Persecutory delusions are defined by the American Psychological Association (APA) as, “the false conviction that others are threatening or conspiring against one.”1 These beliefs are often fixed, even when discounting information is presented. Persecutory delusions are the most common delusions and there are treatment options that can help.2
What Are Persecutory Delusions?
Persecutory delusions, also called delusions of persecution, have been observed in several mental health disorders. At its lowest, 10 – 15% of people consistently experience persecutory delusions and paranoia.3 Often, these delusions are regarding their safety and the safety of others from any number of influences. Furthermore, these beliefs and fears of harm won’t go away if challenged; they are maintained by any supporting evidence that can be found.3
Persecutory delusions and paranoia are most often connected with schizophrenia, a psychotic disorder, because of media presentation of mental health. However, these delusions can be seen in several mental health issues, including other psychotic disorders (e.g., schizophrenia, schizoaffective disorder, delusional disorder, and brief psychotic disorder), substance use disorders, bipolar disorder, major depressive disorder, post-traumatic stress disorder (PTSD), and several personality disorders.2,4
Persecutory delusions may cause symptoms such as: 3,4
- Stress and worry
- Feeling threatened, even with no supporting evidence
- Fear regarding daily events
- Paranoia from random events or behaviors
- Often reaching out to emergency services (e.g., 9-1-1)
- Frequently seeking and worrying about safety
Examples of Persecutory Delusions
Persecutory delusions can look different for everyone, and there’s not a scale to measure them on. However, persecutory delusions can range from mild to severe depending on the level of impairment in the individual’s life. More severe delusions may influence an individual to act in self-protection.
Some examples of persecutory delusions include:
- “They are reading my mind.”
- “My neighbor is helping the CIA spy on me so they can kidnap and kill me.”
- “My coworker is copying all of my work and communications to try to get me fired.”
- “The helicopters above are from the government and they are following me.”
“Persecutory delusions reflect beliefs about a perceived threat, which can take many forms. Conspiracy is a common theme (e.g., being spied on, “they are out to get me”). The perceived persecutors are often known (e.g., neighbors) or known groups (e.g., the government), but can also be paranormal (e.g., aliens, spirits). The specific nature of the delusion often relates to one’s personal, cultural, or religious context (e.g., FBI in the USA or CSIS in Canada). The threat is most often of being physically harmed (e.g., being poisoned), but also often psychological (e.g., causing confusion or distress),” says Dr. Todd Girard, PhD, Associate Professor of Psychology and Graduate Program Director of Toronto Metropolitan University.
Persecutory delusions look different depending on the individual and whether they have certain mental health disorders. While these delusions can be seen on their own, they can be observed differently depending on the mental illness. Persecutory delusions are most known in relation to psychosis, but they can be seen in other mental health disorders.2,4
Some disorders related to persecutory delusions:
Delusions, in general, are a notable potential symptom of schizophrenia. Persecutory delusions are only one subset of the types of delusions included in this criterion. There is a specific type of schizophrenia, called the “paranoid schizophrenia type,” that often presents as a feeling of being targeted, sabotaged, or monitored that may be influenced by auditory hallucinations.2,4
2. Bipolar Disorder
Although bipolar disorder is primarily a mood disorder, individuals can experience psychotic symptoms during manic episodes. During this time, the individual has heightened energy, may start tasks without completing them, engage in risky behavior, and not sleep for days. This state of being can, in some individuals, lead to experiencing not only hallucinations but also delusions, especially of the persecutory type.2,4
Researchers have found some evidence that there is an increased chance of delusions vs. hallucinations and that delusions may be more likely for those in a manic state than in a depressive state.5
3. Post-traumatic Stress Disorder (PTSD)
PTSD is a trauma and stressor-related disorder that occurs as a result of experiencing, witnessing, learning about, or being repeatedly exposed to trauma-based situations or events. Although it isn’t as common, researchers have noted a potential type of PTSD that includes secondary psychotic features.6 In these cases, the individual may also experience psychotic symptoms, especially persecutory delusions that may be reminiscent of their trauma.
