Persecutory Delusion: causes, symptoms, diagnosis and treatment.

Some people live with a fear of attacks and betrayals.

Surely, at some point in our lives, we have had the feeling that someone is watching us or even that we are being followed in the street. When this sensation becomes a firm and permanent belief, it is called persecution delirium..

In persecution delirium or persecutory delirium, the person lives with a series of irrational ideas and beliefs in which he/she believes that he/she is being persecuted, spied on or that different people or organizations are after him/her; almost always with the intention of attacking or causing harm, 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 his relationship with any other person.

What is persecutory delirium? Definition and characteristics

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

In other words, a delusion is a completely irrational belief, without any demonstrable basis.. Beliefs that the patient maintains in spite of being shown to be false. After clarifying this we can explain persecution delirium as the false belief of being followed, stalked or harassed by one or more persons.

This can be a very serious condition for the patient, as the patient's general thinking becomes embedded in irrational thinking; making all the patient's mental processes revolve around his delusion.

Symptoms and signs

The main characteristic of delusions of persecution is the presence of alterations in the content of thought, mainly due to distorted or false interpretations of the context or situation that surrounds him/her..

A person who manifests persecution delusions may think that his neighbors, or anyone with whom he crosses a glance, 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 it directly with his or her delusion. Yet, despite the characteristics of this thought deformation, there are common thoughts characteristic of delirium, there are common thoughts characteristic of delirium of persecution.

1. Being followed by someone

It is the most common of all the ideations and consists of the belief that one or more persons follow him continuously. In addition, it is common for the person to associate this stalking with an intention to harm him or her.

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

2. Being spied on

Frequently patients with delusions of persecution think that in addition to being followed by someone, that someone is doing it with the intention of spying on them for some reason. Hence, many sufferers try to hide continuously, causing a situation of insecurity and extreme anxiety.

3. Being tormented

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

In this case the subject may think that every time he/she does not find something it is because someone is hiding it from him/her.

4. Being ridiculed

Finally, one of the thoughts included in delusions of persecution is the thought that those who follow him/her do so with the intention of ridiculing or mocking him/her.

Frequent causes

In spite of all the above mentioned, the manifestation of delusions does not constitute a pathology by itself, but arises as a symptom of some of the psychological alterations that are exposed next.

According to DSM-IV-TR indications, delusions of persecution are the most common form of paranoid schizophrenia delusions; but they can also appear in schizoaffective disorder, since they constitute the most common feature of the persecutory subtype of delusional disorder.

Such delusions may 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 for the duration of the drug's effects or persist even though the drug's effects have subsided.

Types of persecution delirium

There is not only one type of delirium of persecution, but they are divided into two types depending on these are divided into two types depending on whether the harm the person thinks will be inflicted is physical or psychological.

When the harm is physical, the subject feels besieged by people who want to cause physical harm. Harm such as beating him up, running him over, or even killing him.

However, if it occurs psychically, the patient believes that the aggressions are happening on a moral level. Attempting to discredit, make fun of him or have fun at his expense.

Diagnosis

Since these beliefs and ideations are usually extremely 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. Differentiating between delusions and overvalued ideas

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

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

2. To detect changes or fluctuations in mood.

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

However, if it manifests without any mood disturbance, it is probably a mood disorder with psychotic symptoms, if it manifests itself without any type of mood disturbance, it should be diagnosed as schizoaffective or schizophreniform disorder..

3. Investigating the causes of the delirium

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

4. Ruling out medical pathology or substance use as a cause.

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

Therefore, 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 delusions of persecution as soon as possible, in order to stabilize the patient and make the delusions subside.It is essential to treat persecution delusions as soon as possible in order to stabilize the patient so that the delusions subside, including hospitalization if necessary.

Thus, pharmacotherapy is an essential initial phase for the improvement of the person, with antipsychotic drugs, such as Risperidone or haloperidol, being the first-line drugs for these symptoms.

In addition, when persecutory 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 abuse or medical illness, it is necessary to treat these conditions as well, since they are the initial cause of the disorder.

Once the patient is stabilized, psychological treatment is added, both at the individual and family level**. The most effective therapies to combat delusions have proven to be cognitive-behavioral**, as well as social skills training and rehabilitation measures.