People with schizophrenia often have delusions: false beliefs about themselves or the world around them. The types of delusions in schizophrenia can vary, but persecutory delusions are the most common.

Schizophrenia is a mental health condition caused by changes in the brain’s structure and function. It’s classified as a psychotic disorder, meaning its prominent features involve psychosis — a mental health state where your brain inaccurately perceives reality.

Hallucinations, delusions, and disorganized thinking are the hallmark psychotic symptoms of schizophrenia. At least one is necessary to receive a diagnosis under criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).

Delusions are extremely common in schizophrenia, and they can take on a variety of themes.

The DSM-5-TR defines delusions as false beliefs that are held with an unwavering commitment despite proof they’re incorrect.

This type of belief in something untrue isn’t always an indicator of psychosis. An ongoing debate also exists regarding how delusions are truly defined in relation to mental health conditions.

Some experts believe delusions exist on a psychosis continuum, ranging from “delusion-like ideas” to true delusional beliefs seen in conditions like schizophrenia.

Under this framework, delusions in schizophrenia are conceptualized as “primary” delusions. They’re differentiated from delusion-like ideas because they aren’t the result of your own conclusions over time. They emerge suddenly and unexpectedly and exist as the result of a mental health condition.

According to the DSM-5-TR, the strength of your belief is what sets delusions apart from strongly held ideas. In other words, you believe in a delusion no matter what and can’t be swayed from that belief.

The DSM-5-TR lists seven themes typically seen in schizophrenia delusions. You may experience one or multiple (called mixed type), but the most common is the theme of persecutory, also referred to as “paranoid.”

The DSM-5-TR also includes unspecified as a delusion type to indicate circumstances where the delusion does not fall into any of these seven themes.


Persecutory delusions (or paranoid delusions) involve the belief that a group or individual plans to act negatively against you, possibly through physical harm, harassment, or sabotage.


When you believe that everyday people, places, events, and objects hold personal significance in your life despite no logical connection to you, it’s known as a referential delusion.

An example would be seeing someone eating ice cream and believing that situation was them sending a secret signal about circumstances that could impact your life.


Grandiose delusions center on the belief that you’re exceptional compared to everyone else in abilities, wealth, or fame. You may believe you have special powers, for example, or are an undiscovered talent.


Believing someone else is in love with you is an erotomanic delusion.

For example, an erotomanic delusion might include thinking a celebrity loves you even when you’ve never met or corresponded.


Nihilistic delusions get their name from the philosophical concept of nihilism, which suggests life has no fundamental meaning or purpose. Nihilistic delusions involve thoughts related to non-existence, like believing a major catastrophe will occur or that humanity is already in the afterlife.


Somatic delusions involve a preoccupation with health and organ function. They can include irrational beliefs about how your body functions or inaccurate beliefs about how natural sensations predict illnesses.

For example, attributing the typical sensation of hunger to progressive stomach cancer.


Bizarre delusions include any false belief that is completely implausible, isn’t derived from ordinary life experiences, and isn’t seated in cultural practices.

The DSM-5-TR gives the example of believing your internal organs have been removed by an outside force and replaced with someone else’s organs.

Common themes among bizarre delusions include:

  • Thought withdrawal: Belief your thoughts have been removed by an outside force.
  • Thought insertion: Belief alien thoughts have been placed in your mind.
  • Delusions of control: Belief that an outside force is manipulating your thoughts and actions.

The signs and symptoms of delusional thinking can vary based on the theme of the delusion and any underlying mental or physical health conditions.

In general, signs someone may be experiencing delusions include:

  • expressing rigid, untrue beliefs that can’t be swayed regardless of proof or quality evidence to the contrary
  • extreme resistance to debate or arguments about the belief
  • unusual behaviors based on the delusion, like wearing a special hat to “protect their thoughts”
  • impaired function in important areas of life like work, school, or relationships
  • experiencing distress from the delusion, like excessive anxiety, fear, or worry
  • other symptoms of psychosis, like hallucinations, could be present

Can you have delusions and not experience schizophrenia?

Delusions are a feature of psychosis and are not limited to schizophrenia. Delusions can be experienced in other mental health conditions such as:

It’s also possible to experience delusions from:

Delusions aren’t treated as a separate entity in a schizophrenia diagnosis. Treating schizophrenia successfully involves addressing all of your symptoms, including delusions.

As a feature of psychosis, delusions often respond to antipsychotic medications.

Psychotherapy, family therapy, and community support programs are other important components of a schizophrenia treatment plan, even though therapy cannot directly reduce delusions.

Instead, these non-medication treatment approaches help you learn to recognize delusions, develop coping skills, and establish strategies that allow you to regain function in important areas of life.

Delusions in schizophrenia are commonly accompanied by anosognosia, a lack of insight into the disorder. This means you don’t recognize you’re experiencing a mental health condition.

Remember, the core feature of a delusion is conviction. It’s not something you’ll be able to “talk someone out of.” Only professional treatment can help improve delusional thinking.

You can respond to delusional thinking by:

  • remaining calm and not arguing
  • redirecting the conversation when possible
  • avoiding reinforcing or validating the delusion
  • allowing open communication about the delusion
  • expressing empathy for the emotions and feelings experienced, not the delusion
  • monitoring safety and involving family members
  • encouraging professional support

Delusions are untrue, rigid beliefs you maintain despite proof or sound evidence against the belief. They’re a symptom of psychosis, a mental state where you have an inaccurate perception of reality.

Delusions are a primary symptom of schizophrenia, but they aren’t limited to schizophrenia. People can experience delusions with other mental and physical health conditions that affect areas of the brain responsible for reality perception.

While there are many different types of delusions seen in schizophrenia, persecutory delusions are the most common.