You persistently have the feeling that someone is following you. You’re often nervous that people are gossiping about you. You wonder whether people are reading your thoughts. There are dangerous people out there to get you.

Your friends tell you you’re being paranoid.

Meanwhile, you’re not so sure.

So you ask yourself:

“Am I actually paranoid…or is it real?”

Do I Have Paranoia?

In today’s day and age, the term “paranoid” is so commonly used that it’s become a catch-all phrase for everything and anything. “You’re just being paranoid” is what friends tell each other to shrug off pessimistic concerns about things not going as planned. “Stop being paranoid” is a common rebuttal to any doom-and-gloom forecast, even when warranted.

We all worry from time to time about unfortunate things that might happen. But clinical paranoia doesn’t refer to those innocuous, every-day issues like thinking a friend is mad at you when they send a “we need to speak” text (remember to check the facts and not jump to conclusions), or thinking you probably shouldn’t drive if you’re feeling drowsy because you might get into an accident. Indeed, you probably shouldn’t.

Clinical paranoia is more severe. You have clinical paranoia when you feel like there are people out to get you in some real way (for example, you have a feeling that they’re spying on you or trying to hurt you) without any proof or evidence to corroborate your feelings. Though statistical evidence shows that such an occurrence is more than unlikely, you still fear them happening, even if such fears aren’t based in reality.

Paranoia and Psychosis

Feeling paranoid is one of the symptoms of psychosis, a mental health condition that results when an individual loses touch with reality. If you have psychosis, you probably have a combination of hallucinations, delusions, and paranoia. Hallucinations are when you see or hear things that are not real. Some people hear voices in their heads. Others see shadows, lights, or people that are not really there. Delusions are notions that aren’t based in reality. For example, a person can start to think that they have special powers that others don’t. Or, an adolescent can entertain the notion that someone is madly in love with them, even though they really aren’t.

Paranoia and delusions often go hand-in-hand. For example, a teen experiencing psychosis could start thinking they’re being followed by the police. Or that others are reading their minds and hearing everything they’re thinking. These are classic examples of paranoid delusions.

How does psychosis develop in teens?

There are a number of ways.

First, teens with mental health conditions like schizophrenia (or a history of schizophrenia) are more likely to experience psychosis. An adolescent can also start having symptoms of psychosis (like paranoia) if they are taking recreational drugs. If you experiment with amphetamines, marijuana, Ecstasy, or hallucinogens (or a combination of such drugs, which is called polydrug use), you might start losing touch with reality and thinking that bad things are going to happen to you. This is called drug-induced psychosis.

But before you start thinking you have psychosis, keep this in mind: if you stumbled upon this article by searching “Am I paranoid?” then you probably are not, in fact, experiencing full-blown psychosis. A teen experiencing clinical psychosis does not question their take on reality. They do not ask others (or Google) whether what they’re thinking is real or not. Because to them, it’s as clear as day.

Teens experiencing psychosis fully believe that what they’re experiencing is true. Their hallucinations. Delusions. The paranoia. It’s all real life. They really, truly believe that people are following them or that they’re being spied on.

Prodromal Psychosis

At the same time, this is true as well: Psychosis develops gradually. A teen who is still not sure whether what he or she is experiencing is real or not… might be in the prodromal (introductory) stages of psychosis. An adolescent who’s in prodromal psychosis is still in touch with reality, but is starting to experience perceptual changes. They could start seeing visions or shadows, but think their mind is playing tricks on them. They could start having delusions, but then not be sure if it’s all real. In the same vein, you could be having paranoid thoughts, but simultaneously questioning whether these thoughts actually make sense.

So if you are actually starting to entertain the notion that there’s somebody spying on you or out to harm you – and you have no proof – you might want to consider whether you could be in the prodromes of psychosis. Prodromal psychosis can lead to full-blown psychosis, but early intervention and treatment can prevent the progression.

What if someone is actually out to get me?

We’ll need to add an important disclaimer here. If you do have proof that someone is stalking you or spying on you, then you’re not actually being paranoid. For example, if a former friend or ex-significant other is sending you anonymous notes/letters in the mail, or is texting you even when you said you want to stop talking to them, or is threatening to harm you in any way, and you have evidence to support your reality (e.g. text messages/emails/letters/pictures/screenshots – then you need to get help from a third party to help you deal with this real problem. Bring all the evidence you have to your school guidance counselor, principal, or even law enforcement. Talk to your parents as well. They will help you figure out how to stop the stalking and protect you from harm.

However: if you don’t have evidence or proof that someone is following you, stalking you, spying on you, or trying to hurt you, and there is no background context to make such a situation sensible, then consider whether you might be experiencing paranoia or prodromal psychosis.

Do I have paranoia or is it just anxiety?

There’s a lot of overlap between anxiety and paranoia. If you have anxiety, you might have paranoid thoughts very often, as the anxiety is leading you to believe bad things will happen. But it can go the other way around too. Having paranoid delusions—that people are following you or trying to harm you—can make you very anxious, so much so that you don’t even want to leave the house.

Treatment for Paranoia or Prodromal Psychosis

If you have paranoia, severe anxiety, or prodromal psychosis, you could feel powerless and helpless all the time. It could be very hard for you to be around friends and family. It’s difficult to be around yourself, at times.

Speak to an adult immediately if you feel like you’re experiencing paranoia. This could be a parent, your friend’s parent, your school counselor, or another trusted adult. You might need professional treatment for paranoia and/or prodromal psychosis, which includes therapy and occasionally anti-psychotic medication.

If your paranoia is preventing you from functioning at home or at school—meaning, if you can’t live your regular life because you’re so nervous about these bad things happening—then you might need a teen mental health or substance abuse treatment facility that specializes in anxiety, paranoia, and/or prodromal psychosis. That could be an adolescent residential treatment center (RTC), partial hospitalization program (PHP), or intensive outpatient program (IOP) for teens.