The delusion of persecution or persecutory delusion constitutes a set of delusions in which the person believes that he is being persecuted. This psychopathological alteration is characterized by a series of irrational thoughts.
Specifically, the individual with a delusion of persecution may believe that someone is pursuing him to harm him. Likewise, he may also believe that different people or organizations “go after him” or constantly follow him to attack him..
Delirium is usually experienced with great anxiety and can totally affect the life of the subject. The individual can adapt all his behavior around his delusions of persecution.
This psychotic condition is considered a highly serious and disabling disorder that can put both the life of the subject and that of others at risk. People who suffer from it can be totally unpredictable in their actions, since they are governed by delusional thinking.
For this reason, it is highly important to intervene as soon as possible by means of a pharmacological treatment that allows the delirium to be attenuated or remitted. Likewise, in some cases hospitalization may be necessary to contain and protect the person..
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Delirium is a totally irrational belief, which is not based on any corroborative aspect and which is firmly maintained despite multiple evidences showing its falsehood.
The delusion of persecution constitutes a false belief of being followed, spied on, tormented, deceived or ridiculed by a person or a group of people.
Persecution delusion is a serious condition, since an irrational belief is embedded in the person's thinking. This condition makes all the mental processes of the subject can work around the delusion.
However, delirium itself does not configure a psychopathology, but is a symptom, a manifestation of some psychological alteration.
People with delusions of persecution have altered content of thought. These alterations occur due to false or distorted interpretations of external situations that have occurred.
For example, when faced with a person with whom they meet their gaze walking down the street, the individual with delusions of persecution may believe that they are watching. When looking around he sees a person leaning on a balcony, and this adds to his delirium, believing that she is also watching him.
The associations made in the delusion of persecution can be highly disjointed and motley. In this way, no specific stimulus is required for the subject to directly associate it with his delusion..
Among the most common thoughts of delusions of persecution we find:
It is the most typical and is characterized by the belief that other people are constantly following you. The subject may believe that anyone who observes (or is not even able to see) is constantly following him.
Persecution is often associated with harm. That is, the other people follow him with the aim of killing him, ending him or causing him some kind of harm..
It is also quite common for persecution delusions to have ideas of continual torment or harm. The person may believe that the people who spy on him make his life impossible and constantly harm him.
In this sense, any type of connection can also appear. The person may believe that he always misses the bus because of people who spy on him or that he cannot find his wallet because it has been stolen..
Often the delusion of persecution is not limited to persecution, but transcends espionage. In fact, the most common is that the person who suffers from this disorder does not only think that they are being followed, but that they are also constantly spying on him.
This factor makes people feel highly insecure and very anxious. They believe that in any situation they can be controlled and spied on, which is why many times individuals with delusions of persecution constantly try to hide..
The last aspect that can appear in the thought of a persecution delusion is the possibility of being ridiculed or deceived. The person may believe that there is a plot against him and that he wants to always leave him in a bad place.
As it is only a symptom, when a delusion of persecution appears, it is necessary to observe what type of psychopathological alteration it responds to..
Persecutory delirium is, according to DSM-IV-TR, the most common type of delusion in paranoid schizophrenia, and one of the main symptoms of the disease. However, not only delusions of persecution can develop in this pathology
Schizoaffective disorder, delusional disorder, bipolar disorder, or severe depressive episodes can also lead to delusions of persecution.
Other pathologies in which these delusions can be found among their symptoms are: delirium, dementia, schizophreniform disorder, brief psychotic disorder and psychotic disorder due to a medical illness.
Finally, it should be noted that the consumption of psychoactive substances can also cause the appearance of delusions of persecution.
In these cases, the alteration can appear acutely only when the effects of the drug are present or develop a substance-induced psychotic disorder, in which the delirium persists after the effects of the drug have subsided..
Generally speaking, delusions of persecution can be divided into two main types: delusions in physical form and delusions in psychic form..
In persecutory delusion in physical form, the subject feels controlled and cornered by people who want to cause him some harm. In this case, the subject is afraid of people he sees (or imagines) and is convinced that they are pursuing him to harm him..
