What Are Persecutory Delusions?

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 people with this condition think co-workers are sabotaging their work or they believe the government is trying to kill them, persecutory delusions vary in severity. Some people with persecutory delusions believe they have to go to great lengths to stay safe—and consequently, they may struggle to function in everyday life.

While everyone may experience some false beliefs about people being "out to get them" at times, 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.

Types of Persecutory Delusions

People with mental illness may experience persecutory delusions. These delusions are most commonly associated with schizophrenia, but they also may appear during manic episodes of bipolar disorder or with severe depression with psychosis.

Conditions that can cause persecutory delusions include:

Schizophrenia

A condition that involves distortions in thinking and perception. People with this condition often experience hallucinations and delusions, including persecutory delusions.

Bipolar Disorder

A condition that causes extreme shifts in mood, activity levels, and behavior. A person may shift rapidly between periods of excess energy and grandiose mood (mania) to periods of very low mood (depression). Persecutory delusions most often occur during manic episodes.

Major Depression with Psychotic Features

Sometimes known as psychotic depression, this condition involves having both depressive symptoms and episodes of psychosis.

Schizoaffective Disorder

Schizoaffective disorder is a condition that involves symptoms of schizophrenia along with mood symptoms such as mania or depression.

Post-Traumatic Stress Disorder (PTSD)

A condition that can occur after a person has experienced a traumatic event, which can lead to symptoms including flashbacks, nightmares, hallucinations, and delusions.

Dementia

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

Delusional Disorder

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

Delusional disorders are far less common than other mental illnesses that may involve psychosis. It's estimated that only 0.2% of the population experiences delusional disorder.

Less common types of delusions include:

• Somatic delusions: The fixed false belief that one has a physical defect or medical problem
• Erotomanic delusions: The conviction that someone is in love with them

Signs of Persecutory Delusions

People with persecutory delusions believe that harm is going to occur and that other people intend for them to be harmed.

People 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 up the street are spying on me and are going to steal my stuff."
  

Sometimes, people with persecutory delusions report their concerns to the authorities. When nothing happens, they often grow suspicious that the authorities are somehow involved. They also 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 of Persecutory Delusions

There are several causes linked to psychosis, including childhood trauma as well as societal, genetic, and biological factors.

• Biological factors: Brain abnormalities or an imbalance of chemicals in the brain as well as alcohol and drug use can contribute to persecutory delusions.
• Childhood trauma: Some studies have specifically linked childhood trauma to paranoia.
• Genetic factors: Delusional disorders are more common in people who have a family member with a delusion disorder or schizophrenia.
• Societal factors: Movies, books, pop culture, and other societal factors may increase or fuel persecutory delusions.

Factors Associated With Persecutory Delusions

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 people with persecutory delusions have in common.

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 people 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.

Negative Thoughts

People 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.

People with persecutory delusions also tend to be overly critical of themselves. Researchers suggest that cognitive biases, including negative thinking, play a role in the onset and maintenance of persecutory delusions.

Interpersonal Sensitivity

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.

People with persecutory delusions also 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.

Abnormal Internal Experiences

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

For example, a person 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."

Insomnia

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

Irrational Reasoning

One study found that people who experience persecutory delusions are more likely to jump to conclusions. People who jump to conclusions gather little information before making decisions and can be quite impulsive.

For example, people who jump to conclusions may assume a stranger who is holding up a phone is taking a picture of them. They also may believe that a group of people who are laughing must be laughing at them. 

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

Diagnosing Persecutory Delusions

Persecutory delusions are a symptom of some types of mental health conditions. To treat them effectively, it is important to first determine what might be causing them 

To make a diagnosis, a doctor will perform a physical exam, take a medical history, and perform a psychiatric assessment. They may also screen for substances or order brain imaging tests to better understand what might be causing these symptoms.

Once they understand a person's current symptoms, history, and health status, they can use the diagnostic criteria in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR) to help diagnose their condition.

Treatment for Persecutory Delusions

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.

Therapy

A 2014 study found that cognitive behavioral therapy (CBT) can be an effective intervention. When therapists helped patients reduce worry and rumination, persecutory delusions decreased. CBT also led to significant reductions in other psychiatric symptoms and general levels of paranoia.

The results of one clinical trial found that a specific treatment called the Feeling Safe program was an effective intervention for people experiencing persecutory delusions. The program focuses on helping people develop new memories focused on safety. Results suggest that half of people participating in the program significantly improve their symptoms.

Medication

Depending on the illness, antipsychotics, antidepressants, or other mood-stabilizing medications may be used. The specific medications that may be effective depend on an individual's specific diagnosis. For example, research suggests that antipsychotics can be effective for the treatment of delusional disorders.

Support Services

People who are experiencing delusions also 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.

Inpatient Hospitalization

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

Coping With Persecutory Delusions

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

Have Empathy

While you might be tempted to tell the person that they're delusional and their thoughts are irrational, your efforts may do more harm than good.

Seek Support for Yourself

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 partner, sibling, parent, or child, consider seeking therapy for yourself also. 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.

If appropriate, they may even be able to coach you on conducting some reality testing with your loved one. This practice involves gathering facts that support the delusion as well as facts that refute the delusion.

Consider Family Therapy

Family therapy also can 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.

Keep in Mind

Watching someone you love experience persecutory delusions can be overwhelming at times. But with intervention and support, you can help your loved one find ways to cope.