Occasionally once every couple months I'll have break down level paranoia where I believe even family and friends have a plot to kill me. It's not often but it's scary when it does happen. I used to abuse heavy stimulants, so I'm wondering if this is residual stimulant psychosis, ptsd, or bipolar with paranoia (I've had that thrown at me)
Bump for visibility. I've never experienced these things irl so I can't really chime in too much.
Have you ever had an ACE (adverse childhood experience) test? If I'm remembering correctly paranoia can show up as a symptom, coupled with burnout and stress. Someone else mentioned schizophrenia, which I would guess is the most well-known cause for that level of distress. That sounds like a rough roller coaster to be stuck on though, I hope you can find a better answer and some relief.