A new study published in Psychological Medicine revealed that loneliness and paranoid thoughts may be far more intertwined than previously understood. Results from the research show that loneliness is not only strongly linked to paranoia, but that the two also happen to reinforce each other in a self-perpetuating cycle.

While both loneliness and social isolation are forms of social disconnection, we learn from the study that loneliness plays a particularly powerful role in suspicious thinking. That includes subtle “ideas of reference” and more severe persecutory thoughts. Cognitive mechanisms such as rejection sensitivity and attributional biases were also found to mediate this link. This suggests that the way people interpret social cues may be a key driver of how loneliness fuels paranoia.

I recently spoke with the author of the paper, Prof. Błażej Misiak, MD, PhD — Professor of Psychiatry and Head of Department at Wroclaw Medical University — to understand what these findings mean and how the loneliness–paranoia connection could open new doors for both prevention and treatment. Here’s a summary of our conversation.

What inspired you to explore the connection between loneliness and paranoid thoughts?

We were struck by how often patients and participants in community studies talked about feeling isolated and mistrustful. Loneliness is usually seen as a social or public health issue, while paranoia is thought of as a psychiatric symptom. But both involve difficulties in how we relate to others. We wanted to understand whether they might share psychological roots and whether reducing loneliness could be a way to also ease suspicious or paranoid thinking.

Were there any personal observations, gaps in existing literature or clinical needs that motivated this research?

Clinically, many people with paranoid thoughts also report feeling profoundly alone, but this overlap hadn’t been systematically studied. The literature had gaps: loneliness research rarely considered severe mental health outcomes, and paranoia research often overlooked everyday social experiences like isolation. Filling that gap felt important both for science and for clinical care. Moreover, evidence linking loneliness and cognitive biases was mostly provided by cross-sectional studies limiting insights into temporal associations.

Many people see loneliness as a social problem and paranoia as a clinical one. What surprised you most about finding a connection between the two?

What surprised us was just how mutually reinforcing they are. Loneliness doesn’t just predict paranoia; paranoia in turn worsens loneliness, creating a vicious cycle. It challenged the idea that these are two separate worlds — one “social,” one “clinical.” Instead, they’re deeply intertwined, and even relatively mild suspicious thoughts in the community seem to be linked to how connected or disconnected people feel.

You mention that loneliness and paranoid thoughts influence each other. Can you explain what that cycle looks like in everyday life?

Imagine someone who feels lonely and disconnected. That sense of exclusion can make them more likely to interpret ambiguous situations negatively — perhaps thinking a group of people whispering nearby must be talking about them. Those suspicious interpretations can then make them withdraw further, avoid new connections or distrust potential friends, which only deepens loneliness. It’s a loop that keeps feeding itself.

Rejection sensitivity came out as a key mediator in your findings. Why do you think lonely people become so hyper-attuned to rejection?

When people feel chronically disconnected, they often become more vigilant to social cues — scanning for signs of exclusion. That heightened sensitivity makes sense as a kind of protective strategy, but it can backfire. If you expect rejection, you may interpret neutral or even friendly signals as negative, which increases both feelings of loneliness and suspicious, paranoid interpretations.

You found loneliness is more tied to ideas of reference than persecution. Could you explain what that looks like in everyday life and why loneliness might push people in that direction?

Ideas of reference are thoughts like, “That conversation across the room is about me” or, “That advert seems personally relevant.” They’re different from persecutory thoughts like, “People are trying to harm me.” We found loneliness was more strongly linked with these subtle, self-referential ideas. 

One possible reason is that when people feel isolated, they become highly self-focused and attuned to signals of belonging or exclusion. That may draw them into interpreting unrelated events as personally meaningful, without necessarily assuming hostile intent.

What practical steps, whether through therapy, daily habits or social changes, could help break the link between loneliness and paranoid thinking?

On the individual level, therapies that target social cognition — like cognitive-behavioral approaches addressing rejection sensitivity — can help people reframe ambiguous social situations. Daily habits such as structured social activities, volunteering or group hobbies can also reduce isolation in a safe way. 

At a societal level, reducing stigma and creating inclusive community spaces matter too. Ultimately, interventions that build trusting connections may be one of the best ways to reduce both loneliness and paranoia.

Take the science-backed Perseverative Thinking Questionnaire to see how repetitive negative thoughts may be affecting your mental health.