A persecutory delusion is a common type of

delusion A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some o ...

al condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an individual or a group of people. Persecution delusions are very diverse in terms of content and vary from the possible, albeit improbable, to the completely bizarre. The delusion can be found in a multitude of disorders being more usual in

psychotic disorders Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior t ...

, such as

schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...

schizoaffective disorder Schizoaffective disorder (SZA, SZD or SAD) is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis is made when the person has symptoms of both schizophrenia (usually psychosis) and a mood disorder: ...

and

delusional disorder Delusional disorder is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect.American Psychiatric Association. (2013). ''Diagnosti ...

. Persecutory delusion is at the more severe side of the

paranoia Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concer ...

spectrum and it often induces anxiety, depression and sleep disturbance, patients with this delusion have also been found to have a low self-esteem. Persecutory delusions have a high percentage to be acted upon, such as not leaving the house due to fear or acting violently. Persecutory type is a common type of delusion and is more prevalent in males.

Theory of mind In psychology, theory of mind refers to the capacity to understand other people by ascribing mental states to them (that is, surmising what is happening in their mind). This includes the knowledge that others' mental states may be different fro ...

deficits are present in people with this delusion. As with others disorders it is thought that persecutory delusions is a combination of genetic and environment factors. This type of delusion is difficult to treat. A couple of methods are used, therapy, specifically

cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...

, medications, namely

first First or 1st is the ordinal form of the number one (#1). First or 1st may also refer to: *World record, specifically the first instance of a particular achievement Arts and media Music * 1$T, American rapper, singer-songwriter, DJ, and rec ...

and

second The second (symbol: s) is the unit of time in the International System of Units (SI), historically defined as of a day – this factor derived from the division of the day first into 24 hours, then to 60 minutes and finally to 60 seconds ...

generation

antipsychotic Antipsychotics, also known as neuroleptics, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but ...

s and

hospitalization A hospital is a health care institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...

in severe cases.

Characteristics

Persecutory delusions are persistent, distressing beliefs that one is or will be harmed, they continue even in the face of evidence. This condition is mainly seen on

but can also be found on manic episodes of

bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...

psychotic depression Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms.Hales E and Yudofsky JA, eds, The American Psychiatric Press Textbook of Psychiatry, Washington, DC: American Psychia ...

, and

personality disorder Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...

. Alongside

delusional jealousy Pathological jealousy, also known as morbid jealousy, Othello syndrome or delusional jealousy, is a psychological disorder in which a person is preoccupied with the thought that their spouse or sexual partner is being unfaithful without having a ...

, persecutory delusions are the most common types of delusion in males and are a frequent symptom of psychosis. The delusions are often paired with anxiety, depression, and disturbed sleep. People with persecutory delusions have an increased difficulty in attributing mental states to oneself in addition to others and oftentimes misread others' intentions as a result. The degree of functionality in people who suffer from persecutory delusions is considered normal, though people who present with this form of delusion are often in the bottom 2% in terms of psychological well-being. A correlation has also been found between the delta of imagined power the persecutor has and the control the sufferer has over the delusion. Those with a higher delta between the two factors have a higher rate of depression and anxiety. In urban environments, going outside leads people with this delusion to have a major increases in levels of paranoia, anxiety, depression and lower self-esteem. People with this delusion often live a more inactive life and are at a higher risk of developing high blood pressure, diabetes and heart disease, having a lifespan 14.5 years less than the average in their area as a result. Those with persecutory delusions have the highest risk of acting upon those thoughts, such as by not leaving the house out of the fear of being harmed, or acting violently due to a perceived threat. Safety behaviors are also frequently found, individuals who feel threatened perform actions in order to avert their feared delusion from occurring. Avoidance is commonly observed, people with this delusion might avoid going to the mall or the metro where they feared harm. Individuals also try to lessen the threat, such as only leaving the house with a trusted person, reduce their visibility by taking alternative routes, increase their vigilance by looking up and down the street, or acted as if they would resist attack by being prepared to strike out.

