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Paranoia or Panic Attacks?

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Hello Doc! My name is Mike. I’m currently 23 years old and live in a very mountainous secluded area in western Pennsylvania. I’m translated from a large city roughly 5 years ago where you could shake your neighbors hand through while you both sat at your respective kitchen tables. Meaning, it was a packed area, Washington D.C.

I was involved in some criminal activities at home but never got in any serious trouble. I became friends with a group of people through my best friend Josh whom I grew up with from 6th grade until I moved. After moving I went back home a year or so later to see everyone and party a bit. I had a very bad panic attack type of thing (I’m not sure what to call it?) where I suddenly suspected everyone in that group of friends, including my best friend Josh was going to kill me. People who I’d known for years and as I mentioned one of which I spent almost my entire life living next door to. I believe I actually saw a large butcher knife in someone’s hand and the other had another blunt object. Or so I thought, I don’t know if it was real or not. They didn’t threaten me verbally or physically but I panicked and told them I was going outside to smoke.

I immediately took off and went to the nearest bus station and called a family member who spent 4 hours trying to find me because I was too disoriented to explain where I was or how to get there. I came back home the following day, back to the mountains.

Now several years later I have not been back to my original area and have had minimal contact (I’ve only spoken with my friend Josh via the phone on a couple of occasions.) He recently contacted me through my fathers cell phone (tonight) and he and another one of my old friends spoke with my parents and I on three-way calling. Josh wants to come up and see me within the next couple of weeks.

I’m terrified of this, I honestly think he’s coming to kill me and I don’t know what to do. How can I tell him no? My parents love him as well, he’s like their second son. I’ve even had thoughts my parents are some way involved because we’re struggling with money right now. I know these thoughts are probably crazy because I know my parents love me. But I can’t stop the thoughts. I’m just terrified and I don’t know what to do.

This really re-triggered my fear, I’ve had a couple panic attacks since the original incident but nothing near this bad. Just marginal ones where while I was having them I shook it off and reassured myself it was crazy. I know there’s something wrong and I can fight it off usually.

Sorry for the long winded letter and the grammar but I don’t know what else to do. I need help or a suggestion or anything you can offer.

Paranoia or Panic Attacks?

Answered by on -


Dear Mike, thank you for your detailed letter. You refer to these incidents as panic attacks. It makes sense that you would label them that way because when they occur part of what you experience is panic and anxiety. But I am not sure these experiences are panic attacks. What you consider panic attacks might actually be bouts of paranoia. Panic attacks are often confused with paranoia.

Some of the symptoms of panic attacks include racing heart, palpitations, sweating, visibly shaking, shortness of breath, dizziness, feeling “unreal” or feeling like you are about to lose control. You did not mention any of these physical symptoms. During your episode you became very frightened of the idea that your friends were trying to kill you. You believed that you actually saw one of them holding a butcher knife. This naturally frightened you and you immediately left for the nearest bus station. There was anxiety and panic associated with the incident but it’s more likely that you were exhibiting signs of paranoia.

Paranoia is a persecutory delusion. It’s the belief that someone or a group of people are attempting to harm you in some manner, physically, emotionally or mentally.

Lately these paranoid thoughts and feelings have returned. This is due to a recent contact from the group of friends that you once feared may have tried to harm you. I would strongly recommend that you seek help from a mental health professional immediately. The fear that you describe is, according to you, out of control. You are beginning to fear that your parents are involved in the plot to harm you. This shows that the paranoia may be intensifying and it needs to be treated.

A mental health professional can help you gain control of this fear either by teaching you a way to ground yourself in reality or by prescribing you a low dose of medication. I believe you’re an excellent candidate for help at this time because of your keen awareness of this growing fear. You also seem open-minded and willing to seek help. If you meet with a qualified mental health professional there is a high likelihood that you could gain control of your fear but it requires that you seek help immediately.

In summary, you are probably experiencing paranoia and not panic attacks but I cannot know this for sure based on a short letter. I believe that if you sought help immediately there is a very good chance that you can effectively decrease or eliminate these episodes of paranoia. If you do not seek help the concern is that these incidents will become more frequent and significantly impair your ability to function.

I would advise against meeting with the friends you believe are attempting to harm you until you have sought treatment. That’s because you’ve already begun to experience paranoia associated with these friends and seeing them may only intensify these feelings. Lastly, please seek help immediately and do not put this off. I do not mean to alarm you but I know that if you go to treatment there is a good chance you can be helped. Please consider writing back and letting me know how you are doing.

Paranoia or Panic Attacks?

This article has been updated from the original version, which was originally published here on February 23, 2009.

Therapists live, online right now, from BetterHelp:

Kristina Randle, Ph.D., LCSW

Kristina Randle, Ph.D., LCSW is a licensed psychotherapist and Assistant Professor of Social Work and Forensics with extensive experience in the field of mental health. She works in private practice with adults, adolescents and families. Kristina has worked in a large array of settings including community mental health, college counseling and university research centers.

APA Reference
Randle, K. (2019). Paranoia or Panic Attacks?. Psych Central. Retrieved on October 28, 2020, from
Scientifically Reviewed
Last updated: 31 May 2019 (Originally: 23 Feb 2017)
Last reviewed: By a member of our scientific advisory board on 31 May 2019
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