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Teens Live in Times of Unexpected Uncertainty and That Can Make Them More Paranoid

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT

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Teen Mental Health: The Connection Between Uncertainty and Paranoia

It’s common to hear phrases in everyday speech that are similar, or identical to, the words you find in clinical mental health diagnoses. People say things like this all the time:

I’m depressed.

You’re paranoid.

The anxiety is getting to me.

You’re delusional.

When people say these things, they’re often easy to understand in context. Someone who’s sad may say “I’m depressed” without having clinical depression. We might tell friends that overthink things “It sounds like you’re being a little paranoid.” If we’re worried about an upcoming or ongoing event, we might say “Omg, waiting is making me so anxious.” Or, when someone describes an opinion or point of view about something that’s demonstrably false, we might tell them they’re “delusional.”

Half the time we say these things, we’re joking – and most of the time that’s okay. In context, these phrases can make sense. In some cases, though – when speaking to people with significant mental health issues, for instance – a more sensitive, thoughtful word choice may be a better option.

The thing is, these words – depressed, paranoid, anxiety, delusion – all have distinct clinical meanings. They describe very real mental health disorders. They may also describe symptoms associated with serious mental health disorders. The symptoms people diagnosed with major depressive disorder (MDD), paranoid personality disorder (PPD), general anxiety disorder (GAD), or delusional disorder (DD) experience are no joke. Depending on the severity, adolescents and teenagers who receive these diagnoses often require professional support and treatment at a teen behavioral health center, teen psychiatric treatment center, or a residential mental health treatment center that specializes in adolescent behavioral health.

Let’s take paranoia, for instance.

Paranoia: New Research Offers a New Concept

After living through the ups and downs of 2020 – primarily the coronavirus pandemic – many people are suspicious of things they previously trusted or took for granted. From politics to public health, it seems like the ground shifted under our feet. Things that were once rock-solid are now in question. Sometimes it seems as if facts are no longer facts as we used to know them. If you get enough people to buy into something, groupthink takes over. Suddenly we live in a world where consensus, rather than data and evidence, creates reality.

That can be disturbing for anyone. For teenagers with a mental health disorder that involves paranoia, it can cause problems. Meaning it can exacerbate the severity of their symptoms and cause their condition to escalate.

By all reasonable metrics, the end of the pandemic is very close at hand. Nevertheless, we all feel the effects of a year full of surprises.

One thing that’s played a role in the uncertainty of this year has been the increase in conspiracy theories. If you read the news or scrolled through social media, you encountered elaborate conjecture. You saw theories about the origin of the coronavirus. You read memes about the safety of vaccines and saw wild stories about elections and politicians.

A team of researchers at Yale University explains that this is not a new phenomenon:

“When our world changes unexpectedly, we want to blame that volatility on somebody. To make sense of it, and perhaps neutralize it. Historically in times of upheaval, such as the great fire of ancient Rome in 64 C.E. or the 9/11 terrorist attacks, paranoia and conspiratorial thinking increased.”

They performed a series of experiments indicating that unexpected uncertainty – rather than the misinterpretation of social and environmental cues – may play a role in paranoia.

What is Paranoia?

Most of us can define the word paranoid, in the non-clinical sense, without consulting a dictionary. In its simplest form, paranoid means unnecessarily suspicious of people and events or thinking people are acting with malicious intent when there is no evidence to support those conclusions.

However, the concept of paranoia – as a disorder/pathology – dates to prehistory, when people used it to describe any and all mental disorders. Our common understanding of the concept of paranoia began around the 1800s. Here’s how the American Psychological Association (APA) defines classical paranoia:

“Conceptualized in the 19th century by German physicians, [paranoia] is a rare disorder characterized by elaborate, fixed, and systematic delusions, usually of a persecutory, grandiose, or jealous character, that develops insidiously, cannot be accounted for by any psychiatric disorder, and exist in the context of preserved logical and orderly thinking.”

The 20th century brought us a science-based definition of paranoia. Which – as you can see from the following paragraph – is already out-of-date:

[Paranoia is] a former diagnosis for a relatively rare disorder in which the person reasons rightly from a wrong premise and develops a set of persecutory delusions, such as being conspired against, poisoned, or maligned. It is equivalent to persecutory-type delusional disorder.”

As of 2014, with the publication of the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), clinicians no longer view paranoia as a standalone diagnosis, but rather, as a symptom closely related to several different mental health disorders. The American Journal of Psychiatry defines paranoia succinctly:

“Paranoia is the pervasive and unwarranted mistrust of others.”

They identify paranoia as a symptom common to paranoid personality disorder, delusional disorder, and paranoid schizophrenia.

Now let’s get back to that new Yale study, and discuss why their findings might mean trouble for teens in 2021.

