Twisty the Clown is back — or is he?

His existence in the miniseries “American Horror Story: Cult,” debuting Tuesday, depends on whether you’re as paranoid as the show’s lead screamer, Ally Mayfair-Richards (Sarah Paulson). John Carroll Lynch’s sadistic creature, who first terrorized audiences three years ago in “AHS: Freak Show,” is just one nightmare in Ally’s world. Along with her life partner (Alison Pill) and their upscale restaurant, she’s threatened by a conniving nanny, a chemical-spewing truck, a half-dead body hanging in her meat locker, Donald Trump’s presidency, a blue-haired sociopath running for city council and a liberal-bashing Billy Eichner in a beekeeper’s outfit.

“This is exhausting,” says her wife after Ally’s umpteenth breakdown. Indeed. Co-creators Ryan Murphy and Brad Falchuk know how to elicit chills, but the pace is so relentless that by the third episode, you may just want to crawl under your blanket and dream warm thoughts.