A mother sits with her daughter on a couch. The daughter has paranoid delusions, and the mother is figuring out what to say (and not say) to her that can display empathy and support.

What to Say (and Not Say) to Someone With Paranoid Delusions

October 30, 2023

6 min.

Six tips on how to talk to someone with paranoid delusions with empathy and support.

By: Alex Bachert, MPH

Clinically Reviewed By: Dr. Don Gasparini

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Table of Contents

How to talk to someone with paranoid delusions

Paranoid delusions are false, fixed beliefs that a person is being threatened or mistreated. When people experience paranoid delusions, they often feel that others are out to get them; this could be specific people (like parents), authority figures (like teachers or coaches), or groups (like the government). Paranoid delusions can also cause behaviors such as suspicion, hypervigilance, hostility, irritability, and withdrawal — all of which can be especially difficult for teens and young adults as they navigate school, social situations, and early career moves. 

So, how do you talk to a loved one who is suffering from paranoid thoughts and delusions? You know you want to help them, but you might not be sure where to start or how to continue the conversation without making their paranoia worse. Coping with a loved one with paranoia requires patience, compassion, and an understanding of what they’re going through. If you know someone with paranoid delusions, here are six tips to help you communicate with them more effectively.

1. Establish trust

Building trust is an important step in connecting with anyone who has a mental health condition. Establishing trust may require time and patience, but it can lay the foundation for creating a safe and supportive environment for more meaningful conversation with individuals with paranoid delusions. 

So, how can you establish trust when it seems like the other person isn’t always listening? Here are some tips:

  • Follow through on commitments or promises 
  • Consistently offer kindness, compassion, and empathy
  • Avoid pressuring them 
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2. Listen

It may be obvious to you that a person’s delusions are unfounded or unrealistic, but for them, the feelings and concerns are very real. Even if you don’t believe that the person is in danger, make an effort to learn about their fears and how to support them. 

To start, listen to what they’re saying with the goal of understanding their experience and perspective. This can be done with simple questions, such as: “Can you tell me what’s going on? What are you experiencing right now?” 

Someone suffering from paranoid thinking may say something like: “That teacher is trying to ruin my reputation,” or “I know my parents put a camera in my room to spy on me.” From there, practice reflective listening to ensure you’ve understood your loved one: “I hear you saying X. Did I get that right?” 

3. Learn how to support their needs

Once you understand your loved one’s delusions, you’ll be better prepared to support them. To do this, Mental Health America suggests something called “rolling with the delusions.”

The idea is to identify behaviors, resources, and environmental changes that will help them feel calm and reduce stress. You can start with a simple statement, such as “I’m here to support you, and we’ll get through this together,” and then ask for what they need. You can follow up with questions such as:

  • It seems you feel like X. What do you think will make it better?
  • Is there anything that makes you feel better?
  • What do you find soothing during periods of delusions?
  • Would you like me to play a specific song or movie to help you feel calm?

4. Be mindful of delivery

When speaking with someone who has paranoid delusions, it’s important to be mindful of your tone and delivery. Here are a few considerations to help you offer empathy, warmth, and clarity. 

Tone of voice

Speak in a gentle and understanding tone of voice to avoid coming across as confrontational or aggressive. By doing so, you can help the person feel safe and heard, minimizing the risk of them perceiving your communication as confrontational or aggressive. 


Speak at a moderate pace (not too fast, not too slow) so it’s easier for the other person to follow along. Simple words and sentences can help reduce the chance of miscommunication. 


If someone is experiencing delusions, try to offer them enough time to process the conversation. You can show patience by not rushing their response or pressuring them to make a decision. 


Maintain a relaxed body posture so that you don’t come across as threatening. This means avoiding gestures or stances that may be interpreted as aggressive or intimidating. By keeping a calm and open posture, you can create an environment where the person feels safer and more at ease, which is essential for effective communication and building trust.

5. Discuss professional help

Helping someone overcome paranoid delusions isn’t always easy, but you can start by connecting them with appropriate mental health services. Mental health professionals are trained to diagnose mental illness and recommend appropriate treatment to help manage symptoms.

Paranoid delusions are often a sign of mood or personality disorders, such as:

  • Paranoid personality disorder
  • Schizophrenia or paranoid schizophrenia
  • Delusional disorder
  • Borderline personality disorder 
  • Post-traumatic stress disorder (PTSD)
  • Bipolar disorder with psychotic features
  • Major depressive disorder with psychotic features
  • Substance abuse with psychotic features

Mental health treatment can help your loved one live a safer, more balanced life. If you’re not sure how to raise the topic, here are a few tips to get the conversation started.

Choose the right time

Mental health treatment is a sensitive topic for some people, so find a time when your loved one seems open to the conversation, not during periods of paranoia or distress. Choose a time when both you and your loved one can engage in a calm and focused dialogue, free from external pressures or distractions.

Remind them of your reasoning

Emphasize that their health and safety are your top priority and that therapy is an opportunity to connect them with people and professionals who understand what they’re going through. Reassure them that your goal is to help them lead a safer, more balanced life.

Provide additional information

Come to the conversation prepared with information on the benefits of mental health treatment and maybe even the names of a few providers or programs. Having this information readily available can make the idea of seeking treatment more concrete and less daunting.

Offer to coordinate care

If the logistics of therapy are too overwhelming for your loved one, offer to manage the process for them. You can offer to assist in researching providers, scheduling appointments, and ensuring they have the necessary support to engage in therapy effectively. 

Encourage compliance

If your loved one is already in treatment, encourage them to continue with therapy, medication, group sessions, or anything else that is part of their protocol. Paranoia and delusions may affect their willingness to participate in care but can have negative consequences on their recovery. 

Two young males walking together talking. One of them has paranoid delusions, and their friend is discussing professional help.

6. Prepare for emergencies

If the conversation escalates or the situation becomes unmanageable to the point where you’re worried about a loved one harming themselves or someone else, always know where to turn for help. If you or someone you care about is struggling with their mental health and require immediate support, please dial 911. Additional suicide prevention resources include: 

Get help with Charlie Health

Do you think that a teen or young adult in your life might be struggling with paranoid delusions or other symptoms of serious mental illness? If so, Charlie Health is here to help.

Charlie Health’s virtual Intensive Outpatient Program (IOP) provides personalized treatment for teens, young adults, and families dealing with a variety of mental health conditions, including paranoid personality disorder, paranoid schizophrenia, delusional disorder, and co-occurring conditions.

With the help of experienced therapists and the social support of peers who face similar struggles, your loved one can participate in our online therapy program to improve their mental health and overall quality of life. Charlie Health is available 24/7 to get your loved one started on their healing journey. Fill out this short form to get started now.

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