Saturday 16 June 2018

Effective Strategies to Manage Paranoia in Bipolar Disorder and Schizoaffective Disorder

By Julie A. Fast

In part one of this blog, Exploring Bipolar Disorder and the Sister Diagnosis of Schizoaffective Disorder, I talked about psychosis in bipolar disorder and how some of us with bipolar also have a separate diagnosis of a psychotic disorder. Bipolar with a separate psychotic disorder is called schizoaffective disorder.

In part two I explore the topic of paranoia, a psychotic delusion. All people with bipolar disorder live with the possibility of paranoia. It’s more common than most realize. Paranoia is quite a friendship wrecker. I lived with paranoid thoughts and behaviors for many years before I learned how to control them. I still get paranoid but I’ve learned not to take it out on my friends the way I used to.

As a side note, please know that people can have paranoid behavior without having a mood disorder. Paranoid personality disorder is an example. This article is relevant to anyone who experiences paranoia.

How I Manage My Paranoia

I’ve taught myself to know what I think, say and do when I’m paranoid. I explain how I use this process in my Health Cards Treatment Plan for Bipolar Disorder. It is the only way I have found to manage my bipolar disorder as I can’t take many medications. Before I learned this system I was a tiny boat on a raging ocean of moods. I still have mood swings but I know now what they are and am able to control them. You can learn to do the same. If you’re a friend or loved one of someone with bipolar disorder or schizoaffective disorder, you can also learn to use this system to help. Here is how it works.

What I Think, Say and Do When Paranoid

What I think when I’m paranoid. Please note that I use the word ‘think’ but with delusions it really is more of a feeling than a thought.

Something isn’t right with my friend. She is upset with me and doesn’t want to tell me the truth.

People are meeting and having dinner parties and doing things without me. They don’t want me there, so they don’t invite me.

Friends think I don’t know what is going on, but I do.

Someone is upset with me. I can feel it.

No one is calling me. They are upset with me.

This is not a safe place. I have to get out of here.

Someone is following me in the car.

What I say. This is where I used to get into so much trouble! I would either say these things out loud or send an email.

I write an email or text and accuse someone of not wanting to contact me.

I ask friends, “Are you made at me?” or, “Is there something you want to talk to me about?” Or ”Is something wrong?”

I tell people, “I’m not stupid and I know that there is something wrong and you should just tell me the truth!”


What I do.

I can’t look people in the eye.

I obsessively pour over emails and texts and search for hidden meanings.

I can’t sleep.

I look in my rear view mirror and see that cars are way too close. Someone is following me.

I look for recording devices. Maybe someone has hidden cameras in their kitchen.

I cut myself off from people I feel are harming me by not talking to me.

These are just a few examples. I’m interested to know if you have experienced anything listed above, either as a person with bipolar or as a friend. This paranoia symptom is often missed as it can be subtle. The internet has made paranoid communication much easier and people are very quick to accuse when it takes just a few seconds to send a message.

What if the Paranoid Feelings are Real?

I live in the creative world now and I often see my work used by other people. This is deeply distressing as you can imagine. The difference between this and what I describe above is that in most cases people actually have plagiarized my ideas. I tend to keep quiet about this as it can lead to actual paranoia, but sometimes I do have to take action. The main difference between paranoia and noticing that someone is using one of my ideas without credit is that paranoia is NEVER real. Can the two get confused? Yes, if I am paranoid I can think that someone is using my work who isn’t. This is why I use my Health Cards and never say anything unless I have facts to back me up. Even then, I might not be right!

How I Changed

One day, after a really terrible situation where I sent an awful email to a friend and effectively ended our relationship, I realized I had to change. I write about this experience in my Bp Magazine article Relationships and the Bipolar Trap. Was it easy to change? No. In fact, I still have to watch myself very carefully even though it has been almost twenty years since I sent the letter to my former friend. Here is what I do now.

