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Teen Mental Health: Paranoid Thoughts About Friends

Meagan Burkhart
November 23, 2025
Authored by: Meagan Burkhart,
Edited by: Emma Loker, BSc, PgDip
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Paranoia is the mistrust or suspicion of other people.1 Specifically, paranoid thoughts in teens are those around how others are trying to harm them, despite these thoughts not being based in reality.2 

Most people experience some form of paranoid thinking in their lives because paranoia falls on a continuum.2  While some experience simple concerns or slight mistrust, those with a clinical diagnosis might experience more severe paranoia in the form of delusions.2 

Unfortunately, adolescence is a time when paranoid beliefs may be developed. In fact, some research shows that one in five teens experiences weekly paranoid thoughts, impacting their self-esteem and mental well-being over time.2 

If you’re concerned about signs of paranoia in your teen, a mental health professional can help you get to the root of the issue and suggest avenues for treatment. This page can also work as a useful guide to paranoid thoughts in teens, as it explores:

  • The causes of paranoid thoughts in teens
  • How paranoid thoughts are maintained
  • Anxiety disorders and paranoia
  • Adolescent thought disorders
  • Other mental health warning signs in teens
  • Treatment for paranoia, anxiety, and psychosis 
Teenage girl sitting on floor at the bottom of her bed with her heads in her hands experiencing paranoid thoughts

What Causes Paranoid Thoughts in Teens?

Because paranoia is more likely to emerge in adolescence compared to other periods in a person’s life, it is important that we understand the basis of paranoid thoughts in teens. 

One study looked at how paranoid thoughts started in adolescence and how they developed over time.3 The findings suggest that the onset of paranoid thoughts tended to align with when teens learned about threat and vulnerability, including the possibility of losing trust in peers.3 

Therefore, based on this finding, trust issues in youth may emerge when a close friend turns against a teen or they have a major falling out with a friend group. Gossip, rumours, subtle exclusion, and bullying are all examples of experiences that could make teenagers feel like their peers are untrustworthy.3 

Further, while the initial event that prompts feelings of mistrust may be valid, some teens might continue to be suspicious of peers for a long time after this event has passed. This could lead to a teen doubting others’ intentions and becoming wary of forming new relationships. 

But why do teens retain this level of mistrust after a negative interaction with peers? We consider the potential reasons next. 

How Paranoid Thoughts are Maintained

When paranoid thoughts continue to bother adolescents, these thoughts may hinge on a confusing form of logic. For example, teens may be aware that their suspicions of peers aren’t warranted in most situations, and may also know that their worries are excessive. However, they may continue to experience these thoughts. 

This phenomenon may be especially troubling when adolescents view their paranoid thoughts as “delusional,” “irrational,” or “unhealthy.” This is because they can acknowledge the problem, but still can’t understand why these intrusive thoughts and feelings continue.3

Another theory about paranoia in adolescence revolves around how peer relationships during this time may increase a sense of social competition, which is tied to bullying.4 In addition, adolescents are more sensitive to social threats, risks, and exclusion due to changes in brain development.4

A few examples of paranoid intrusive thoughts adolescents may experience are listed below:5

  • People are out to get me 
  • People are trying to cause me harm 
  • The people around me are plotting against me

Now that we understand some of the paranoid thoughts teenagers can experience related to friends and how they develop, let’s consider when these thoughts lead to larger mental health issues.

Anxiety Disorders and Paranoia

Adolescents with social anxiety disorder often report having paranoid thoughts.6 Theories that support this show that paranoia is based on anxiety and fear. For instance, being anxious about the bad intentions of others, being judged by peers, or being rejected are common in adolescence – and are also at the root of paranoia.6 

In support of this theory, one study found that half of adolescents with social anxiety also reported higher levels of paranoia.6 In addition, the combination of social anxiety disorder and paranoia led to increased distress, lower perceived school inclusion, and anxious attachments in relationships.6 

Further, a similar study investigating anxiety and first episode psychosis found that 25% of the patients with psychosis also met the diagnostic criteria for social anxiety disorder.7 However, it isn’t clear if social anxiety comes before psychosis, if the two conditions develop together, or if social anxiety develops as a result of paranoid thinking.7 In other words, it’s very much a “chicken or the egg” scenario. 

