A delusional disorder is a severe mental illness involving extreme paranoia and psychosis. Delusional disorders have various diagnostic subcategories, but the common feature of these disorders are delusions or firm, adamant beliefs in ideas that are not true or based in reality. According to the current edition of the Diagnostic and Statistical Manual for Mental Disorders (5^th edition), a delusional disorder can be diagnosed when persistent delusions last for at least one month and no other psychotic symptoms are present. While delusional disorders are less common than other psychiatric conditions like schizophrenia, they can cause significant distress and are challenging to treat.

Types of Delusional Disorders

Persecutory delusions are just one type of delusion that can affect those suffering from a delusional disorder. Delusional themes include:

• Persecutory: Belief that someone or something will, or intends to, cause harm to oneself or their loved one(s).
• Referential: Belief that cues (comments, gestures, etc.) are directed at themselves.
• Grandiose: Exaggerated belief in one’s own abilities, talents, power, identity, etc.
• Erotomanic: Belief that someone is in love with them. This type of delusion sometimes escalates into stalking behaviors.
• Nihilistic: Belief that a significant tragedy or catastrophe is going to occur.
• Somatic: Belief that there is a physical and/or medical issue affecting them.
• Jealous: Belief that infidelity is occurring in one’s relationship.

What is Persecutory Delusional Disorder?

Persecutory delusional disorder is a type of psychosis surrounding the belief that one will be harmed, or someone (a person, agency, organization, or group) intends to cause them harm. Those suffering from this type of delusional disorder may also believe they are being spied on, sometimes resulting in repeated, unfounded allegations and police reports.

Research indicates that persecutory delusions are the most likely to be acted upon compared to the other categories. The fear and anxiety accompanying a persecutory delusion are overwhelming, and a person experiencing this type of psychosis believes others will cause them (or a loved one) serious harm. Depending on the severity of the condition, this could lead to someone taking dramatic steps in order to prevent or protect from the believed threat.

Symptoms of persecutory delusional disorder include extreme paranoia, fear, and worry about impending harm, despite the imagined threat being unproven, disproved, or impossible. While everyone experiences fear and anxiety about stressful situations, those with persecutory and other delusional disorders continue to have persistent worry and distress even in the presence of evidence contrary to the belief. These delusions can range from plausible concerns, for example, infidelity of a spouse, to impossible or highly unlikely scenarios.

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How to Help Someone with Persecutory Delusional Disorder

A critical aspect of helping someone suffering from persecutory delusional disorder is to support them in seeking professional psychiatric care. Treatment of psychiatric conditions often includes an individual approach that varies for each patient. To effectively treat persecutory delusions, a combination of psychotherapy and medications is frequently recommended. Because of the nature of persecutory delusional disorder and the rigid belief in the delusions’ reality, patients are often hesitant to seek treatment.  Establishing rapport and trust is crucial to a successful provider-patient relationship.

Safety is also a significant concern regarding persecutory delusions. Because this type of delusion is often the most likely to be acted upon, patients may be at risk for harming themselves or others to cope or mitigate an imagined threat. Psychiatric hospitalization may be necessary to ensure safety until the disorder can be adequately stabilized and follow-up care established.

To learn more about persecutory delusional disorder and other types of delusion disorders, check out Symptom Media’s course catalog here.