Part 1: Understanding Paranoia Through the Lens of Systemic Racism
Paranoia often conjures images of extreme beliefs: people out to get you, conspiring against you, or plotting harm. However, paranoia isn’t always that extreme—it exists on a spectrum, ranging from fleeting concerns about social judgment to full-blown persecutory delusions (fixed beliefs that you’re being targeted despite evidence to the contrary [Freeman et al., 2005]).
Research shows that 30-40% of young adults experience some degree of paranoia, often tied to social anxiety or fears of negative evaluation. More intense paranoid thoughts, affecting around 10-30% of individuals, may include beliefs in conspiracy theories or feelings of persecution. While these thoughts can still exist on a spectrum, in some cases, they may signal early stages of psychotic disorders such as schizophrenia (Freeman et al., 2005).

While paranoia is common, it may require clinical attention when it becomes distressing or interferes with daily functioning. However, this clinical understanding of paranoia–particularly its more severe forms–presents a tension when considering the experiences of marginalized communities, particularly Black Americans. What may be labeled as heightened ‘clinical’ paranoia, in some cases, better reflects justified responses to real, systemic threats and discrimination. Rather than simply a symptom of mental illness, heightened paranoia may reflect lived experiences shaped by systemic racism.
In this two-part blog series, I explore how racial disparities and systemic factors shape paranoia among Black Americans. In highlighting the intersection of paranoia with racial identity and systemic racism, I advocate for more accurate and culturally sensitive mental health assessments.
The Influence of Social Contexts on Paranoia
Paranoia varies widely based on individual and contextual factors. For many, it might be a fleeting worry about being judged by others, but for some, it can escalate to severe, distressing beliefs of being targeted or persecuted—often seen in clinical settings as part of psychotic disorders such as schizophrenia. However, for many Black Americans, heightened vigilance may not always be irrational. In fact, it may reflect an adaptive response to a history of surveillance, policing, dehumanization, and systemic racism. This term ‘systemic racism’ captures the pervasive, institutionalized nature of racial inequality, affecting multiple facets of life and contributing to the heightened vigilance observed in marginalized communities.
This raises an important question: Is it truly ‘clinical’ paranoia when it reflects justified fears grounded in real social and historical threats?
As a non-cisgender person of color, I’ve experienced significant variations in my sense of vigilance depending on my surroundings. For example, I feel more alert when pumping gas late at night in rural Indiana, influenced by the Ku Klux Klan’s historical presence and recent restrictive legislation against LGBTQ+ individuals. In cities like Los Angeles, where diversity is more visible, that tension eases. These shifts in vigilance aren’t random; they’re grounded in real social dynamics.
Understanding paranoia is especially crucial when examining its intersection with race–particularly for Black Americans, who face racial discrimination at higher rates than White individuals and other ethnoracial minority groups (Anglin et al., 2015). To fully grasp how paranoia manifests in these communities, it is essential to understand the systemic dynamics and biases that contribute to these differences.
Paranoia in the Context of Racial Disparities
For Black Americans, the experience of paranoia is profoundly shaped by systemic racism and historical oppression. Daily encounters with racial discrimination may contribute to heightened vigilance and paranoia. For example, a Black individual may feel an increased sense of being watched or judged while shopping or walking in predominantly White neighborhoods. This heightened vigilance may be adaptive, a response to a history of surveillance and policing rooted in systemic racism. These experiences are not isolated but are influenced by broader societal forces that disproportionately affect Black communities, underscoring the need to consider these factors in both research and clinical practice.
Paranoia manifests differently across racial groups. Research shows that Black Americans report higher levels of paranoia compared to White individuals, even in the absence of major mental health issues (Combs et al., 2002; Wolny et al., 2024). This heightened paranoia may reflect the ongoing impacts of systemic racism and racial discrimination on Black communities.
As a child of a Black mother from Chicago’s South Side, I’ve felt the impact of systemic racism and racial discrimination deeply. The Black Lives Matter movement has brought this reality into sharper focus, exposing the daily injustices faced by Black Americans. It is painful to think that even my young cousins, aged 10 and 13, could be seen as dangerous by police simply for wearing a hoodie or being in the wrong place at the wrong time. Even at their young age, they are already internalizing unspoken rules: don’t run, don’t wear a hoodie, don’t draw attention. These lessons are not just abstract; they are reinforced by daily interactions and stories within their communities, teaching them how to navigate a world that often views their presence with suspicion. This personal experience aligns with research showing the heightened vigilance and paranoia in Black communities as a response to systemic racism and the very real threats it imposes (Ridley, 1984; Whaley, 2001).
These experiences highlight the critical need for mental health frameworks that recognize how systemic racism shapes paranoia, a topic we will explore further in Part 2.
Edited by Jonah Wirt and Joe Vuletich
References:
Freeman, D., Garety, P. A., Bebbington, P. E., Smith, B., Rollinson, R., Fowler, D., Kuipers, E., Ray, K., & Dunn, G. (2005). Psychological investigation of the structure of paranoia in a non-clinical population. The British journal of psychiatry: the journal of mental science, 186, 427–435.
Anglin, D. M., Polanco-Roman, L., & Lui, F. (2015). Ethnic variation in whether dissociation mediates the relation between traumatic life events and attenuated positive psychotic symptoms. Journal of trauma & dissociation: the official journal of the International Society for the Study of Dissociation (ISSD), 16(1), 68–85.
Combs, D. R., Penn, D. L., & Fenigstein, A. (2002). Ethnic differences in subclinical paranoia: An expansion of norms of the Paranoia Scale. Cultural Diversity and Ethnic Minority Psychology, 8(3), 248–256.
Wolny, J., Moussa-Tooks, A. B., Bailey, A. J., MacDonald Iii, A. W., Mervis, J. E., & Hetrick, W. P. (2024). Measurement invariance of the Revised-Green Paranoid Thought Scale across Black and White Americans. Schizophrenia research, 266, 227–233.
Ridley, C. R. (1984). Clinical treatment of the nondisclosing Black client: A therapeutic paradox. American Psychologist, 39, 1234–1244.
Whaley, A. L. (2001). Cultural mistrust: An important psychological construct for diagnosis and treatment of African Americans. Professional Psychology: Research and Practice, 32(6), 555–562.
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