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Beliefs others say aren't real, or feeling watched or followed

Also called: Psychosis, paranoia, delusions

Holding beliefs that others say aren't real, or feeling watched or followed when there's no evidence, can be a sign of psychosis. It can be caused by mental health conditions, drugs, lack of sleep, or medical problems, and it's treatable, especially when help comes early. If you or someone else may be in danger, call 911 or 988.

Common causesSchizophrenia, bipolar disorder, severe depression, drugs, medical conditions
Usually serious?Yes; needs evaluation
Get checked ifAlways
If you think it's an emergency, call 911.Thinking about suicide or in crisis? Call or text 988.Being hurt or threatened at home? National Domestic Violence Hotline: 1-800-799-7233.Help with alcohol or drug use: SAMHSA Helpline, 1-800-662-4357.

Overview

Psychosis is when a person has trouble telling what's real. Signs include strong beliefs that aren't based in reality (delusions), feeling watched or plotted against, hearing or seeing things others don't, and confused thinking.

Causes include schizophrenia, bipolar disorder, severe depression, drug use (especially stimulants and cannabis), lack of sleep, and medical conditions like infections, brain injury, or dementia. Early treatment improves recovery.

When to get medical care

Call 911Someone is in danger of harming themselves or others. Confusion with fever, headache, or stiff neck. Thoughts of harming yourself or others: call or text 988, or call 911 if you're in danger.
Get care todayNew beliefs or experiences that others find unusual, especially with not sleeping, drug use, or a sudden change in behavior.
See a doctor soonOngoing suspicion or unusual beliefs affecting daily life. Withdrawing from others.

Causes

Causes include schizophrenia and related disorders, bipolar disorder, severe depression, postpartum psychosis, substance use, medicines (steroids, some others), sleep deprivation, and medical conditions such as infections, thyroid problems, and dementia.

OwieClear has pages on 2 conditions that can cause beliefs others say aren't real, or feeling watched or followed. Each shows how soon to get care.

Common causes

  • Psychosis or schizophreniaOften needs care today

    Psychosis means losing touch with what's real, such as hearing voices, seeing things others don't, or having strong beliefs others say aren't true, like being…

Less likely causes

  • Bipolar disorderSee a doctor if it doesn't get better

    Mood swings between lows (depression) and highs (mania), when someone has lots of energy, needs little sleep, talks fast, or takes big risks.

What you can do at home

  • Reach out to a provider or call or text 988.
  • Avoid alcohol and drugs.
  • Get sleep.
  • Stay with someone you trust.

Medicines

Treatment often includes antipsychotic medicine, therapy, and support services. Coordinated specialty care programs help with first episodes.

At the doctor

The provider will check for mental health and medical causes.

Questions you may be asked

  • What you've been experiencing
  • Sleep
  • Substance use
  • Mood
  • Safety

The exam

A physical and mental status exam.

Tests

  • Blood tests
  • Drug screening
  • Brain imaging if needed

Prevention

Early help matters.

  • Get help early
  • Avoid drugs
  • Protect sleep

Check your symptoms

Most symptoms have more than one possible cause. The symptom checker looks at all of your symptoms together, plus your age, and shows how soon to get care.

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Sources

Last updated 2026-11-13.