Persecutory Delusions: Definition, Examples, & Treatments

Paranoia vs. persecutory delusions at a glance

What Are Persecutory Delusions?

Persecutory delusions, also called delusions of persecution, have been observed in several mental health disorders. Paranoid thoughts are common: around 10 to 15% of people in the general population experience them regularly.³ Full persecutory delusions, the fixed and severe end of that spectrum, are much rarer, affecting an estimated 1 to 3% of people, and they are the most common type of delusion when they do occur. 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

• Anxiety
• 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

What do persecutory delusions look like? Examples

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.

Which mental health conditions cause persecutory delusions?

Persecutory delusions appear across several mental health conditions, most often the psychotic disorders, but they are not limited to schizophrenia. They can occur on their own and look different depending on the underlying illness.^2,4

Some disorders related to persecutory delusions:

1. Schizophrenia

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. Persecutory delusions are among the most recognized symptoms of schizophrenia. Older editions of the DSM listed a formal “paranoid schizophrenia” subtype, but the DSM-5 (2013) and DSM-5-TR (2022) removed all schizophrenia subtypes because they were unreliable and did not predict treatment response. Today clinicians describe schizophrenia by its current symptoms rather than a fixed subtype, though the paranoid pattern, a feeling of being targeted, sabotaged, or monitored and sometimes shaped by auditory hallucinations, is still described informally.^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

How are persecutory delusions treated?

Persecutory delusions are treated with a combination of antipsychotic medication and cognitive therapy, and outcomes have improved sharply since the 2021 arrival of the Feeling Safe programme.¹³ Common treatments include individual and family therapy, antipsychotic medications, and, if needed, emergency hospitalization.¹¹

Here are treatment options for persecutory delusions:

1. Therapy

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.

2. Medication

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

3. Hospitalization

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 can you help someone with persecutory delusions?

The most helpful response to someone with a persecutory delusion is to focus on their feelings, avoid arguing with or validating the belief, and gently encourage professional support. It can be scary to hear someone you care for talk about their delusions, and simply being there for them, without challenging what they say, gives them a safe space with clear 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

What is the Feeling Safe programme, and does it work for persecutory delusions?

The Feeling Safe programme is a cognitive therapy developed by Professor Daniel Freeman and colleagues, including Philippa Garety, at the University of Oxford, and it has produced the largest treatment effects yet reported for persistent persecutory delusions. In a 2021 randomized controlled trial of 130 patients published in The Lancet Psychiatry, roughly half of the people whose delusions had not responded to antipsychotic medication recovered, and about another quarter saw meaningful improvement. Rather than confronting the belief head on, the therapy helps a person build new memories of feeling safe by gradually testing feared situations, while treating the factors that keep persecutory fears alive, such as worry, poor sleep, low self-confidence, and reasoning styles that jump to threatening conclusions. It builds on the same cognitive model behind NICE-recommended cognitive behavioral therapy for psychosis.

The approach is now being adapted for wider access. In 2025, Freeman’s Oxford team reported in Psychological Medicine on Feeling Safer, a six-month guided online version delivered through a web app with less clinician contact time. In an initial study of 14 patients, it produced very large reductions in persecutory delusions, a mean drop of 7.1 points on the PSYRATS delusions scale, comparable to the face-to-face therapy, and a larger randomized trial is underway. The takeaway for readers is that persecutory delusions, long considered hard to treat, now have a psychological treatment with strong and replicated evidence behind it.

Final Thoughts

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.