  1. I memorized what I think, say and do when I’m paranoid. I can’t trust my ill self, but I can trust my well self. The well me creates the Health Card (you can simply create a list of what you think, say and do) and I then use it when I start to get paranoid. Yes, you can teach yourself the signs you are paranoid and you can learn to stop the episode from going too far. It is NOT easy. I first had to see my paranoia was a problem and then had to stick to documenting my behavior so that I could use it later.
  2. I made a promise to myself (and for the most part I have kept it) that I will NEVER, and I do mean NEVER, send a text or email or any form of communication that is accusatory. I stick to my own feelings and my own experiences. This has helped greatly. I no longer say You did this! or You are thinking this! Stopping this one action — the writing and accusing — has saved me a great deal of trouble and saved many of my relationships.
  3. I accept that I still get paranoid. My symptoms are still here but I have learned how to minimize the symptoms.
  4. I do not use any hallucinogenics. This means no cannabis (THC is a strong hallucinogenic and even when I tried low THC, or what was labeled as no THC, I got psychotic.) I keep away from any spiritual journey drugs such as magic mushrooms or Ayahuasca. My brain is too fragile to handle anything that is hallucinogenic.
  5. I tell my friends what to look for. In the beginning I needed a lot of help from others. I needed people to say, “Julie, you asked me to remind you if I thought you sounded paranoid. I am reminding you now.” This helped me a lot. Eventually, I was able to control it on my own.
  6. I keep away from people who are paranoid. I don’t have friends who believe in conspiracy theories, government cover-ups or chem trails. This doesn’t mean they are wrong and I am right. It means that this kind of person is not safe for me. It makes me ill to be around another person with paranoid thinking and talking.
  7. I put my thoughts in a journal and they STAY there. I am always shocked to go back and read what I wrote when I was sick. I think, “Good heavens. I was really paranoid. I am SO glad I didn’t say anything!”
  8. I take meds if needed. They help a lot.

It’s incredibly important to listen to others if you have the symptoms of paranoia. Your brain is not your friend when symptoms are raging. I had to ask for help with all of this.

Tips for Friends, Siblings, Family Members and Health Care Professionals

Make your own thinks, says and does list so that you will not get caught in a Bipolar Conversation. You can then decide how you want to approach the issue. I believe in preparing scripts to use when a friend is not doing well. For example,

Julie, you have been very honest with me about your bipolar disorder and I appreciate this. Right now, I feel that we are in a situation where the bipolar is doing some of the talking. I am concerned about what you are saying and feel you are in a mood swing. I’m here to discuss this with you.


I know that these thoughts come up when life is stressful. I can tell you that I have not changed and you have not changed. The thoughts you have and the feelings you are experiencing sound intense, but please know they are not related to us. We can work on this together.

It helps to have a plan in place that you discuss when your friend is stable. You can ask, “What would you like me to say when I can tell you are paranoid?” And then use the words another person created for you.

Do you have signs of paranoia? Is paranoia causing problems in a friendship with someone who has bipolar? Please know that paranoia rarely goes away. It is a symptom that needs to be managed. Doing this as a team makes a lot of sense!


PS: My next post will be on trigger management. I’ll cover how I recognize and remove triggers to manage the paranoia as well as other aspects of psychosis.


About the Author

Julie A. Fast is the author of Loving Someone with Bipolar Disorder, Take Charge of Bipolar Disorder, Get it Done When You’re Depressed and The Health Cards Treatment System for Bipolar Disorder. Julie is a board member of The International Bipolar Foundation, a columnist and blogger for BP Magazine, and won the Mental Health America journalism award for the best mental health column in the US. Julie was the recipient of the Eli Lily Reintegration award for her work in bipolar disorder advocacy. She is a bipolar disorder expert for the Dr.Oz and Oprah created site ShareCare.

Julie is CEU certified and regularly trains health care professionals including psychiatric residents, social workers, therapists and general practitioners on bipolar disorder management skills. She was the original consultant for Claire Danes for the show Homeland and is on the mental health expert registry for People Magazine.

She works as a coach for parents and partners of people with bipolar disorder. Julie is currently writing a book for children called Hortensia and the Magical Brain: Poems for Kids with Bipolar, Anxiety, Psychosis and Depression. She struggles a lot due to bipolar disorder. Friendships keep her going.

You can find more about her work at and


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