Paranoia, Unpredictable Change, and Teen Mental Health

No one knows the precise cause or origin of paranoia. What mental health experts can identify are the primary risk factors for paranoia:

  • Family history of schizophrenia, delusional disorder, and/or paranoid personality disorder
  • As yet unidentified chemical imbalance in the brain
  • Trauma
  • Extreme stress
  • Severe alcohol/substance use disorder (AUD/SUD)
  • Chronic amphetamine use, particularly methamphetamine

Most mental health researchers and clinicians agree that – excluding substance use disorder and methamphetamine addiction, which can cause paranoia when none of the other factors appear – a combination of all the above factors leads to paranoia.

Those are the known risk factors for paranoid thoughts. Here are some of the signs that a person is experiencing paranoid thoughts or paranoid patterns of thought:

  • Intense and irrational mistrust
  • Extreme suspicion
  • Excess fear and anger
  • Constant feelings of betrayal
  • Hypervigilance
  • Difficulty forgiving others
  • Hyper-defensive/oversensitive to criticism, real or perceived
  • Preoccupation with/belief that other have hidden motives
  • Argumentative/aggressive
  • Problems relaxing
  • Extreme fear of being deceived/take advantage of

The prevailing opinion on why people develop paranoid thoughts – aside from impaired brain function caused by substance use/abuse – is that there’s some sort of chemical or physiological dysfunction that results in a mismatch between the behaviors and/or words of another person and the meaning assigned to those behaviors and/or words by the person who experiences paranoid thoughts. In short, people with paranoia assign reasons and motives to things other people do – and they’re the only ones who see/believe those same reasons and motives.

The Yale researchers have a different theory:

“We think of the brain as a prediction machine; unexpected change, whether social or not, may constitute a type of threat — it limits the brain’s ability to make predictions. Paranoia may be a response to uncertainty in general.”

Let’s discuss that – and how it may affect a teen with a mental health disorder.

Uncertainty, COVID, and Teen Mental Health

If their theory is correct, teens in treatment may face additional challenges. What this means is that the past year puts them at increased risk of experiencing paranoid thoughts or paranoid patterns of thought. For teens diagnosed with paranoid personality disorder, delusional disorder, and/or paranoid schizophrenia, the uncertainty and unpredictability of the past year may exacerbate their paranoid symptoms.

Here’s why:

In the experiment, researchers asked study participants to play a game where choices that led to a successful outcome changed without notice or warning. People diagnosed with mental health disorders associated with paranoia adjusted quickly. They made more volatile and unpredictable choices than people who were not diagnosed with mental health disorders associated with paranoia. Then, researchers conducted a second experiment – this time on laboratory animals – in which the animals were allowed to press three levers, one of which resulted in a treat: a sugar pellet. They also changed the lever required to receive the treat. Next, they gave the animals methamphetamine. While under the influence of methamphetamine, the animals made choices that were volatile, unpredictable, and different than the choices they made without methamphetamine.

The differences were a statistical match to people with paranoia.

This experiment demonstrates two things. First, paranoia may be more about expectations than about misreading social cues. Second, there may be a distinct biochemical or physiological mechanism that underlies paranoid thinking. People with paranoia were quick to change choices based on perceived expectations. However, they were slow to moderate those choices when they learned the rules were changed. This means that perception, as opposed to evidence, drove their choices. With regards to the animals, the introduction of a chemical that induced paranoia strengthens the argument for a biological foundation for paranoia.

Our take:

General uncertainty might lead to an increase in paranoia.

And if there was ever an uncertain year, our teenagers just lived through it. That’s why parents of teens with a mental health disorder that involves paranoia need to watch their teens carefully this summer. If they see symptoms escalate, they may need to seek support for their teenager. If their teen is already in treatment, they may need to alter the treatment plan to account for the additional stress.

What Parents Can Do

For parents whose teens who recently developed a mental health disorder, or parents of teens who recently experienced paranoid thoughts for the first time, it’s important to understand that evidence-based treatment works. An integrated approach involving therapy, medication (as needed), and lifestyle supports can help teens find balance, handle stress, and process uncomfortable and difficult emotions. An adolescent treatment center with clinicians and staff experienced in working with teenagers is likely the best option.

Evidence-based treatments for mental health disorders that involve paranoia include:

  • Medication:
    • Typical antipsychotics
    • Atypical antipsychotics
  • Cognitive Behavioral Therapy (CBT):
    • Individual
    • Group
    • Family
  • Psychosocial support:
    • Simplified environment
    • Reduced stimulation
    • Structured interaction

Depending on the severity of the disorder, the specific diagnosis, and the advice of a mental health professional, teens who experience paranoid thoughts may need support in an outpatient program, an intensive outpatient program (IOP), a partial hospitalization program (PHP), or a residential treatment center (RTC). Spending time in a safe, supportive, therapeutic environment can help a teen develop the skills needed to manage symptoms such as paranoia, which may have increased due to the stress and uncertainty of the past year.

Paranoid thoughts can be upsetting for the person experiencing them, as well as their friends, family, and loved ones. Evidence-based treatment – the sooner the better – can help teens learn to ground themselves, understand their diagnosis and symptoms, and minimize the impact of unpredictable events in the future.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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