"Mercury with Pluto is a big one."
Check.
"Pluto in hard aspect to Sun"
Check. (Sun/Merc. conjunct square Pluto)
"hard Saturn-Neptune aspects"
Check. (opposition, with Neptune conjunct Jupiter)
"8th house moon", "8th house stellium"
Check.
I'm going now, I have to go completely erase my identity :).
No, seriously, it's really a wonder I never worried and scared myself into a rubber room. I actually think Saturn/Neptune may be the worst of these just in terms of CREATIVE paranoia. Maybe on its own it might not be as bad but with the other stuff present those worries are dark. I have had to work very hard on this particular thing and still do.
This is why I really treasure my softer aspects, incidentally. I could easily have turned into a paranoid nut if my chart were just a smidge different.
yup check for saturn square neptune also
also i think we the paranoid 
end up doing ourselves in, somehow we end up bringing or attracting the exact thing we fear
or are paranoid about.
" also i think we the paranoid end up doing ourselves in"
Yup.
And it goes like this....
Ray Davies has an exact Saturn/Neptune square btw. It's an ugly one because Sun, Venus (these two are out of sign), and Moon are tied up in it too.
LOL @ satori in this thread. 
“Just because you're paranoid doesn't mean they aren't after you”
EverythingCoconut said
I have Neptune square Mercury in my chart, and usually I'm alright but sometimes after smoking I used to get pretty badly paranoid and think my friends were talking about me and stuff like that when I wasn't in the room, confused the hell out of me for a couple years/scared me a lil but I'm a lot better with it now and can usually just dismiss it pretty easily.The actual effects of this aspect manifest themselves in a constant struggle of confusion between your Neptune intuition, which takes the negative (or positive) energies of your environment and expresses them as personal and directly meaningful to you. In turn your mercurial logical mind argues against these feelings and tries to tell you that they're irrational and that everything's fine. Neurosis to the max, kind of a horrible situation to be in tbh and the worry used to drain all my energy.
It's hard because with paranoia there's like never a sure way to know if it's right or not, (maybe I misheard them etc) and since Neptune's in my first house these feelings are very strong and so is the confusion they create.
Well said, it's exactly how it is for me with this aspect too... never sure where my paranoia ends and where my intuition begins. I have to say that most of the time, it's been justified.
Can I ask what house this squre is in in your chart?
Thinking about this topic again... Fear is Saturn related, Obsessive-Compulsive is Pluto, and Delusion is Neptune, I think a mix of the 3 would be a pretty potent concontion.