What Are Persecutory Delusions?

Paranoia, Persecution, and False Beliefs

Individuals with persecutory delusions may struggle to function.

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Persecutory delusions occur when someone believes others are out to harm them despite evidence to the contrary. It’s a type of paranoid thinking that can be part of several different mental illnesses.

Whether an individual thinks his co-workers are sabotaging his work or he believes the government is trying to kill him, persecutory delusions vary in severity. Some individuals with persecutory delusions believe they have to go to great lengths to stay safe—and consequently, they may struggle to function normally.

While everyone may experience some false beliefs about people being "out to get them" sometimes, for people with persecutory delusions, their beliefs take a serious toll on their lives. Their delusions are usually a symptom of a mental illness that requires professional help.

Occurrence

Individuals with mental illness may experience persecutory delusions. They’re most commonly associated with schizophrenia but may also appear in manic episodes of bipolar disorder or with severe depression with psychosis.

They may also signal delusional disorder—an illness that is characterized by at least one month of delusions but no other psychotic symptoms.

It's also common for individuals with dementia to develop delusions. It's estimated that 27 percent of individuals with dementia experience persecutory delusions at one time or another.

Delusional disorders are far less common than other mental illnesses that may involve psychosis. It’s estimated that only .2 percent of the population experiences delusional disorder.

Persecutory delusions are one of the most common types of delusion.

Less common types of delusions include things like the belief that one has a physical defect or medical problem (somatic delusion) or beliefs that someone famous or important is in love with him/her (erotomanic delusion).

Examples

Individuals with persecutory delusions believe that harm is going to occur and that other people intend for them to be harmed. Individuals experiencing persecutory delusions may say things such as:

  • “My neighbors break into my house at night and steal my clothes out of my closet.”
  • “The police are following me because they want to torture me.”
  • “An evil spirit is trying to kill me.”
  • "The government is poisoning me through the drinking water."
  • “The people from up the street are spying on me and they’re going to steal my stuff.”

Individuals reporting persecutory delusions may talk in vague terms by saying things like, “They’re out to get to me,” without being able to articulate who “they” are.

Sometimes, individuals with persecutory delusions report their concerns to the authorities. When nothing happens, they often grow suspicious that the authorities are somehow involved.

They also often grow frustrated when no one will help them. They may be confused about why friends and family members don’t seem to share their concerns or they may become angry that no one will take action.

Causes

Childhood trauma is often linked to psychosis. Some studies have specifically linked childhood neglect (such as being placed in foster care) specifically to paranoia.

There may also be some societal factors that increase paranoia. Movies, books, and pop culture may increase or fuel persecutory delusions.

There may also be some genetic factors at play. Delusional disorder is more common in people who have a family member with delusion disorder or schizophrenia.

Linked Factors

People who experience persecutory delusions tend to have several factors in common in terms of the way they think, feel, and behave.

However, it’s unclear whether these factors cause persecutory delusions or whether persecutory delusions cause these things to occur. Here are six things most individuals with persecutory delusions have in common.

#1. Worry and Rumination

People who experience persecutory delusions are likely to spend a lot of time worrying. Several studies have found that rates of worry in individuals experiencing persecutory delusions are similar to the rates of worry that people with anxiety disorders experience.

Time spent imagining implausible outcomes and catastrophic ideas may go hand-in-hand with persecutory delusions. A 2014 study found that a period of worry often precedes persecutory delusions.

Treating the underlying anxiety has been found to be effective in reducing persecutory delusions.

Individuals who learn skills to reduce their worrying may be able to better manage their symptoms.

#2. Negative Thoughts About One's Self

Individuals who feel different, apart, inferior, and vulnerable are more likely to be paranoid. A 2012 study assessed 301 patients with psychosis three times over the course of a year. The researchers found that negative thoughts about one's self predicted the persistence of persecutory delusions.