In the delusion of persecution in a psychic form, on the other hand, the subject considers that the people who persecute him morally attack him to discredit him. The individual does not fear that people will come after him to cause real physical harm, but believes that these people constantly take actions to ridicule him.
People who suffer from this type of delirium can manifest a large number of behaviors associated with it. In general, individuals with delusions of persecution have the following characteristics:
Establishing that a certain idea refers to a delusion can be remarkably easy at first glance. However, to establish the diagnosis of delirium, a series of steps must be followed.
The mere appearance of an extravagant or unreasonable idea does not, by itself, show the presence of delusion. Thus, to guide the diagnosis of a delusion of persecution, three fundamental questions must be taken into account.
This first step is essential to be able to establish the diagnosis and requires the differentiation of the delusional idea from the habitual beliefs. A differential diagnosis should be made between a delusional idea and an overrated idea.
A certain belief can have a certain real or rational basis and, based on it, discern in different ways. In these cases we speak of overvalued ideas, which must be analyzed in detail to be differentiated from delusions.
In the delusion of persecution, there is no other explanation than that provided by the subject who suffers it. In this way, as soon as the delusion is interfered with by rational thoughts, these are quickly rejected by the individual..
In this sense, it is important to let the patient speak and propose alternative hypotheses, in order to observe the degree of conviction that the person has about the belief..
In delusions of persecution, both the irrationality and the degree of conviction in the belief is absolute, so these two aspects must appear in order to make a diagnosis..
Persecution delusion is only a symptom, so for its correct diagnosis it is necessary to know what its appearance responds to. In the same way that to diagnose a tummy ache, its cause must be investigated (gastrointestinal disorder, indigestion, contusion, etc.), to establish the presence of persecution delirium, the pathology that causes it must also be found..
The status and global symptoms of the patient must be evaluated in order to diagnose some of the psychopathologies related to delirium..
The diagnosis of schizophrenia, schizophreniform disorder, schizoaffective disorder, major depression or bipolar disorder are the main ones to consider.
Persecution delusion can vary greatly depending on whether it is motivated by mood disturbances or not.
In the event that delusions appear exclusively during episodes of major depression, mixed episodes or manic episodes, the diagnosis of mood disorder with psychotic symptoms will be made..
When the delusion of persecution appears without alteration of the mood, we will be facing a psychotic disorder: schizophrenia, schizophreniform disorder, schizoaffective disorder or delusional disorder.
Finally, in some cases the delusion of persecution can appear as a direct effect of a substance or a medical illness. For this reason, for its correct diagnosis it is also necessary to evaluate the psychoactive substances consumed by the subject, as well as possible ingested medications..
Finally, certain organic diseases can also cause delusions, which is why a medical examination is required to rule out or diagnose this condition..
Persecution delusions need to be treated as soon as possible, with the aim of stabilizing the patient and getting irrational beliefs to subside.
Initial treatment should always be based on pharmacotherapy, through the use of antipsychotic medications. Those most widely used are haloperidol, risperidone, olanzapine, quetiapine, and clozapine..
These drugs should be monitored by a thorough medical control, and a correct diagnosis of delirium of persecution..
In the event that delusions are caused by substance use or the direct effects of a medical illness, it will also be essential to treat these conditions, since they are the cause of delirium..
When the subject has very high levels of anxiety or agitation, anxiolytic drugs, such as benzodiazepines, are also usually administered. Likewise, in the face of frank delusions, hospitalization is usually necessary to control symptoms.
Subsequently, it is convenient to add psychological treatment to pharmacotherapy, both through individual and family psychotherapy.
Cognitive behavioral treatment is usually a good tool to combat delusions. Social skills training, adherence therapy, and rehabilitation measures are other treatments applied to subjects with schizophrenia..
Finally, it is important that the subject who has suffered a delusion of persecution carries out a psychological follow-up to be able to detect as soon as possible the appearance of other outbreaks or delusions..
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