Your question: Why do I always feel scared and paranoid?
By
OptimistMinds
| Reviewed by
Dr. Mark Mohan Kaggwa
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Author bio
The Optimistminds editorial team is made up of psychologists, psychiatrists and mental health professionals. Each article is written by a team member with exposure to and experience in the subject matter. The article then gets reviewed by a more senior editorial member. This is someone with extensive knowledge of the subject matter and highly cited published material.
Reviewer bio
Dr. Mark Mohan Kaggwa is a psychiatrist with experience in both clinical and research work. Major research contributions have been in forensic psychiatry, suicidology, medical education, and addiction psychiatry. He writes and reviews articles on these topics.
Brief bio
I have a wealth of expertise and experience in research and publication in psychiatry. I am a psychiatrist who has led and participated in several research projects and trainings, covering various topics such as addiction, forensic psychiatry, student mental health, and suicidology. I have a strong track record of mentoring and guiding early career researchers, especially students, to achieve academic excellence and recognition.
I have supervised and supported several students to publish their first peer-reviewed articles in high-impact journals such as the Lancet. Five of my mentees have received prestigious awards for their scientific contributions through publications, conference presentations, and travel grants. I derive great satisfaction and motivation from seeing others succeed and grow in their research careers.
Through mentoring activities, I have also enhanced my research and publication skills, resulting in over 70 publications in the past three years. My notable publications include several Lancet Psychiatry papers, widely cited and whose findings are implemented in various settings. I have also won several awards for my writing skills, such as the best journal article from the Royal College of Psychiatry Journals in August 2023.
Many of my articles have been featured on the cover pages of various journals, reflecting their significance and impact. I have also disseminated my research findings through conferences, seminars, and lectures, where I have been invited as a keynote speaker on three occasions.
I am passionate about solving real-world problems and improving the lives of people with mental health issues, especially those who are marginalized and vulnerable, through a team-based approach. I believe in training others to increase the field’s diversity of knowledge and perspectives.
I have extensive experience in data analysis, research methodology, design, and implementation science, which enables me to execute and train others effectively and efficiently. I am also a motivated team leader, an innovative problem solver, and a collaborative partner. My contribution is instrumental to this project’s success and advancing knowledge in this field.
Ongoing research projects:
- Self-harming behaviours among forensic patients in Ontario.
This project which started in December 2022, focuses on identifying the risks associated with physical self-harming behaviors and their related correlates
Role: Principal Investigator
- Suicide, all-cause mortality, and self-harming behaviours among forensic patients in Ontario.
This project is based on administrative databases to determine trends of suicide and all-cause mortality among forensic patients in Ontario. The project has been running since July 2023 to date
Role: Principal Investigator.
- Horticulture therapy’s role in reducing aggressive incidences among forensic patients in Ontario.
In this stepwise pragmatic cluster-randomized, we employ horticulture therapy in rehabilitating forensic patients in Ontario.
Role: Principal Investigator
- A preliminary study exploring the relationship between electroretinography waveforms and suicidal behaviour severity.
This project seeks to identify the waveforms that are related to suicidal behaviours among patients with depression. Recruitment for the study started in October 2023
Role: Principal Investigator
- Positions, Scientific Appointments, and Honors
| 2023 – present | American Psychiatry Association Colloquium fellow 2023, American Psychiatry Association, USA |
| 2022 – present | McMaster Forensic Psychiatry fellowship, McMasters University Department of Psychiatry and Behavioural Neuroscience, Hamilton, Canada |
| 2018 – 2021 | First Mile Fellowship (Masters support program), Massachusetts General Hospital Institute of Health Professions, USA
|
- Contributions to Science
- Suicidology epidemiology
I have been involved in projects investigating the prevalence of suicidal behaviours in various parts of the world. This work has reported the burden and associated factors among the following populations: university students, individuals affected by food insecurity, and those affected by the COVID-19 pandemic.