4. Delusional Disorder
Delusional disorders, as the name suggests, are primarily based on the individual’s experience and maintenance of continuous delusions.2 Persecutory delusions can occur in this disorder, even while maintaining an average lifestyle. These individuals may experience delusions more often that misinterpret daily life, yet maintain the ability to function.7
5. Major Depressive Disorder (MDD) With Psychotic Features
MDD, commonly known as depression, is a mood disorder associated with feeling sad, lonely, down, hopeless, worthless, and even suicidal. While it isn’t as common, individuals who experience depression can also experience psychosis, including persecutory delusions. Depressive thinking shares processes with persecutory delusions and may influence the continued experience of paranoia.8
6. Personality Disorders
Personality disorders involve disordered thought processes, feelings, and experiences. Paranoid personality disorder often consists of suspicious, paranoid, and guarded behavior and thinking, even without factual evidence to support it.9
Borderline personality disorder is observed in people who have no central sense of self, often due to trauma, and experience significant impairments in many areas of their lives, like distrusting others and feeling abandoned after a small argument. Especially under stress, individuals with BPD can experience paranoia that further distorts their thinking.10
Treatment Options For Persecutory Delusions
Historically, persecutory delusions have been difficult to treat.13 While research is still being done, common treatments for persecutory delusions include individual and family therapy, antipsychotic medications, and, if needed, emergency hospitalization.11
Here are treatment options for persecutory delusions:
Therapy is individualized to each client based on the reason they’re coming to sessions. It’s important to know that there is generally no “one style fits all.” That being said, increasing research into the cognitive processes behind persecutory delusions shows evidence to support the role of cognitive-type therapies for treatment.11,12 In sync with medications, cognitive behavioral therapy for psychosis (CBTp) has helped treat psychotic symptoms.13
In addition, family therapy can help address and communicate the individual’s mental health issues with their families.7 For more information and help on how to find a therapist, explore a therapist directory.
As mentioned above, the combination of therapy and psychotropic medication has been noted to help treat psychosis.13 Among the types of medication, there are conventional antipsychotics (e.g., Thorazine, Haldol, and Prolixin) and atypical antipsychotics (e.g., Risperdal, Clozaril, Seroquel, and Zyprexa). Cleveland Clinic notes that atypical antipsychotic medications have an observed history of treating symptoms of delusions. Individuals may also receive sleep or antidepressant medications.7
Hospitalization is not a daily treatment for mental health disorders, but the existence of persecutory delusions can be a predictor of emergency hospital admissions.14 In most cases, hospitalization will not be the first choice unless the individual is at risk of hurting themselves or others. This may become an option if the individual is at a severe level of delusion.7
Once the individual is stabilized, the hospital generally works with staff to provide support and maintain medication.
How to Help Someone Experiencing Persecutory Delusions
It can be scary to hear someone you care for talk about their delusions, especially if you don’t know how to respond or help. It’s important to know that you are helping by being there for them and not challenging what they are saying, helping them focus on their feelings, and allowing them a safe space with boundaries.
Here are ways to help someone with persecutory delusions:
1. Don’t argue, dismiss, or challenge the person’s delusion
Although what they are saying to you may not make sense, delusions are fixed beliefs that thrive on any found evidence regardless of contradiction. They may be feeling fearful or scared and doing any of the above will only fix the belief more and may make them feel unsafe with you.15,16,17
2. Listen but don’t validate the reported delusion.
While you may want the individual to feel safe with you, validating the delusion will only further ingrain the belief(s). That being said, it can be helpful to allow them space to talk about their concerns so they can feel safe expressing themselves to you.15,16,17
3. Focus on the feelings behind the delusion.
By focusing on their emotions rather than the delusion, the individual may feel heard, listened to, and safe with you.16,17
4. Keep an open mind and remind them they are safe.
It can be easy to dismiss persecutory delusions internally since you are not validating the delusion, yet keeping an open mind can help you remain empathetic and open to the discussion. By reminding them they are safe, they may feel comfortable talking with you about their general concerns.15,16,17
5. Encourage them to get help in a non-judgmental way.
While you can provide a safe space, you may not have the capability to provide professional mental health support for their concerns. As a potential safe space, encouraging them to get help, and even offering to go with them if you both are comfortable with that, can provide them another perspective of what they are experiencing as well as your care for them.15,17
6. Respect their choice but keep yourself aware of crisis support.
At the end of the day, it is the individual’s right to seek professional help. It is important to know, if possible, if the individual is in danger of harming themselves or others. If so, find a way to easily access a mental health emergency support team or phone line for help.17
7. Take care of yourself and set boundaries.
In the process of caring for others, it is easy to lose track of yourself and your priorities. Set boundaries about what you will and will not do, especially if you feel unsafe in the conversation, and take time for yourself since you cannot pour from an empty cup.17
Delusions of persecution can be difficult to experience or deal with second-hand, but there are ways to heal, cope, and move forward. Remember, you’re not alone, and if you’re struggling, don’t hesitate to reach out to a therapist or mental health professional.