Researchers found that individuals with persecutory delusions were overly critical of themselves. Self-compassion has been found to reduce paranoid thoughts.

#3. Interpersonal Sensitivity

A 2010 study found that people with persecutory delusions tend to be high in interpersonal sensitivity, meaning that they feel vulnerable in the presence of others due to fear of criticism or rejection.

Individuals with persecutory delusions are more likely to interpret neutral events as containing hostility from others. Interpersonal sensitivity is also positively associated with higher levels of anxiety and depression.

#4. Abnormal Internal Experiences

Individuals with persecutory delusions sometimes misinterpret external events. However, some research has found that this is only true when the individual is experiencing an unsettled internal state.

Unexplained anxious arousal, feelings of depersonalization, or perceptual disturbances can cause an individual to look for answers from the external environment.

For example, an individual who has experienced a negative life event or poor sleep may feel “off.” Consequently, they may place blame on the environment for why they feel bad. Someone might think, “I feel anxious because someone is spying on me.”

#5. Insomnia

A 2012 study found that having insomnia increased the odds of developing paranoid ideation by threefold. Poor sleep has also been found to be a predictor of the persistence of existing paranoia.

Insomnia is a treatable condition. Helping people improve the quantity and quality of sleep may be key to reducing persecutory delusions.

#6. Irrational Reasoning

A 2014 study found that people who experience persecutory delusions are more likely to jump to conclusions. Individuals who jump to conclusions gather little information before making decisions. Consequently, they can be quite impulsive.

Examples of jumping to conclusions may include assuming a stranger who is holding up his phone is taking a picture of you or thinking that a group of people who are laughing must be laughing at you. 

The study also found that individuals who jumped to conclusions had a poorer working memory of performance, lower IQ, lower intolerance of uncertainty, and lower levels of worry.

Treatment

Treatment varies greatly depending on the type of mental illness someone is experiencing. Sometimes, underlying issues, like insomnia or past trauma, must be addressed. At other times, reducing anxiety can be a helpful intervention. A 2014 study found that cognitive behavioral therapy (CBT) can be an effective intervention. When therapists helped patients reduce worrying and rumination, persecutory delusions decrease.

CBT also led to significant reductions in other psychiatric symptoms and general levels of paranoia.

Treatment may also include medication. Depending on the illness, antipsychotics, antidepressants, or other mood stabilizing medications may be used.

Individuals who are experiencing delusions may struggle with everyday tasks, like going to work, running errands, and paying bills. They may require professional in-home support services to assist them with daily tasks.

However, sometimes people with delusions distrust professionals, which can make treatment even more complicated. Inpatient hospitalizations may be required at times to help an individual gain better control over the symptoms.

How to Support a Loved One

Supporting a person who is experiencing persecutory delusions can be hard. You might have to spend a lot of time listening to the person explain how they’re being persecuted—even though there’s no evidence that it’s true. Or, there may be times when the individual insists that you’re out to get them, too.

While you might be tempted to tell the individual that they're delusional and their thoughts are irrational, your efforts may do more harm than good. A better approach is to focus on how your loved one is feeling. Say things like, “I know this is really stressful for you.” Express concern by saying things like, “I notice you are overwhelmed.”

Get support for yourself as well. A support group could help you learn about the struggles, strategies, and resources other people in similar situations have found helpful. Whether the person experiencing persecutory delusions is your sibling, parent, or child, consider seeking therapy for yourself. A mental health professional can help you gain a better understanding of your loved one’s illness and the strategies that can help you cope.

A trained mental health professional may be able to coach you so you can conduct some reality testing with your loved one if it's appropriate to do so. This involves gathering the facts that support the delusion as well as the facts that refute the delusion. Rather than tell the individual that their beliefs aren't true, reality testing helps the other individual draw their own conclusions based on the evidence.

Family therapy can also help you determine how to best respond to a person who is experiencing delusions. Knowing what to say and how to support someone can be very beneficial to their treatment.

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