Is extreme paranoia common with severe bipolar disorder?

Even on meds (lithium, etc). What about the ability not to cope with any stress at all? Anxiety attacks... low self-esteem... inability to enter into dating relationships?

oh... it's not me. I'm trying to decipher the behavior of a friend who is diagnosed bipolar and is currently in a depressive episode...

Bipolar has some psychotic events but they are not necessarily paranoia. She became extremely afraid during a psychotic period. The removal of such is very slow because it is a chemical memory. The depression is from her bad expectations for love and sex. The upper brains had to erase a false belief and the depression chemicals were a waste product. The medication is to dull the effects. She has to avoid false expectations and be calm to recover. The spinal fluid is cleansed very slowly thus releasing the lower brain to operate properly. There is much more to consider about emotional imbalances but this is a beginning. Search my answers for more or message me on Q and A. You should be able to follow this stuff unemotionally.

From my own experience, no, but it might have something to do with the meds their on. They can cause all kinds of things,
Yes, it can be especially if one is having a psychotic episode or are severely manic.
self, MSW
Well like you said your self " Extreme Paranoia... Severe Bipolar Disorder" - They go hand in hand :)
environment could be a factor, also med dosage or just the wrong meds. I take Topomax for my bipolar disorder and it works. different cocktails for different people. I also recommend a good psychologist for counseling. someone your friend can relate to. therapy won't help if you're with the wrong therapist.
Bipolar is usually not the only pathology in a person with this problem. Sometimes, the other problems mask the bipolar disorder. For example, a person might present with the classic symptoms of an autism spectrum disorder (perhaps PDD/NOS) and then somebody makes a breakthrough in treatment and it's realized that the patient is not depressed (classic asperger's) but bipolar. The paranoia could be coming from the PDD, which is based on five related vectors:
1. intelligence. Autism includes mental retardation. Asperger patients can have normal or high intelligence. PDD patients can have genius IQs, which frequently explains why they are so high-functioning: they use the intelligence to mask the other problems.
2. anxiety. Anxiety to beat the band. Anxiety that makes panic disorder look like something you get from taking Mr. Roger's neighborhood seriously.
3. verbal. Autism patients are in a very low percentile with respect to verbal facility. Asperger patients may have a high verbal capacity but use it weirdly. PDD patients can cover the spectrum.
4. social. This is the crux of the autism spectrum disorders. PDD patients have a marked inability to initiate or sustain normal adult conversation. Couple that with inability to read body language and respond to ordinary social clues and you end up with an isolated person who can't climb out of the hole.
5. depression. Even if there were not a predisposition to depression, the preceding four vectors would make an otherwise healthy person, well, sad. But ASDs come with a fierce genetic predisposition to depression, except for a certain subset of the population, who are bipolar instead of depressed.

So...are you trying to decipher this person's behavior? or are you trying to crack open the shell and have a relationship?

If you're inclined to crack open the shell, be aware of a few things. One is that if you're successful, this person will likely latch onto you like a barnacle. It will hurt, hurt real bad, hurt both of you, if it turns out to be more than you can handle. And there will be an emotional tsunami coming your way when you do make the breakthrough, because he probably has never trusted anyone before, and he has an awful lot of sharing to do.

One way to turn the key is to tell him that there is nothing he can do that will make you lose faith in him. You're in for the long haul, and it includes the smelly stuff. He will also need to know that he can tell you anything and everything, and you'll still be there for him.

And he will still drive you crazy, because he's not playing with the same deck as you are. There's no telling if it's a full deck or not, because it's not a standard deck in the first place. It's a scary ride...but it can be a terrific life. Just be prepared for the ride to hit some wicked lows as well as exhilarating highs, and be aware that the genetic heritage for ASD includes several gene that are autosomal dominant, which means if it leads to little ones, they will be very much at risk for the same condition.

Remember that it's treatable. You just have to be aware and seek treatment. And make sure his treatment program is responsive to his symptoms, because conventional treatment often sees Axis I, Axis II, and overlooks the underlying syndrome.