Overall, there is a clear connection between social anxiety in youth and paranoid thoughts, but the exact mechanism of it isn’t clear yet. However, what is clear is that if you notice social anxiety symptoms tied to paranoid thoughts in your child, mental health treatment may be appropriate.

Paranoia and Adolescent Thought Disorders

Although paranoid thoughts can occur in anxiety disorders, they are more closely tied to adolescent thought disorders, most notably schizophrenia.8 

Aside from paranoia, other signs of thought disorders are illogical thinking and speech that is grammatically correct but has no real meaning (poverty of content).8 These symptoms of thought disorders have been shown to predict psychotic episodes later on in adolescents.8

To diagnose schizophrenia in youth, the DSM requires that the child show a combination of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms.9 In addition, these symptoms have to carry on for at least six months to meet the clinical criteria.9 When schizophrenia is diagnosed before the age of 13, it is known as “childhood onset,” and if it is diagnosed before the age of 18, it is considered “early onset.”9

Some of the early signs of schizophrenia prior to an episode of psychosis are odd beliefs, mild psychotic symptoms, and problems with social, academic, and self-care functioning.9 These symptoms are known as “prodromal symptoms,” meaning they occur before an acute episode of psychosis.9

To be clear, adolescents experiencing hallucinations, delusions, bizarre behaviors, and impairment in functioning are likely in an acute psychotic episode. That being said, if you notice the prodromal symptoms mentioned emerging in your child, these can be early signs of psychosis in teens.

It is important to note that schizophrenia is very rare in the childhood population, so practitioners should always rule out differential diagnoses before starting a course of treatment. Sometimes, teens presenting with psychotic-like symptoms and paranoid thoughts actually meet the diagnostic criteria for bipolar disorder, depression, schizoaffective disorder, or autism.9 Ensuring that your child gets the correct diagnosis is crucial for their mental health recovery.

Other Mental Health Warning Signs in Teens

We’ve discussed anxiety disorders and schizophrenia as mental health disorders that can impact teens today, but there are other related mental health warning signs to look for. 

If you are worried that your child is dealing with a psychiatric disorder, consider the following mental health warning signs in teens:10

  • Low self-esteem
  • Poor sleep
  • Changes in diet 
  • Fatigue
  • Spending excessive time on social media
  • Learning problems in school
  • Using drugs or alcohol

These are some of the common symptoms of a variety of mental health disorders in teens, including depression, anxiety, eating disorders, and personality disorders, to name a few. If your teen shows some of these signs, it may be important to seek advice from a healthcare practitioner.

Treatment for Paranoia, Anxiety, and Psychosis

If you realize that your child is dealing with paranoid thoughts, anxiety, or psychotic tendencies, there are several treatment recommendations. The most appropriate route will depend on their specific symptoms and needs, and a mental health professional can provide guidance on this.

Below, we discuss some evidence-based options for treatment for psychosis:

Medication Treatment for Schizophrenia

First, let’s consider the medications that are appropriate for different mental health disorders associated with paranoia, anxiety, and psychosis. 

When treating schizophrenia in adolescents, antipsychotic medications are typically used.9 There are different types of antipsychotic medications, and more recently, we’ve seen an increase in the use of atypical antipsychotics in teens due to the lower rates of side effects.9 A few examples of atypical antipsychotic medications used to treat schizophrenia are risperidone, aripiprazole, olanzapine, paliperidone, and lurasidone.9 

Medication adherence is very important for treating schizophrenia in youth because discontinuing an antipsychotic medication significantly increases the risk of relapse.9

CBT for Psychosis

There are a few psychological interventions that have proven to be effective in treating psychotic disorders in teens, including cognitive behavioral therapy (CBT) and cognitive remediation therapy (CRT).11

Cognitive behavioral therapy for teens focuses on changing unhelpful negative patterns of thinking and the problematic behaviors that follow those thoughts, as well as emotion regulation. In addition, CBT emphasizes the importance of using coping skills to deal with current and future problems. When CBT is used to specifically target psychotic disorders, it involves processing the current problems, addressing persistent symptoms, managing triggering situations in the future, relapse prevention, and motivation for treatment.11,12

CRT and Paranoid Thoughts

Another form of therapy that addresses paranoid thoughts in teens is CRT (cognitive remediation therapy). This form of therapy targets neurocognitive dysfunction, including problems with working memory, attention, cognitive processing, and flexibility.12 To do so, the therapist breaks up the behavioral skills into four modules: cognitive differentiation, attention, memory, and social perception.12 In addition, CRT for adolescents typically includes psychoeducational treatment, parent seminars, and problem-solving sessions.12

