Persecution delirium: causes, symptoms, diagnosis and treatment

Certainly at one point in our life we ​​had the feeling that someone was looking at us or even following us on the street. When this feeling becomes a firm and permanent belief, it is called an illusion of persecution..

In the illusion of persecution or delusion of persecution, the person coexists with a series of irrational ideas and beliefs in which they believe they are being persecuted, spied on or that different people or organizations are looking for them; almost always with the intention of assaulting or causing harm, both physical and psychological.

This condition is experienced with great anxiety and can involve any thought or aspect of the patient’s daily life, conditioning their relationship with someone else.

What is the delusional persecution? Definition and characteristics

According to the latest edition of the DSM-V Diagnostic Manual, an illusion would consist of “a false belief based on an incorrect inference regarding external reality, which is firmly held, even if almost everyone believes and although it is a test or incontestable and clear evidence to the contrary “.

In other words, an illusion is a completely irrational belief without a demonstrable basis. Belief that the patient holds well that he proves to him that they are false. Having clarified this, we can explain the illusion of persecution as the false belief of being followed, harassed, or harassed by one or more people.

This can be very serious for the patient, because the general thought of the patient is embedded in an irrational thought; making all the mental processes of the patient revolve around his delirium.

Symptoms and signs

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

A person who displays illusions of persecution may think that his neighbors, or anyone with whom he meets a gaze, is watching him.

The inferences made by a person with this disorder can be shrill and random, so that no specific stimulus is needed for the person to directly associate it with their delirium. However, despite the characteristics of this distortion of thought, there are common thoughts peculiar to the illusion of persecution.

1. Be followed by someone

It is the most common of all ideas and consists of the belief that one or more people follow it all the time. In addition, it is common for the person to associate this harassment with an intention to cause harm.

For example, the person who pursues him does so with the intention of killing him.

2. Be spied on

Patients who have delusions of persecution often think that in addition to being followed by someone, that someone is doing so with the intention of spying on them for some reason. Therefore, many people who suffer from it try to hide permanently, which creates a very extreme situation of insecurity and anxiety.

3. Being tormented

Another very common feature of the illusion of persecution is that ideas of continued torment or harm arise. These people may believe that those who persecute them make their life impossible through small acts or situations.

In this case, the subject may think that each time they cannot find something, it is because someone is hiding it.

4. Be ridiculed

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

common causes

Despite all of the above, the manifestation of delusions does not constitute a pathology in itself, but appears as a symptom of some of the psychological alterations discussed below.

According to the DSM-IV-TR, delusions of persecution are the most common form of delusions of paranoid schizophrenia; but they can also appear in schizoaffective disorder, as 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.

The other pathologies in which they can be found are:

  • dementia
  • Mild psychotic disorder
  • schizophreniform disorder
  • Delirium
  • Psychotic disorder due to medical illness
  • Substance-Induced Psychotic Disorder: In this case, delirium may appear acutely while the effects of the drug last or persist even though they have subsided.

Types of persecution delusions

There is not one type of illusion of persecution, but these are divided into two types depending on whether the damage that the person thinks is going to be inflicted is physical or mental.

When the damage occurs physically, the subject feels harassed by people who want to cause physical damage. Damage such as beating, crushing or even killing it.

However, if they are presented psychically, the patient considers that the aggressions follow one another on the moral level. Trying to discredit him, make fun of him, or have fun at his expense.


Since these beliefs and ideas are usually extremely extravagant and incredible, it is relatively easy to identify and diagnose them as delusions.

However, for a correct diagnosis a number of previous factors should be taken into account.

1. Differentiate between delusional ideas and overestimated ideas

It is absolutely essential to make a differential diagnosis between a delusional idea and a habitual belief of the patient but which is overrated. For example, it can be complicated when it comes to beliefs and ideas based on religion.

In addition, when we diagnose illusions of persecution, we must make sure that the irrationality and degree of conviction are absolute; because it is an unequivocal sign of delirium.

2. Detect mood changes or fluctuations

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

however, if it manifests without any type of mental alteration, it should be diagnosed as a schizoaffective or schizophreniform disorder.

3. Look for the causes of delirium

The delirium of persecution being a symptom of a wider pathology, the patient’s condition and symptomatology should be assessed. In order to diagnose one of the associated pathologies mentioned above.

4. Discard medical condition or substance use as the cause.

As mentioned in the section on the etiology of persecutory delusions, these can sometimes be a consequence of the use of drugs or psychoactive substances, or they can even be the product of certain organic diseases.

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


It is imperative to face the illusions of the persecution as soon as possible, In order to stabilize the patient and that delusions call back; even arrive at the hospital in case it is necessary.

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

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

However, when delusional beliefs are caused by substance use or a medical illness, these conditions should also be treated, as they are the root cause of the disorder.

Once the patient is stabilized, psychological treatment is added, both individually and as a family.. The most effective therapies for combating delusions have been found to be cognitive-behavioral; as well as training and rehabilitation measures in social skills.

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