1) Kaggwa M.M, Akatussasira R, et. al. The global burden of suicidal behaviour among people experiencing food insecurity: A systematic review and meta-analysis. Journal of Affective Disorders. 2023. https://doi.org/10.1016/j.jad.2023.09.012
2) Nahrin R, Al-Mamun F, Kaggwa M.M, et al. Prevalence and factors associated with suicidal ideation among students taking university entrance tests: revisited and a study based on Geographic Information System data. BJPsych Open. https://doi.org/10.1192/bjo.2023.526
3) Abaatyo, J., … Kaggwa, M.Ml. Suicidal behaviour among inpatients with severe mental conditions in a public mental health hospital in Uganda. BMC Psychiatry 23, 346 (2023). https://doi.org/10.1186/s12888-023-04858-x
4) Kaggwa MM, Nuwamanya S, Ashaba S, Rukundo GZ, Harms S. An Adolescent’s Use of Veterinary Medicines: A Case Report Exploring Addiction. Journal of Psychoactive Drugs. 2021/08/08 2021;53(4):339-344. doi:10.1080/02791072.2021.1873466
5) Kaggwa MM, Muwanguzi M, Nduhuura E, et al. Suicide among Ugandan university students: evidence from media reports for 2010–2020. BJPsych International. 2021;18(3):63-67. doi:10.1192/bji.2021.13
6) Mamun MA, Al Mamun F, Hosen I, … Kaggwa MM, et al. Suicidality in Bangladeshi Young Adults During the COVID-19 Pandemic: The Role of Behavioral Factors, COVID-19 Risk and Fear, and Mental Health Problems. Risk Manag Healthc Policy. 2021;14:4051-4061. doi:10.2147/rmhp.S330282
7) Kaggwa MM, Arinaitwe I, Muwanguzi M, et al. Suicidal behaviours among Ugandan university students: a cross-sectional study. BMC Psychiatry. 2022/04/01 2022;22(1):234. doi:10.1186/s12888-022-03858-7
8) Kaggwa MM, Mamun MA, Najjuka SM, et al. Gambling-related suicide in East African Community countries: evidence from press media reports. BMC Public Health. Jan 24 2022;22(1):158. doi:10.1186/s12889-021-12306-2
9) Kaggwa MM, Rukundo GZ, Wakida EK, et al. Suicide, and Suicide Attempts Among Patients Attending Primary Health Care Facilities in Uganda: A Medical Records Review. Risk Manag Healthc Policy. 2022;15:703-711. doi:10.2147/rmhp.S358187
10) Rukundo GZ, Wakida EK, Maling S, Kaggwa MM, et al. Knowledge, attitudes, and experiences in suicide assessment and management: a qualitative study among primary health care workers in southwestern Uganda. BMC Psychiatry. Sep 12 2022;22(1):605. doi:10.1186/s12888-022-04244-z
11) Manouchehri A, Marznaki ZH, Atim LM, Mohammadian Amiri M, Kaggwa MM. The relationship between causes of suicidal attempts in Iran and individual and social variables: a retrospective study. BMC Psychiatry. Dec 12 2022;22(1):780. doi:10.1186/s12888-022-04449-2
12) Kaggwa MM, Najjuka SM, Favina A, Griffiths MD, Mamun MA. Suicidal behaviors and associated factors among medical students in Africa: A systematic review and meta-analysis. Journal of Affective Disorders Reports. 2022/12/09/ 2022:100456. doi:10.1016/j.jadr.2022.100456
13) Al-Mamun, F., Kaggwa, M.M., Hosen, I. et al. Suicide related to the COVID-19 pandemic in India: A systematic review. Discov Psychol 3, 2 (2023). https://doi.org/10.1007/s44202-022-00063-1
- University student’s mental health
Following my experience as a student and seeing many of my colleagues face vast challenges in their pursuit of knowledge. I investigated various aspects of university students’ mental health to find solutions to an ever-growing problem. I have published a few peer-reviewed articles on subjects ranging from depression, burnout, behavioural addictions, and sexual risk behaviours, among others.
