They have a self-consciousness to the point of grandiosity
The kind of self-consciousness that we’re talking about here is the negative one: the one that doesn’t let you look beyond yourself. It’s the one that constantly focuses on your flaws, problems, and safety, up to the point of obsession. People who suffer from social anxiety, for instance, are extremely self-conscious.
They are way too aware of themselves. They also overthink how they look and sound, and they think that everyone is focused on them. They always exaggerate their flaws, and as a result, they simply can’t relax in any social context. One of the best options is to shift their focus outward.
Paranoia after 60 usually works like this: they are constantly focusing on themselves, and if there’s something you can do to stop that, they will stop being self-conscious. Paranoid people have a very similar type of self-consciousness. They usually forget that the world doesn’t really revolve around them and that people don’t care as much as they think.