19th Jan 2023
Persecutory delusions are a symptom of psychosis that can occur within the context of several mental health conditions. Someone experiencing persecutory delusions will firmly believe that someone or something is intending to cause them harm, which can cause a great deal of anxiety and concern, and sometimes lead to other behaviors such as aggression.
Persecutory delusions are often experienced within the context of a psychotic episode, which can occur due to several mental health disorders, including schizophrenia, bipolar disorder, or a major depressive episode. Research suggests that 70% of people experiencing a first episode of psychosis have one or more persecutory delusions .
They are believed to be a symptom of severe paranoia, in which the person experiencing these delusions has a false belief that there is a threat to their safety or well-being . This threat may arise from an internal or external experience, such as an emotion or environmental situation, which is then assigned meaning that confirms the delusion .
Persecutory delusions are often completely implausible ideas, such as a delusional belief that the mafia are watching and following you, but for the person experiencing these delusions, they feel real and entirely plausible.
Sometimes, people who experience these types of delusions are unable to understand or accept any alternative ideas that could suggest their delusion may be incorrect. They feel with complete certainty that these ideas are real, thereby maintaining their delusion and causing a persistence of persecutory ideas .
Because of the perceived threat experienced by people with persecutory delusions, they may sometimes act upon these ideas out of fear or protection. This can cause behaviors such as boarding up windows and doors to the house, avoiding any social interactions, or aggressive behaviors toward the source of the perceived threat .
Persecutory delusions can occur in the context of several mental health conditions, including :
Persecutory delusions can be based on any theme or idea relating to a perceived threat to personal safety . Examples of persecutory delusions may include:
Research suggests that there are many causes of persecutory delusions, related to impaired information processing, emotional dysregulation, environment, and perceived vulnerability .
Persecutory delusions are closely related to feelings of anxiety or depression. These conditions have been found to increase the risk of persecutory delusions occurring and are often exacerbated by these delusions, causing an ongoing cycle of persisting symptoms .
Similarly, low self-esteem and negative thoughts about the self are also closely related to the occurrence of persecutory delusions and may arise in the context of a depressive episode .
People with low self-esteem may believe that they deserve criticism or rejection, thus expecting hostility from others. This can cause a feeling of vulnerability, which can lead to an increase in paranoid thoughts, such as believing and expecting harm will occur .
People who are prone to worrying have a higher risk of going on to experience paranoia and persecutory delusions. Similarly, those who experience persecutory delusions have been found to often worry or ruminate on their thoughts. It is also believed that higher levels of worry can cause a longer and more persistent period of persecutory delusions .
There is a great deal of evidence to show that a lack can sleep can cause an episode of psychosis and other serious mental illnesses . In particular, paranoid thinking is closely related to disturbed sleep, such as insomnia, which is regularly experienced prior to the occurrence of persecutory delusions .
It is also likely that paranoia then worsens insomnia, by creating feelings of anxiety and depression, in turn exacerbating the persecutory delusions, creating a persistent cycle of symptoms .
Previous studies show that people who experience delusions are more likely to jump to conclusions and are inflexible in the way they formulate beliefs .
Often, there appears to be an inability to demonstrate analytical reasoning by considering any alternatives to the delusion. Without gathering sufficient information or evidence, a strong belief will be formulated with complete certainty, and the persecutory delusion will be accepted as truth .
Substances alter the way the brain works and can thus cause a change in perception, which may lead to a misinterpretation of internal or external experiences . Many drugs have been found to increase the risk of paranoid ideation, particularly cannabis .
Various studies suggest that trauma is linked to the development of psychotic symptoms and paranoid beliefs, indicating increased risks of persecutory delusions in patients who have experienced bullying, neglect, or abuse in childhood, trauma or assault in adulthood, or have a diagnosis of post-traumatic stress disorder (PTSD) .
Currently, there is not a clear understanding of the specific relationship between neurobiology and persecutory delusions, but research does suggest a link between dopamine levels and the formation of delusions .
There is evidence to indicate that altered levels of dopamine can cause schizophrenia and other psychotic symptoms, further indicating that it may play a part in the development of persecutory delusions .
As is the case in many mental disorders, genetics can increase the risk of developing paranoia and delusional ideation. Research suggests that a family history of psychosis increases the risk of psychotic disorders and symptoms in children, particularly paranoid thinking .
Depending on the context in which the persecutory delusions are experienced, a doctor may prescribe a medication to help alleviate symptoms .
Antipsychotic medications are often used in the treatment of schizophrenia or episodes of psychosis to treat key symptoms such as hallucinations and delusions.
Mood stabilizers are used to treat certain psychiatric disorders such as bipolar disorder. These medications help reduce extreme mood changes, so they can aid in reducing the occurrence of persecutory delusions that occur during manic or depressive episodes.
Antidepressants may be prescribed to treat symptoms of depression, so they can aid in reducing negative feelings that may contribute to the occurrence of persecutory delusions.
Benzodiazepines may be prescribed to help alleviate symptoms of anxiety or to aid in improving sleep quality.
Several types of therapy are available to help in managing mental health conditions and the appropriate therapy may differ, depending on the context in which the persecutory delusions are experienced and the occurrence of any other co-existing symptoms.
Cognitive behavioral therapy (CBT) may be extremely useful for someone who has a propensity to worry or experience negative thoughts about themselves . CBT can help to alter negative thoughts and associated behaviors, teach positive coping strategies, and improve sleep, all of which can help to reduce the occurrence of persecutory delusions .
Other types of cognitive therapy can be useful in reducing persecutory delusions, such as programs that focus on specific causes of delusions and paranoid thinking, including sleep disturbances, worrying, low self-confidence, feeling unsafe, and impaired reasoning .
Psychotherapy can help in processing traumatic experiences, reducing anxiety, and gaining a better understanding of the underlying causes of persecutory delusions, which may then aid in reducing persistent symptoms .
If you are trying to help or support someone who experiences persecutory delusions, you can :