1) Kaggwa MM, Devine J, and Harms S. The opioid crisis fuelled by health systems: how will future physicians fare? BJPsych International, 2023, 1-3, https://doi.org/10.1192/bji.2023.12
2) Sserunkuuma, J., Kaggwa, M. M., et al. Problematic use of the internet, smartphones, and social media among medical students and relationship with depression: An exploratory study. Plos One, 18(5), e0286424. https://doi.org/10.6084/m9.figshare.22794644
3) Kajjimu J, Kaggwa MM, Bongomin F. Burnout and associated factors among medical students in a public university in Uganda: A cross-sectional study. Adv Med Educ Pract. 2021;12:63-75. doi:10.2147/amep.S287928
4) Al Mamun F, Hosen I, Misti JM, Kaggwa MM, Mamun MA. Mental Disorders of Bangladeshi Students During the COVID-19 Pandemic: A Systematic Review. Psychology research and behavior management. 2021;14:645-654. doi:10.2147/PRBM.S315961
5) Najjuka SM, Checkwech G, Olum R, Ashaba S, Kaggwa MM. Depression, anxiety, and stress among Ugandan university students during the COVID-19 lockdown: an online survey. Afr Health Sci. Dec 2021;21(4):1533-1543. doi:10.4314/ahs.v21i4.6
6) Kaggwa MM, Kajjimu J, Sserunkuma J, et al. Prevalence of burnout among university students in low- and middle-income countries: A systematic review and meta-analysis. PLoS One. 2021;16(8):e0256402. doi:10.1371/journal.pone.0256402
7) Kaggwa MM, Arinaitwe I, Nduhuura E, et al. Prevalence and Factors Associated With Depression and Suicidal Ideation During the COVID-19 Pandemic Among University Students in Uganda: A Cross-Sectional Study. Front Psychiatry. 2022;13:842466. doi:10.3389/fpsyt.2022.842466
8) Kihumuro RB, Kaggwa MM, Kintu TM, et al. Knowledge, attitude and perceptions of medical students towards mental health in a university in Uganda. BMC Med Educ. Oct 20 2022;22(1):730. doi:10.1186/s12909-022-03774-0
9) Kihumuro RB, Kaggwa MM, Nakandi RM, et al. Perspectives on mental health services for medical students at a Ugandan medical school. BMC Med Educ. Oct 25 2022;22(1):734. doi:10.1186/s12909-022-03815-8
10) Kaggwa MM, Muwanguzi M, Najjuka SM, et al. Risky sexual behaviours among Ugandan university students: A pilot study exploring the role of adverse childhood experiences, substance use history, and family environment. PLoS One. 2022;17(11):e0277129. doi:10.1371/journal.pone.0277129
11) Muwanguzi, M., Kaggwa, MM., et al. Exploring adverse childhood experiences (ACEs) among Ugandan university students: its associations with academic performance, depression, and suicidal ideations. BMC Psychology, 2023/01/13.
- Influence of family caregivers and peer influence on patient’s mental health
From the unique perspective of using caregivers in caring for mental health patients in Mbarara Regional Referral Hospital. I embarked on understanding their roles, burdens, and significance in patients’ recovery. I continued to explore this in different populations, such as those involved in the criminal justice system. In this adventurous journey, I published a few peer-reviewed articles.
1) Kaggwa, M.M, Olagunju, A.T, Prat, S, Harms, S, and Chaimowitz, G. Peer support mental health teams in correctional settings in Uganda. Lancet Psychiatry, January 2023. https://doi.org/10.1016/S2215-0366(22)00431-X.
2) Kaggwa MM, Najjuka MS, Kesande C, et al. Length of stay of hospitalized patients at tertiary psychiatry facilities in Uganda: the role of caregiver’s presence. Discover Mental Health. 022/07/04 2022;2(1):15. doi:10.1007/s44192-022-00018-x
3) Kaggwa, M.M, Najjuka SM, Mamun, MA, Griffiths, MD, Nyemara, N, and Ashaba, S. Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma. BMC Psychiatry. January 2023. http://dx.doi.org/10.1186/s12888-023-04553-x
4) Nuwamanya S, Nkola R, Najjuka SM, et al. Kaggwa MM. Depression in Ugandan caregivers of cancer patients: The role of coping strategies and social support. Psychooncology. Oct 26 2022;doi:10.1002/pon.6057
5) Najjuka SM, Iradukunda A, Kaggwa MM, et. Al., The caring experiences of family caregivers for patients with advanced cancer in Uganda: A qualitative study. Plos One, October 2023.
- Mental healthcare and psychiatry epidemiology in Uganda
I have also contributed to understanding Uganda’s mental healthcare system through written commentaries, perspectives, reviews, and primary research.
1) Kaggwa MM, Harms S, Mamum M, A. Mental health in Uganda. Lancet Psychiatry; 2022. Oct;9(10):766-767. doi: 10.1016/S2215-0366(22)00305-4.
2) Kaggwa MM, Najjuka SM, Bongomin F, Mamun MA, Griffiths MD. Prevalence of depression in Uganda: A systematic review and meta-analysis. PLoS One. 2022;17(10):e0276552. doi:10.1371/journal.pone.0276552
3) Abaatyo J, Kaggwa MM, Favina A, and Olagunju AT. Readmission and associated clinical factors among individuals admitted with bipolar affective disorder at a psychiatry facility in Uganda. BMC Psychiatry, 23, 474 (2023). https://doi.org/10.1186/s12888-023-04960-0
4) Abaatyo, J., Favina, A. & Kaggwa, M.M. Absconding among admitted patients with bipolar affective disorder diagnosis in Uganda. BMC Psychiatry 23, 318 (2023).
