Seeking Help for Friend with Paranoia

Reader’s Question

I have just searched your site for the solution to my best friend’s problem. Thank you in advance if you can please solve it.

Case: He is 34 years old, working as an engineer in a reputable company in a senior position. He was the top student in his student life, during which time he earned many awards. BUT now he has the following problems:

  1. He talks with himself in a low voice.
  2. He is afraid that someone is following him.
  3. He always says that someone is taking his photographs with hidden cameras but we haven’t able to find any camera or anything like that.
  4. He is always afraid that someone is recording his telephone conversations.
  5. He is afraid that someone wants to harm him and his family.
  6. He is afraid that someone wants to involve him in a court case.
  7. He feels that his all old friends and relatives now are in the favor of his enemies.
  8. He feels that now no one is his friend.

Psychologist’s Reply

These are symptoms of a signficant psychiatric concern. If we review the themes in his symptoms, as you describe them, there are themes of 1) Paranoia and suspiciousness, 2) Hyperalertness and hypersensitivity, 3) Sense of threat and impending doom, 4) Loss of support in the community. Several conditions may create these symptoms. All symptoms reflect changes in the brain’s chemistry. We’ll go from the mildest to the worst:

Depression and Severe Stress
Individuals who are experiencing a depressive disorder become hypersensitive and take everything around them personally. They feel they are being judged, criticized, and even selected for bad treatment. They also develop a sense of impending doom, feeling their life is gradually getting out of their control. If this is the case, he will likely have a history of increasing stress over the past 18 months. He will also report other symptoms of depression such as sleep/appetite/energy problems, crying spells, etc.
Depression/Stress in a person with Personality Issues
We all have a personality and various features of that personality such as being shy or outgoing, suspicious or trusting, relaxed or compulsive, etc. The presence of depression/stress always amplifies/increases whatever personality traits we have — the shy individual under stress becoming more socially uncomfortable and suspicious. In this situation, your engineer friend might have always been somewhat suspicious or odd in this behavior, but now we see an increase in those features.
Medication Toxicity
Certain medications prescribed for medical conditions can produce psychological conditions. Many medications have depression as a possible side effect. Some medications actually have paranoia as a possible side effect because they influence the neurotransmitter Dopamine in the brain. If he has been receiving medications, been involved in dialysis, or undergone any significant medical treatment procedures — this is a possibility.
Clinical Paranoia
This is the worst. In paranoia, the neurotransmitter Dopamine elevates in the brain. This neurotransmitter controls our perception of personal relevancy — identifying issues in our involvement that are and are not related to us personally. ADHD children have low levels of Dopamine and for that reason, nothing in their environment seems important to them. When Dopamine is excessive, everything in our environment is suddenly directly related to us. In his case, he begins to feel watched, followed, and monitored. Sprinkler heads at the office are felt to be cameras and recording devices. Casual comments by co-workers are interpreted as being related to a conspiracy against him. In severe cases, he may begin hearing voices (thus talking to himself). Based on what you describe, he is exhibiting free-floating paranoia ideation, something we often see in the early stages of paranoia. Patients with many years of paranoia ideation developed fixed or systematized delusions that are very complex — not the general sense that people are out to harm them.

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Your friend needs psychiatric consultation as soon as possible. This is unlikely to disappear and will actually become more severe if untreated. I would suggest encouraging a psychiatric examination. A psychiatrist is best trained to not only idenify the nature of his symptoms but to provide medications that will reduce and control his paranoia. You can find additional information on this subject in an article I’ve written entitled Chemical Imbalance. It’s available on my website at This website also has additional information on symptoms and medications.

As his friend, assure him that you don’t have answers to his concerns about threats or enemies — but that as his friend, you will help him find answers to his emotional distress through professional resources in your community.

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