Research shows that both CBT and CRT are effective in reducing psychotic symptoms in adolescents.9,11,12 In addition, the combination of medication therapy and psychological treatment is recommended.9

Teenage boy at park with group of friends smiling after support for paranoid thoughts

MissionPrep: Offering Treatment Programs for Teen Mental Health

At Mission Prep, we prioritize matching teens to the appropriate level of mental health care. Our team treats a variety of mental health disorders in adolescents, including depression, anxiety, and thought disorders such as schizophrenia. We also have outpatient therapy options, as well as more intensive residential treatment programs suited for all levels of severity in adolescents. 

If you’ve noticed that the symptoms we described in this article are emerging in your child, contact us today. A member of our team can talk to you about your current situation and what we can do to help.

References

  1. Freeman, D., & Loe, B. S. (2023). Explaining paranoia: Cognitive and social processes in the occurrence of extreme mistrust. BMJ Mental Health, 26(1). https://doi.org/10.1136/bmjment-2023-300880
  2. Schlier, B., Ellett, L., Thompson, E., et al. (2024). Measuring paranoid beliefs in adolescents: A comparison of the Revised-Green et al.’s Paranoid Thoughts Scale (R-GPTS) and the Bird Checklist of Adolescent Paranoia (B-CAP). Research on Child and Adolescent Psychopathology, 52, 1319–1327. https://doi.org/10.1007/s10802-024-01187-9
  3. Bird, J. C., Freeman, D., & Waite, F. (2022). The journey of adolescent paranoia: A qualitative study with patients attending child and adolescent mental health services. Psychology and Psychotherapy: Theory, Research and Practice, 95(2), 508–524. https://doi.org/10.1111/papt.12385
  4. Raihani, N. J., & Bell, V. (2019). An evolutionary perspective on paranoia. Nature Human Behaviour, 3(2), 114–121. https://doi.org/10.1038/s41562-018-0495-0
  5. Freeman, D., Stahl, D., McManus, S., Meltzer, H., Brugha, T., Wiles, N., & Bebbington, P. (2012). Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Social Psychiatry and Psychiatric Epidemiology, 47(8), 1195–1203. https://doi.org/10.1007/s00127-011-0433-1
  6. Kingston, J. L., Schlier, B., Leigh, E., Widyasari, D., & Bentall, R. P. (2025). Social anxiety and paranoid beliefs in adolescents. JCPP Advances, 5(3), e12280. https://doi.org/10.1002/jcv2.12280
  7. Michail, M., & Birchwood, M. (2009). Social anxiety disorder in first-episode psychosis: Incidence, phenomenology and relationship with paranoia. The British Journal of Psychiatry, 195(3), 234–241. https://doi.org/10.1192/bjp.bp.108.053124
  8. Bearden, C. E., Wu, K. N., Caplan, R., & Cannon, T. D. (2011). Thought disorder and communication deviance as predictors of outcome in youth at clinical high risk for psychosis. Journal of the American Academy of Child & Adolescent Psychiatry, 50(7), 669–680. https://doi.org/10.1016/j.jaac.2011.03.021
  9. Sunshine, A., & McClellan, J. (2023). Practitioner review: Psychosis in children and adolescents. Journal of Child Psychology and Psychiatry, 64(7), 980–988. https://doi.org/10.1111/jcpp.13777
  10. Salminen-Tuomaala, M., Nissinen, K., & Haasio, A. (2023). Detecting signs of mental health problems in secondary school-aged youth. Depression, 15, 16. https://doi.org/10.5430/cns.v11n1p28
  11. Gergov, V., Milic, B., Löffler-Stastka, H., Ulberg, R., Vousoura, E., & Poulsen, S. (2022). Psychological interventions for young people with psychotic disorders: A systematic review. Frontiers in Psychiatry, 13, 859042. https://doi.org/10.3389/fpsyt.2022.859042
  12. Browning, S., Corrigall, R., Garety, P., Emsley, R., & Jolley, S. (2013). Psychological interventions for adolescent psychosis: A pilot controlled trial in routine care. European Psychiatry, 28(7), 423–426. https://doi.org/10.1016/j.eurpsy.2013.05.008
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