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Understanding the Link Between TBI and Paranoia (And How to Treat It)

man biting his nails from paranoia and TBI

Paranoia is a rare but serious complication of TBI. It causes a person to have exaggerated suspicions of the people around them, especially their loved ones.

In today’s article, you will learn more about the link between TBI and paranoia, plus what family members can do to help their loved one cope.

Let’s get started.

Causes of Paranoia after TBI

Paranoia is not a diagnosis itself. Rather, it is a symptom of something called psychosis.

Psychosis refers to a group of thought disorders that cause a person to lose contact with reality. There are many possible causes of psychosis after brain injury. Some of these include:

Several studies report that psychosis occurs in about 4% to 8.9% of TBI patients. There is usually a delay of onset between the brain injury and the presentation of psychotic symptoms.

The onset of psychosis can range from a few days to over twenty years after TBI; however, studies suggest that the majority of patients show symptoms within the first five years.

The length of time between onset and TBI depends on the type of brain injury. A delay of less than one year is associated more with diffuse axonal injuries. Longer delays usually occur after damage to the temporal lobe.

Damage to the orbitofrontal cortex can also cause psychosis and paranoia.

Symptoms of Paranoia

woman's eyes peeking through blinds

©iStock/ Vyacheslav Dumchev

Paranoia causes TBI patients to become exceedingly defensive. They can believe they are under threat even though there may be little to no evidence of that.

Patients may also believe a specific person or group is out to sabotage them, or believe that the people they love are lying. Many convince themselves that people gossip about them behind their back.

To the person with paranoia, these beliefs appear completely rational, so they do not usually respond well to arguments trying to prove them wrong.

A person with paranoia can also become hostile and sarcastic with those around them. If they feel threatened, they can even display aggressive behavior. This usually provokes a hostile reaction in others, thus confirming the patient’s suspicions.

Other symptoms of paranoia include:

  • Unforgiving and holding grudges
  • Doubting the loyalty of others
  • Detachment and social isolation
  • Defensive and argumentative
  • Trouble admitting faults
  • Hypersensitivity to criticism

People with paranoia after TBI can also experience auditory and visual hallucinations.

Are All Suspicious Thoughts Paranoia?

Everyone experiences suspicious thoughts, and sometimes these thoughts are justified. Sometimes, a person you know really is lying to you or trying to hurt you.

Your experience can also make you more suspicious. For example, if someone you trusted hurt you, it is natural to doubt all friendships at first.

However, suspicions can become paranoia if you refuse to consider any contradictory evidence. Other signs of paranoia include:

  • Basing your suspicions on feelings and ambiguities, not facts.
  • No one else shares your suspicions.
  • It is unlikely that someone would single you out.
  • Your suspicions are damaging your relationships.

Distinguishing Paranoia from Anxiety

man looking scared and biting fingers

Although the two conditions can look very similar and can even fuel each other, anxiety and paranoia are separate issues.

The major difference between the two is the person’s level of insight or self-awareness. Most anxiety patients realize that they struggle with anxiety. They know they are not truly in danger, but they are unable to control their physical reactions.

With true paranoia, on the other hand, the person does not believe that they are paranoid. For them, their reactions to others are perfectly reasonable.  

This can make treating paranoia more difficult than anxiety. However, it is not impossible.   

Treating Paranoia After TBI

A comprehensive assessment from a neuropsychologist will be needed to diagnose a person with paranoia or psychosis after TBI.

The psychologist will ask the patient about their work and personal relationships, and how they might respond to a hypothetical situation. This will help the psychologist form a treatment plan.

Treating paranoia will involve combining medications with talk therapy. Some medications that can help treat paranoia include:

  • Antipsychotics
  • Benzodiazepines
  • Antidepressants

A psychologist can also help the person learn how to reduce their feelings of paranoia using different cognitive therapy techniques.

Treatment for paranoia can be very successful with the right therapy. Unfortunately, because paranoia patients believe their suspicions are true, it can be difficult to get them to agree to treatment.

This can be further complicated if the person with paranoia has had a brain injury, because TBI also impacts self-awareness.

Helping Someone with TBI and Paranoia

man comforting girlfriend with TBI and Paranoia

If you have a relative or loved one experiencing paranoia after TBI, it can be hard to know what to do.

The following are a few tips to help your relative cope and hopefully accept treatment:

  • Don’t dismiss them. Even if the person’s beliefs are unfounded, their fears and feelings are real. Try to understand what they must feel like, and make sure that you are gentle with them. Never get into an argument about their suspicions.
  • Focus on their feelings. Keeping the focus on their feelings can also help them see treatment as an option. Tell them that their stress must be exhausting, and there are people who can help reduce their stress. This may be more agreeable than telling them everything they believe is false.  
  • Provide distractions. Sometimes distractions such as a game can help the person calm down and forget about their paranoia for a little bit. This is helpful if they are starting to become agitated or aggressive.
  • Tell them what you are doing. Make sure you announce what you are doing before you do it. For example, tell them when you are about to enter their room. Barging in unannounced can frighten them.

It’s also important to talk to the person about their fears when they are in a calm mental state. Some people find it helpful to write down all their suspicions and then write down reasons why those may not be true.

However, this activity is better suited for mild paranoia patients. Do not force the person to do this exercise, as that can backfire.

For more personalized tips on living with a person with paranoia, schedule an appointment with a mental health professional.

Understanding Paranoia After TBI

Paranoia can be a difficult side effect of TBI to live with. It can cause extreme stress in patients and damage cherished relationships.

Fortunately, with a combination of medication and therapy, it is possible to manage paranoia and have fulfilling friendships again.

Featured Image: ©iStock/ AaronAmat

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