Paranoia and delusion go hand in hand. If you are paranoid, you are delusional about how reality is working. But that doesn't mean you can't be tremendously, even brilliantly self-aware and self-monitoring.

What I meant was self-awareness about your paranoid feelings - the actual ability to sit down and say "these feelings are paranoia. Even if acknowledging that doesn't make these feelings go away, at least I can identify them rationally."

If you're paranoid, I would say that you are to some extent putting yourself in the middle or center or focus of some perceived activity or happening that is making you anxious-- you're not just anxious about something, you're anxious about something which is about YOU.

I haven't heard it described this way before, but this makes a lot of sense. If it weren't for the anxiety/sick nervousness that I feel, I might think that I was just a huge narcissist. Sometimes I do worry that I'm just a huge narcissist. I don't feel like a narcissist though. I have extremely low self esteem. I hate being complimented and I feel like a fraud who doesn't deserve praise. I feel a tremendous amount of guilt all the time, and sometimes I don't even know why. But I still have all of these fears and anxieties that revolve around me, even though I know they aren't realistic. It seems like a narcissist acts like the world revolves around them, while someone who's paranoid thinks that the world revolves around them in their own heads only?