Persecutory Delusions

Persecutory delusions are persistent, troubling, false beliefs that one is about to be harmed or mistreated by others in some way. These beliefs occur in some people with delusional disorder, a rare mental illness, and cause significant distress, including anxiety, depression, and fear.

Most people with delusional disorder function normally, but the fear of being harmed can be so great as to cause an individual to become isolated or even suicidal.

Delusional disorder is a mental illness that is categorized as being a psychotic disorder and on the spectrum with schizophrenia and schizoaffective disorder. Psychotic illnesses are characterized by some type of break with reality, and in the case of delusional disorder this means holding strong beliefs that, despite evidence they are false, persist. This condition was once called paranoid disorder, and those who live with it struggle to distinguish between what is real and what isn’t.

Although someone with delusions may become obsessed with their false beliefs, which in turn can lead to impairment, most people with this condition function normally and don’t act in ways that seem overly bizarre. This is because, unlike those delusions caused by other conditions, those caused by delusional disorder are things that really could happen. Delusions are not uncommon but are often symptoms of another mental illness, like schizophrenia. Delusional disorder is rare.

Someone with a delusional disorder may have one or more types of delusions, and these include persecutory delusions. When someone suffers from false beliefs that are persecutory, they believe they are being mistreated or that someone they love or care about is being or will be mistreated. The delusions are non-bizarre, meaning although they are false they could really happen. Some examples of persecutory delusions include:

• Being spied on by someone who means harm or who is part of a conspiracy
• Being followed or tracked
• Being lied to or given misinformation
• Being the victim of a plot
• That harm is going to occur imminently

Generally, any kind of false belief that involves being harmed, being mistreated, or being plotted against are counted as persecutory. Individuals may have different, specific details in their delusions.

Many people with delusional disorder function normally, but there are complications and additional symptoms related to the delusions that can cause distress and may lead to dysfunction. For instance, having persecutory delusions can trigger anxiety, depression, and insomnia. Studies have found that the psychological well-being of people who experience persecutory delusions to be in the lowest two percent of the general population.

The fear of being harmed by someone can lead to impairment if the condition is not treated. Many people can function well for a long time, but obsessing over the delusions and the fear and anxiety they cause can ultimately lead to seclusion. An individual with these delusions may become too frightened to leave the house or go to work. In some cases, persecutory delusions may lead to suicidal behaviors and hospitalization.

Delusional disorder with any type of delusion is very rare, so studies into what may cause it are limited. As with other mental illnesses it is thought that genetics, environment, and brain abnormalities all play a role in making someone more susceptible to experiencing persecutory delusions.

Stressful life experiences and trauma may be important triggers for people who develop delusional disorder. One study found that in people diagnosed with schizophrenia, those who experienced persecutory delusions were much more likely to have been victims of emotional abuse or neglect as children. Other studies have associated low self-esteem and negative thoughts about self with a greater risk of delusions that are persecutory in nature.

Delusional disorder with persecutory delusions is diagnosed when the false beliefs persist for a month or longer and cannot be better explained as a symptom of another mental illness, like schizophrenia. The main type of treatment for delusions is therapy. Antipsychotic medications may help as a supplement to therapy, but when used alone these drugs are not very effective in managing delusions.

Treating someone with persecutory delusions can be challenging, and this illness is chronic. Those who commit to ongoing therapy, learning to manage delusions, improve self-esteem and self-efficacy, and develop coping mechanisms, typically experience periods of remission, but the delusions may return. Family education and positive support is also important in successful treatment of the delusions.