When someone experiences persecutory delusions, they believe a person or group wants to hurt them. They firmly believe this is true, despite the lack of proof.

Persecutory delusions are a form of paranoia. They’re often seen in schizophrenia and other mental illnesses, like schizoaffective disorder and post-traumatic stress disorder.

The main symptoms of persecutory delusions is a person believing that others intend to harm them or that they’re being accused of doing something horrible that they never did.

The belief, which is based on bizarre or irrational reasoning, affects how a person behaves and thinks.

Persecutory delusions may cause symptoms like:

  • fearing ordinary situations
  • feeling threatened without reason
  • frequently reporting to authorities
  • extreme distress
  • excess worry
  • constantly seeking safety

If their delusions are disputed, the person may further explain the belief with more unrealistic reasoning.

If a person has persecutory delusions, they might say things like:

  • “My co-workers are hacking into my email and trying to get me fired.”
  • “The neighbors are planning to steal my car.”
  • “People walking outside are putting thoughts inside my head.”
  • “The mailman is spying on my house because he wants to hurt me.”
  • “The airplane above us is the government, and they want to kidnap me.”
  • “Everyone believes that I want to hurt things.”

The person will say these things as if they’re facts. They might also use vague terms and seem agitated or suspicious.

Difference between paranoid and persecutory delusions

Though paranoia and persecutory delusions are related, they’re technically different thought processes.

In paranoia, a person feels overly doubtful and fearful of others. These feelings are very intense, making it difficult to trust people.

Persecutory delusions occur when paranoia becomes extreme. A person’s paranoid feelings become fixed beliefs, even when they’re presented with opposing evidence.

Persecutory delusions appear in various mental illnesses, including schizophrenia, schizoaffective disorder, and more.

Schizophrenia

Schizophrenia is characterized by a distorted sense of reality. It often involves hallucinations and delusions.

Specifically, the most common kind of delusions in schizophrenia are persecutory delusions. It’s considered a positive symptom of schizophrenia, previously called paranoid schizophrenia.

Other symptoms include:

  • disorganized thinking
  • abnormal motor behavior
  • loss of interest in daily activities
  • neglecting personal hygiene
  • lack of emotion
  • social withdrawal

Bipolar disorder

Persecutory delusions may occur in bipolar disorder. In this condition, a person experiences extreme emotional changes. Depending on the type of bipolar disorder, a person may experience episodes of depression and mania or hypomania.

Symptoms of a depressive episode may include:

A manic episode might include:

Typically, persecutory delusions appear during manic episodes.

Schizoaffective disorder

Schizoaffective disorder involves symptoms of schizophrenia and a mood disorder. There are two types:

  • Bipolar type. This includes symptoms of schizophrenia plus manic and depressive episodes.
  • Depressive type. In this type, a person has symptoms of schizophrenia and depression.

Possible symptoms include delusions, including persecutory delusions. Other symptoms may include:

  • hallucinations
  • impaired speech
  • unusual behavior
  • feeling sad or worthless
  • poor personal hygiene

Major depressive disorder with psychotic features

Persecutory delusions might also appear in depression. Usually, it occurs in major depressive disorder with psychotic features, previously called psychotic depression.

Severe depression causes persistent and extreme sadness. Other possible symptoms include:

In this type of depression, the above symptoms are accompanied by episodes of psychosis. An episode involves hallucinations and delusions, which may include persecutory delusions.

This may be related to feelings of worthlessness and guilt. If a person feels they deserve harm, they might think others want to hurt them.

Delusional disorder

In rare cases, a person can have delusions that can’t be explained by a mental illness, medical condition, or substance. This is known as delusional disorder.

A person with delusional disorder can experience many types of delusions, including those of persecution.

Delusional disorder is diagnosed when a person has one or more delusions for at least one month. Other symptoms are:

  • hallucinations associated with the delusions
  • irritability
  • low mood
  • anger

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) occurs after someone experiences a traumatic or scary event. It causes persistent stress and fear, even after the event has passed.

PTSD can cause persecutory delusions. This is likely if the traumatic event involved a threatening person or group.

Other possible symptoms are:

To diagnose the cause of persecutory delusions, doctors may use the following:

  • Physical exam. A doctor will check your physical health for potential or related causes.
  • Screenings for substances. You may be screened for alcohol and drug use, which could cause similar symptoms.
  • Imaging tests. An MRI or CT scan may be used to further understand your symptoms.
  • Psychiatric evaluation. A mental health professional will ask about your delusions, hallucinations, and feelings. They’ll also check if your symptoms meet certain diagnostic criteria.

Treatment depends on the underlying cause and severity of your symptoms. Generally, it involves:

Medication

Your doctor will likely prescribe medication to manage your symptoms, such as:

  • Antipsychotics. Antipsychotic drugs are used to manage delusions and hallucinations.
  • Mood stabilizers. If you experience extreme changes in mood, you may be given mood stabilizers.
  • Antidepressants. Antidepressants are prescribed to relieve depressive symptoms, including feelings of sadness.

Psychotherapy

Psychotherapy is used to manage thought processes and delusions. You’ll discuss your beliefs with a mental health professional, who will help you compare them to reality.

The goal of therapy is to:

  • control delusions
  • better recognize reality
  • reduce anxiety
  • cope with stress
  • improve social skills

Therapy may be done individually, in a group, or both. Your family may be asked to join.

Hospitalization

If your symptoms are severe, you might be hospitalized. This is likely if you are:

  • detached from reality (psychosis) and unable to care for yourself
  • behaving dangerously
  • feeling suicidal

In a hospital, a team of health professionals can stabilize you and keep you safe.

If a loved one has persecutory delusions, you may feel unsure how to respond.

Here’s what you can do to help:

  • Listen. Though it may be difficult, listening to the person helps them feel respected and understood.
  • Avoid disputing or supporting their delusions. When a person’s delusions are disputed, they will further believe them. At the same time, “playing along” with the delusion reinforces it.
  • Redirect the situation. Instead of fighting or supporting their delusions, calmly share a different viewpoint. For example, if someone believes a parked car is spying on them, mention the possibility that the driver is shopping at a store.
  • Be supportive. It’s important to be supportive and nonjudgmental, even when the delusions are under control.

A person with persecutory delusions is unable to recognize reality. They strongly believe people or groups, like the government, intend to harm them. These beliefs are often unrealistic or bizarre.

Persecutory delusions frequently appear in mental health disorders, like schizophrenia or schizoaffective disorder.

If you think a loved one is experiencing delusions, be supportive and encourage them to see a mental health professional.