Causes

A study assessing schizophrenia patients with persecutory delusions found remarkably higher levels of childhood emotional abuse within those people but found no differences of trauma,

physical abuse Physical abuse is any intentional act causing injury or trauma to another person or animal by way of bodily contact. In most cases, children are the victims of physical abuse, but adults can also be victims, as in cases of domestic violence or wo ...

, physical neglect and

sexual abuse Sexual abuse or sex abuse, also referred to as molestation, is abusive sexual behavior by one person upon another. It is often perpetrated using force or by taking advantage of another. Molestation often refers to an instance of sexual assa ...

. Biological elements, such as chemical imbalances in the brain and alcohol and drug use are a contributing factor to persecutory delusions, genetic elements are also thought to influence, family members with schizophrenia and delusional disorder are at a higher risk of developing persecutory delusion.

Treatment

Persecutory delusions has been difficult to treat and is therapy resistant. Medications for

are often used, especially when positive symptoms are present. Both first-generation antipsychotics and

second-generation antipsychotics The atypical antipsychotics (AAP), also known as second generation antipsychotics (SGAs) and serotonin–dopamine antagonists (SDAs), are a group of antipsychotic drugs (antipsychotic drugs in general are also known as major tranquilizers and ne ...

may be useful. Since these delusions are often accompanied with worry, using

to tackle this thought has shown to reduce the frequency of the delusions itself, improvement of well-being and less rumination. Vitamin B12 supplements have shown positive results in treating patients with persecutory delusion. Virtual reality cognitive therapy has a way to treat persecutory delusions, has shown a reduction in paranoid thinking and distress. Virtual reality permits patients to be immersed in world that replicates real life but with a decreased amount of fear, patients are then proposed to fully explore the environment without engaging in safety behaviors, thus challenging their perceived threat has unfounded.

Diagnosis

The ''

Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

'' (DSM-5) enumerates seven types of delusions and the

International Classification of Diseases The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...

(ICD-11) defines fifteen types of delusions both including persecutory delusion. They state that it's a common type of delusion that includes the belief that the person or someone close to the person is being maliciously treated, this encompasses thoughts that oneself has been drugged, spied upon, harmed, mocked, cheated, conspired against, persecuted, harassed and so on and may procure justice by making reports, taking action or responding violently. Two psychologist,

Daniel Freeman Daniel Freeman (April 26, 1826 – December 30, 1908) was an American homesteader and Civil War veteran. He was recognized as the first person to file a claim under the Homestead Act of 1862. Freeman was also the plaintiff in a landmark separ ...

and

Philippa Garety Philippa Garety is Professor of Clinical Psychology and Clinical Director of the Psychosis Clinical Academic Group (CAG), South London and Maudsley NHS Foundation Trust. Garety specializes in the psychological understanding and treatment of psyc ...

have advanced a diagnostic table for persecutory delusion divided in two criteria that must be met, the individual believes that harm is going to occur to oneself at the present or future and that the harm is made by a persecutor. There's also points of clarification, the delusion has to cause distress to the individual, only harm to someone close to the person doesn't count as a persecutory delusion, the individual must believe that the persecutor will attempt to harm him or her and

delusions of reference Ideas of reference and delusions of reference describe the phenomenon of an individual experiencing innocuous events or mere coincidences and believing they have strong personal significance. It is "the notion that everything one perceives in the ...

do not count within the category of persecutory beliefs.

Legal aspects

When the focus is to remedy some injustice by legal action, persecutory delusions are sometimes called "

querulous paranoia In the legal profession and courts, a querulant (from the Latin ''querulus'' - "complaining") is a person who obsessively feels wronged, particularly about minor causes of action. In particular the term is used for those who repeatedly petition a ...

". Querulous paranoia is found more frequently on males between 40 and 60 years old. In cases where reporters of

stalking Stalking is unwanted and/or repeated surveillance by an individual or group toward another person. Stalking behaviors are interrelated to harassment and intimidation and may include following the victim in person or monitoring them. The ter ...

behavior have been judged to be making false reports, a majority of them were judged to be delusional.

References