5) Anyayo L, Ashaba S, Kaggwa MM, Maling S, Nakimuli-Mpungu E. Health-related quality of life among patients with bipolar disorder in rural southwestern Uganda: a hospital-based cross-sectional study. Health and Quality of Life Outcomes. 2021/03/10 2021;19(1):84. doi:10.1186/s12955-021-01729-5
6) Kaggwa MM, Namatanzi B, Kule M, et al. Depression in Ugandan Rural Women Involved in a Money Saving Group: The Role of Spouse’s Unemployment, Extramarital Relationship, and Substance Use. Int J Womens Health. 2021;13:869-878. doi:10.2147/ijwh.S323636
7) Kaggwa MM, Acai A, Rukundo GZ, Harms S, Ashaba S. Patients’ perspectives on the experience of absconding from a psychiatric hospital: a qualitative study. BMC Psychiatry. 2021/07/26 2021;21(1):371. doi:10.1186/s12888-021-03382-0
8) Kaggwa MM, Najjuka SM, Harms S, Ashaba S. Mortality Among Patients Admitted in a Psychiatric Facility: A Single-Centre Review. Clinical Audit. 2021 2021-06-17 2021;13:21-28. doi:10.2147/CA.S308757
9) Kaggwa MM, Nkola R, Najjuka SM, Bongomin F, Ashaba S, Mamun MA. Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System. Risk Manag Healthc Policy. 2021;14:2789-2795. doi:10.2147/rmhp.S314451
You can view some of my scholastic work from the following
eRA COMMONS: ORCID ID: https://orcid.org/0000-0002-4733-154X
Scopus Author ID: https://www.scopus.com/authid/detail.uri?authorId=57221518864
Researchgate ID: https://www.researchgate.net/profile/Mark-Kaggwa
Loop profile: https://loop.frontiersin.org/people/926359/overview
Semantic Scholar Link: https://www.semanticscholar.org/author/Mark-Mohan-Kaggwa/2046806840
Google scholar: https://scholar.google.com/citations?user=pPNqr_AAAAAJ&hl=en
My reply:
Hi, I hope this message finds you well. My name is Cesar Guedez, a psychologist trained in cognitive behavioral therapy. If you are reading this, you are probably going through a bad time. Everyday life fills us with pressures and worries and sometimes you can feel overwhelmed. Fear is a natural emotion related to the perception of real or imagined danger, and you cannot avoid it, but you can control it. Fear is related to paranoia in the sense that both are related to the perception of danger, but it should be noted that they are not the same.
Fear is an emotion and paranoia is a mental state. Fear can be more general, evoking physical and psychological sensations related to a frightening style. Paranoia is more specific, focusing on the fact that something or someone wants to harm you at any moment, so you must remain in a state of hypervigilance to get hurt.
Both aspects are normal in life, and do not pose a clinical problem unless they are too severe and recurrent. So I would like to start by telling you that your emotions and actions have an origin. They may be irrational in the sense that they have no logic to others, but in your subjective perception you have reason to believe all the messages your fear and paranoia send you.
How does it feel to be afraid and paranoid?
Suddenly feeling scared is common in anxiety, as anxiety dysregulates your body and emotions in response to the feeling that there is a threat or danger. In anxiety, people feel scared and terrified in response to stress and the abrupt emotional changes it generates. In addition to this, anxiety causes you to think negative thoughts about yourself, such as that you are insufficient or useless, which inevitably generates fear and anger.
Sometimes it is difficult to name the emotions you feel, so you mention words you have heard and believe have to do with the problem you are experiencing. However, it is important to distinguish things in order to address them appropriately. There are key differences between fear and paranoia, you may experience only one of them, both or neither, and knowing this will allow you to better understand your emotional experience as well as where to direct coping strategies (1).
Fear
- Occurs when a thing, person or event appears that you find frightening.
- It generates physical reactions in your body such as tachycardia, sweating and muscular tension.
- It makes you fear for your personal safety.
- It is transient and specific to the frightening situation.
Paranoia:
- You are always on the defensive.
- You feel offended by any comment.
- You do not tolerate criticism of any kind.
