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Persecutory Delirium: Causes, Symptoms and Treatment

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Surely, at some point in our lives, we have had the feeling that someone is looking at us or even that they are following us down the street. When this feeling becomes a firm and permanent belief, it is called a delusion of persecution..

In the delusion of persecution or persecutory delusion, the person lives with a series of ideas and beliefs irrational in which he believes that he is being persecuted, spied on or that different people or organizations are going to for him; almost always with the intention of attacking or causing some damage, both physical and psychological.

This condition is experienced with great anxiety and can involve all the thoughts or aspects of the patient's daily life, conditioning her relationship with any other person.

What is persecutory delusion? Definition and characteristics

According to the latest edition of the DSM-V diagnostic manual, a delusion would consist of “a false belief based on an incorrect inference regarding reality which is firmly held, despite the fact that almost everyone believes and despite what constitutes incontrovertible and obvious proof or evidence of what is contrary".

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In other words, a delusion is a completely irrational belief, without any demonstrable basis. Belief that the patient maintains despite showing them that they are false. After clarifying this, we can explain the delusion of persecution as the false belief of being followed, harassed or harassed by one or more people.

This can suppose a very serious illness for the patient, since the general thought of this is inserted in an irrational thought; making all the mental processes of the patient revolve around her delusion.

Symptoms and signs

The main characteristic of delusions of persecution is the presence of alterations in the content of thought, mainly due to distorted or false interpretations of the context or situation around you.

A person who manifests delusions of persecution may think that his neighbors, or anyone with whom he crosses a glance, is watching him.

The inferences made by someone with this disorder can be strident and random, so that no specific stimulus is needed for the person to associate it directly with their delirium of her. Still, despite the characteristics of this distortion of thought, there are common thoughts of the delusion of persecution.

1. Be followed by someone

It is the most common of all ideations and consists of the belief that one or more people are continually following you. In addition, it is common for the person to associate this stalking with an intention to cause him some harm.

For example, the person who is chasing you does so with the intention of killing you.

2. Being spied on

Often times patients with delusions of persecution think that in addition to being followed by someone, that someone does so with the intention of spying on them for some reason. Hence, many of the people who suffer from them try to hide continuously, causing a situation of extreme insecurity and anxiety.

3. Be tormented

Another very frequent characteristic of delusions of persecution is that ideas of constant torment or harm arise. These people may believe that those who persecute them are making their life miserable through small acts or situations.

In this case, the subject may think that every time he does not find something it is because someone is hiding it from him.

4. To be ridiculed

Finally, one of the thoughts that are included in the delusions of persecution is that whoever follows him does so with the intention of ridiculing or making fun of him.

Frequent causes

Despite everything mentioned above, the manifestation of delusions does not constitute a pathology per se itself, but arises as a symptom of some of the psychological alterations that are exposed to continuation.

According to DSM-IV-TR, delusions of persecution are the most common form of delusions of paranoid schizophrenia; but they can also appear in the schizoaffective disorderas it is the most common feature of the persecutory subtype of delusional disorder.

These delusions can also appear in manic and mixed episodes of bipolar disorder. and in severe depressive episodes with psychotic properties.

Other pathologies in which we can find them are:

  • Dementia
  • Mild psychotic disorder
  • Schizophreniform disorder
  • Delirium
  • Psychotic disorder due to medical illness
  • Substance-induced psychotic disorder: in this case, the delirium may appear acutely while the effects of the drug last or persist despite the fact that they have subsided.

Types of delusions of persecution

There is no single type of persecution delusion, but These are divided into two types according to whether the damage that the person thinks they will be inflicted is physical or psychological.

When the damage occurs physically, the subject feels besieged by people who want to cause some physical damage. Damages such as beating, run over, or even killed.

However, if it occurs psychically, the patient believes that the aggressions occur on a moral level. Trying to discredit, make fun of him or have fun at his expense.


Since these beliefs and ideations are often highly bizarre and unbelievable, they are relatively easy to identify and diagnose as delusions.

Even so, for a correct diagnosis of it is necessary to take into account a series of previous factors.

1. Differentiate between delusions and overrated ideas

It is absolutely essential to carry out a differential diagnosis between a delusional idea and a habitual belief of the patient but one that is overrated. For instance, this can get complicated when dealing with beliefs and ideas based on religion.

Furthermore, when delusions of persecution are diagnosed, we must make sure that both the irrationality and the degree of conviction are absolute; since this is an unequivocal sign of delirium.

2. Detect changes or fluctuations in mood

If delusional beliefs appear only during episodes of manic, major depression, or mixed, we are probably dealing with a mood disorder with psychotic symptoms.

Nevertheless, if it manifests without any type of mood alteration, it should be diagnosed as schizoaffective or schizophreniform disorder.

3. Investigate the causes of delirium

Since persecutory delirium is a symptom within a broader pathology, it is necessary to evaluate the patient's condition and symptoms. With the intention of diagnosing any of the related pathologies mentioned above.

4. Rule out medical pathology or substance use as the cause.

As mentioned in the section on the etiology of persecution delusions, these can sometimes be consequence of the consumption of drugs or psychoactive substances, or may even be the product of certain diseases organic.

So a medical examination or an evaluation of the substances consumed by the patient is essential to place these delusions in the correct diagnosis.


Treating delusions of persecution as soon as possible, in order to stabilize the patient and that the delusions remit; even going to hospital if necessary.

Thus, pharmacotherapy is constituted as an essential initial phase for the improvement of the person, being antipsychotic medications, such as risperidone or haloperidol, the main drugs for these symptoms.

In addition, when persecutory delirium is accompanied by high levels of anxiety or agitation, the administration of anxiolytic drugs such as benzodiazepines.

However, when delusional beliefs are caused by substance use or a disease It is necessary to treat these conditions as well, since they are the initial cause of the disorder.

Once the patient has stabilized, psychological treatment is added, both at an individual and family level **. The most effective therapies to combat delusions have turned out to be cognitive-behavioral **; as well as social skills training and rehabilitation measures.
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