What is Persecutory Delusion?

Introduction

Persecutory delusions are a set of delusional conditions in which the affected persons believe they are being persecuted, despite a lack of evidence.

Background

Specifically, they have been defined as containing two central elements:

  • The individual thinks that harm is occurring, or is going to occur.
  • The individual thinks that the perceived persecutor has the intention to cause harm.

According to the DSM-IV-TR, persecutory delusions are the most common form of delusions in paranoid schizophrenia, where the person believes “he or she is being tormented, followed, tricked, spied on, or ridiculed”, or that their food is being poisoned. They are also often seen in schizoaffective disorder and, as recognised by DSM-IV-TR, constitute the cardinal feature of the persecutory subtype of delusional disorder, by far the most common.

Delusions of persecution may also appear in manic and mixed episodes of bipolar disorder, polysubstance abuse, and severe depressive episodes with psychotic features, particularly when associated with bipolar illness.

Prevalence

A 2020 study by Sheridan and colleagues gave figures for lifetime prevalence of perceived stalking by groups, a common form of persecutory delusion, at 0.66% for adult women and 0.17% for adult men.

When the focus is to remedy some injustice by legal action, persecutory delusions are sometimes termed “querulous paranoia”.

In cases where reporters of stalking behaviour have been judged to be making false reports, a majority of them were judged to be delusional.

Treatment

Medications for schizophrenia are often used, especially when positive symptoms are present. Both first-generation antipsychotics and second-generation antipsychotics may be useful. Cognitive behavioural therapy (CBT) has also been used.

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