What Are Delusions of Persecution?

Medically Reviewed by Smitha Bhandari, MD on November 14, 2021

You’ve probably believed something one time or another that turned out to be untrue. But if you have a rare mental illness called delusional disorder, no amount of facts and reason can shake your thinking. People with delusions cannot tell which beliefs are real and which are imaginary.

Delusions come in several types. The most common is delusions of persecution. It’s when you’re convinced that someone is mistreating, conspiring against, or planning to harm you or your loved one. Another type is grandiose delusions, where you have an unrealistically inflated sense of yourself or your achievements.

Someone with persecutory delusions might seem normal. But if their delusions are severe enough, they might become obsessed to the point that it disrupts their everyday life.

Sometimes, their false belief can be something improbable but not impossible. They may, for instance, suspect their neighbors of spying on them, or fear that the police want to torture them. Other times, their delusions are irrational, such as believing an evil spirit plans to abduct them.

Usually, the delusions spring from misinterpretations or exaggerations of real feelings and experiences. For example, they might perceive a stranger’s innocent glance as threatening.

Sometimes, this paranoia can be associated with:

Hallucinations. This is when you see, hear, or feel things that don’t exist. Hallucinations aren’t very common with delusional disorders. If you have them, they’re related to your delusion. So if you falsely believe that your co-worker planted spoiled food in your car, you may think you smell something rotten.

Mood changes. You might feel upset, depressed, and irritable. But such moods should last briefly and happen only during your delusional period.

We don’t exactly know what causes delusions. But experts believe it’s probably genetic. Sometimes, delusions can be a sign of another condition, including:

The state of your mind can also play a part in triggering delusions of persecution. It’s more likely to happen if you:

  • Are prone to worrying and over-analyzing
  • Are overly sensitive to criticism or tend to misinterpret other people’s comments or gestures
  • Have low self-worth or negative thoughts about yourself
  • Constantly feel anxious, fearful, or unsettled without reason
  • Have trouble sleeping
  • Tend to jump to conclusions

Many people with delusions of persecution also have depression or anxiety. They also tend to lack strong personal relationships and are often physically unwell.

No test can confirm that you have a delusional disorder. But your doctor will take a detailed mental history and rule out other causes to make a diagnosis.

You have this or another type of delusional disorder if you meet these criteria:

  • You’ve had one or more delusions that lasted a month or longer.
  • You have not been diagnosed with schizophrenia.
  • You show obviously bizarre behavior other than your delusions.
  • If you’ve had any episodes of mania or depression, they didn’t last longer than your delusional periods.
  • Your delusions don’t stem from drugs, another medical condition, or a different mental disorder.

It can be hard to get help with a delusional disorder because you might not realize that anything is wrong. Or you might be embarrassed or scared to see a doctor. But treatment is key to feeling better.

Antipsychotic drugs. Your doctor likely will prescribe medication first. Studies show that antipsychotic drugs such as olanzapine (Zyprexa) and risperidone (Risperdal) can help most people.

Talk therapy. Studies suggest that a type of psychotherapy called cognitive behavioral therapy may help lower delusional thinking. But more research is needed to know how much and why. This form of counseling gives you a safe place to discuss your delusions with a mental health expert. Simply talking about your persecutory delusions in the right way can help you control them.

Involuntary treatment. If your delusions pose possible harm for you and others, you may need to stay at a hospital or a treatment center until you’re stable. States and localities have different laws about when and for how long you can be forced to get treatment against your will.

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