Q. How to confirm whether my mental issues is due to schizophrenia or anxiety?

Answered by
Dr. Parth N. Nagda
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 12, 2020 and last reviewed on: Mar 19, 2020

Hello doctor,

These past few days I have been bad as I have focused back on my schizophrenia obsession. It mainly focuses on times I have been paranoid, or times I have visualized things as something else. Examples: when slacking off at work thinking, what if there are cameras in the office or internet tracking software. When having a bad intrusive thought thinking, what if someone around me can read my thoughts and thinks I am crazy. Seeing the silhouette of something really far away and imagining it is something else like a door stopper from very far away looks like the shape of a bird or a sandbag propped in the shape of a cat.

These are just a couple of examples that make me fear I am paranoid/delusional or on the edge of hallucinating things. There are other ones along those same lines that pop up on random occasions that I do not necessarily believe 100% but the possibility still causes me anxiety. Then the fact that they cause me anxiety causes me even more anxious after the fact wondering if these are paranoid or delusional thoughts.

I have talked to my therapist about these fears in the past but I may have left something out or not brought up these examples in clear enough detail. She does not believe I have schizophrenia. I also have talked to a psychiatrist and she told me these types of paranoid ideas may occur in anxiety or depression.

I am just terrified that paranoia is not a symptom of OCD and my poor vision cannot explain the minor visual imaginings (not even hallucinations just premature constructions of shapes/outlines) and that I am not taking appropriate action to combat a much deeper mental illness.

My only issue with my thoughts is that they did not occur after I started fearing schizophrenia. I have always had general anxiety. They all have happened throughout my past. After I started fearing schizophrenia I combed through my memories to try to find evidence that I am developing it. And in that rumination process, I picked out all the times I have had paranoid thoughts. Though I usually do not believe the thoughts or hold them to be true, I still get anxious at 'what if'. I am hoping that is the defining characteristic that proves they are products of anxiety and OCD versus schizophrenia. Am I schizophrenic? Could it be just anxiety? I also have an uncle who is schizophrenic and that always scares me. Does it mean I am too?



Welcome to

Thank you for such a detailed history. It makes things very clear.

I will sum up the main clinching reason why you do not have schizophrenia. You have insight. Means you know what is wrong with you and you can attribute a reasonable logical cause to this and know where to seek help. This is not the case with schizophrenics. They do not have insight into the paranoia. They will believe it is real.

This is an anxiety spectrum disorder and this over inclusive repetitive thinking can also happen in OCD (obsessive compulsive disorder) as well as a generalized anxiety disorder. Treatment for both essentially remains the same, only the dosages differ a little. Do not worry. This is not schizophrenia.

Also, do not keep in mind that schizophrenia has a higher chance of transmission from parents. Having an uncle with schizophrenia means you just share some genetic component. Keep in mind that the same gene is responsible for schizophrenia, autism, bipolar disorder, and depression/anxiety. So if your uncle has schizophrenia, that means you can have some sort of mental illness, either something as mild as anxiety, or as severe as schizophrenia. Please get started on SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin-norepinephrine reuptake inhibitor) type of medicines in addition to your therapy. If you have not undergone some sessions of CBT (cognitive behavioral therapy), please do that with a clinical psychologist since it will help you manage the symptoms of anxiety. Also, please do deep breathing exercises daily four to five times a day. When you are anxious, you can do some more sessions of deep breathing until you calm down. It will reduce the panicked feeling that you have.

Thank you doctor,

So if I am not schizophrenic, could all those paranoic ideas mean I have paranoia? or a paranoid personality disorder? I have spent the last days crying. I am very afraid of being paranoic or some serious mental illness.



Welcome back to

No, you do not have a paranoid personality disorder. It is just a form of worry, to put it simply. And that worry/ fearfulness is a part of your anxiety disorder. Anxiety and depression go hand in hand, remember that.

The fact that you had insight as I said earlier and now the fact you said you are crying (remorse /guilt) again is very much in favor of mixed anxiety-depressive disorder.

People who are schizophrenics do not cry since they do not think they have a problem. Same thing with paranoid personality disorder. Those people will know that they are right and all others are wrong. Believe me, it is not a serious mental illness.

You have anxiety which, about 15 to 20 percent of people have it if you are wondering about the lifetime prevalence. Please visit a psychiatrist and get started on antidepressants or anxiolytic drugs such as SSRI (selective serotonin reuptake inhibitors) or TCA (tricyclic antidepressants) class of medicines. They will help restore the chemical imbalance of serotonin in your brain. The lowered levels of that neurotransmitter is making your brain to have reduced stress handling capacity and that is why you are having these symptoms.

The medicines will take about a week or 10 days to show its effect and are usually taken for three or four months and then gradually tapered off. It is not a lifelong medicine.

Hi doctor,

I understend. I hope it is just anxiety and I can manage it. I am so scared though. I will visit a psychiatrist for medicine. I am scared not to have those paranoid ideas again, and if somehow they may occur again. Could it be due to my extreme anxiety? I also noticed that my self-esteem is very low. I feel like crying, easily criticized or unloved, very sensitive, easily disappointed, cannot sleep at night and wake up in a panic attack. If someone is quite serious or says something more seriously, I feel like they are mad at me. If someone is arrogant or rude with me or with other people, I am affected. My thinking is foggy and at the same time my anxiety and fear of being crazy or becaming crazy is extremely high. I fear that in any moment I will lose touch with reality. I am just terrified of losing my mind.



Welcome back to

As I have said above, you have mixed anxiety and depression. The paranoia as you call it, is nothing but a form of fear or worry that something will happen. That is a part of anxiety. The other symptoms are typical of depression such as low self-confidence, feelings of helplessness, hopeless and worthlessness, sad mood, crying spells, difficulty sleeping, excessive worried ruminative thoughts about the past, etc. These are all classical depressive symptoms.

The medicine will work for both, just give it some time as mentioned above.

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