured by a psychotic mind, which is why they’re so hard to fight. They feel so real!

Finding the Path Back to Reality

Thank heavens I’ve taught myself to recognize paranoid thoughts and then fight my way back into reality.

Several days after my party, I received a call from David. My mind reactively said, “Don’t answer it.” But I knew I had to just skip that thought and answer anyway.

For days, I’d worked on examining my thoughts and feelings to see if there was any truth to my beliefs and accusations. There was zero evidence. So I waited things out and calmed down. Soon, my rational mind was back. When David called, I took control of my feelings and answered the phone. “Hi!” he said. “I’m getting off an hour early so that I can get to your birthday on time!” Ah! After all of my worries, it was a simple misunderstanding. “I feel so stupid!” he said, and added, “I missed a friend’s wedding like this a few months ago, too.”

Proof, once again, that my brain hadn’t told me the truth earlier in the week. I let out a deep breath, relieved, and said, “We can celebrate next time we meet.” And we did. With chocolate!

UPDATED: Originally printed as “Fast Talks: Tricks of the Mind,” Spring 2011

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