- You react impulsively to anything you perceive as an attack.
- You feel that people talk bad about you behind your back.
- You feel that you cannot trust anyone because “people are treacherous”.
- You are always expecting something bad to happen to you or your loved ones.
- You become overly controlling and meticulous about your personal safety.
- You believe that the world is a frightening and dangerous place.
- May be related to hallucinations and delusions.
Why is this happening to you?
There are different causes for paranoia and fear, which explain why the sufferer is in a constant state of emotional reactivity and hypervigilance.
Traumatic experience
A traumatic experience such as a robbery, assault, accident or experience of violence of any kind can make you more susceptible to being paranoid or fearful, constantly fearing the possibility of what happened to you happening again.
Genes
Studies suggest that there is some genetic predisposition to be paranoid and fearful if your parents or grandparents experienced mental health problems such as anxiety, depression and psychotic disorders (2).
Substance use
Consuming addictive stimulant substances keeps your brain stimulated and on the defensive, as it dysregulates brain activity. From amphetamines to nicotine and caffeine, these chemicals are linked to feelings of hypervigilance and constant fear that someone could hurt you.
Anxiety
Anxiety is strongly related to fear and paranoia. It expresses itself through irrational thoughts that arouse distressing emotions in you. Anxiety creates catastrophic scenarios that trigger fear and paranoia. It can make you believe, for example, that someone will break into your house at night, that people chatting at work are actually criticizing you, or that your friends and loved ones are secretly angry with you. All of this is unfounded, with no basis or logic to support the idea, but anxiety passes these thoughts off as real, setting you into a state of fear and paranoia.
What can you do to stop feeling scared and paranoid?
There are strategies you can implement to combat fear and paranoia, however it is always advisable to seek professional help to better understand the origin of your symptoms and to consider a more focused therapy. In some cases, paranoia requires a medical diagnosis and medication that helps to reduce the symptoms and have an enjoyable life.
Question your thoughts
Intrusive thoughts (3) are generated by anxiety and are these irrational and unavoidable thoughts that you have, which generate worry, fear and paranoia. It can take time to recognize your intrusive thoughts, but with practice you will learn to identify them by writing them down in a notebook.
These thoughts are dysfunctional and illogical, so you must constantly test them for veracity. For example, if your thought is “my boss is going to fire me” you should ask yourself questions to refute that idea: Have I been scolded by my boss recently? Has anyone criticized my work performance? These questions seek to question the intrusive thoughts, and decrease the paranoia and fear related to them.
Relaxation and breathing
Jacobson’s relaxation technique may be useful for you, as it works with the whole body and focuses on decreasing the unpleasant sensations associated with anger, anxiety, fear and paranoia. This technique is done lying down, in a quiet environment and with your eyes closed. It consists in that from your feet to your head, you focus your attention on a part of your body, making slow movements, tensing and releasing the tension.
For example in your feet, you make slow circular movements, tense them and then release the tension. Then you do the same with your legs, and so on until you reach your head. It will take as long as you feel necessary, but it lasts approximately 10 to 20 minutes. It is a slow but effective exercise, that with time you will learn to control it perfectly and you will notice an improvement in the control of anxiety (4).
Write down your emotions and thoughts
Writing about what you fear is positive for expressing and draining the agony you experience with fear and paranoia. No matter how illogical you feel your words are, it is valuable to write because it externalizes the anguish that consumes you inside and makes you realize what your fears and dysfunctional ideas are and then dedicate yourself to addressing them.
In my experience…
The feeling of fear and paranoia can be very overwhelming, as it wears on your mind through anxious and repetitive thoughts related to the sense of danger. Although fear is useful to protect you from potential threats, it can also consume your life when it is overblown and exaggerated.
Your main job is to conclude your feelings and understand them as part of a problem that demands action. It is not your fault that you are going through this, but you do have the responsibility and the ability to take action to cope with it and improve your quality of life.
Remember that you have the ability to improve your psychological state, even if during moments of anxiety or depression you feel hopeless. We can always make small changes that will pay off in the long run. The fact that you are contacting me to seek professional attention in psychological counseling is already a step, and I recognize and applaud you for that. You are already doing something and wanting to change always leads you in the right direction.
I invite you to seek professional help when you feel that even applying these suggestions, your situation does not improve. Cognitive behavioral therapy is very effective in treating different forms of anxiety and will give you more accurate tools to manage your emotions
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References
Take Control of Your Anxiety Today: Personalized Counseling with BetterHelp
