yes, therapy helps!
Persecutory delirium: causes, symptoms, diagnosis and treatment

Persecutory delirium: causes, symptoms, diagnosis and treatment

March 5, 2024

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

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

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


What is persecutory delirium? Definition and characteristics

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

In other words, a delirium is a completely irrational belief, without any demonstrable basis . Belief that the patient maintains despite demonstrating 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 several people.


This can suppose a very serious suffering for the patient, since the general thought of this is inserted in an irrational thought; causing all of the patient's mental processes to revolve around his delirium.

Symptoms and signs

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

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

The inferences made by someone with this disorder can be strident and random, so no specific stimulus is needed for the person to associate directly with their delirium. Even so, in spite of the characteristics of this deformation of thought, there are common thoughts typical of delusions 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 him continuously. In addition, it is usual for the person to associate that stalking with an intention to cause him or her harm.

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

2. Being spied

Frequently patients with delusions of persecution think that in addition to being followed by someone, that someone does it with the intention of spying on him 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. Being tormented

Another characteristic very common in the delirium of persecution is that ideas of torment or continuous damage arise. These people may believe that those who persecute them are making their lives impossible through small acts or situations.

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

4. Being 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.

Common causes

In spite of everything mentioned above, the manifestation of delusions does not constitute a pathology in itself, but rather arises as a symptom of some of the psychological alterations that are described below.

According to the indications of DSM-IV-TR, delusions of persecution are the most common form of delusions of paranoid schizophrenia; but they can also appear in schizoaffective disorder, since it is the most common characteristic 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 delirium may appear acutely while the effects of the drug last or persist even though they have subsided.

Types of persecution rave

There is not a single type of persecution delirium, but rather these are divided into two types according to whether the damage that the person thinks they are going to inflict is physical or psychological .

When the damage occurs physically, the subject feels besieged by people who want to cause some physical damage. Damages like beating him up, running over him or even killing him.

However, if presented psychically, the patient believes that the aggressions follow one another on a moral plane. Trying to discredit, make fun of him or have fun at his expense.

Diagnosis

Since these beliefs and ideas are usually highly extravagant and not very credible, it is relatively easy to identify and diagnose them as delusions.

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

1. Differentiate between delusions and overrated ideas

It is absolutely essential to make a differential diagnosis between a delusional idea and a habitual belief of the patient that is overvalued. For example, this can be complicated when dealing with beliefs and ideas based on religion .

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

2. Detect changes or fluctuations in mood

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

But nevertheless, if it manifests without any type of psychic alteration it must be diagnosed as a schizoaffective or schizophreniform disorder .

3. Investigate the causes of delirium

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

4. Discard the medical pathology or substance use as a cause.

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

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

Treatment

It is essential to treat the delusions of persecution as soon as possible , in order to stabilize the patient and that the delirious ideas remit; even hospitalization in case it was necessary.

Thus, pharmacotherapy is an essential initial phase for the improvement of the person, with antipsychotic drugs, 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, it is common to administer anxiolytic drugs such as benzodiazepines.

However, when delusions are caused by the consumption of substances or a medical illness, it is necessary to treat these conditions as well, since they are the initial cause of the disorder.

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


Delusional disorder | Mental health | NCLEX-RN | Khan Academy (March 2024).


Similar Articles