Delusions Of Persecution: Causes, Symptoms, Treatment

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Delusions of persecution refer to false beliefs or perceptions in which a person believes that they are being treated with malicious intent, hostility, or harassment – despite significant evidence to suggest otherwise. Imagine waking up and thinking that your next-door neighbor was plotting to kill you, or that your spouse had sprinkled some poison in your morning coffee. These are a couple scenarios that may occur for individuals afflicted with persecutory delusions.

Perceiving that someone is out to harm your reputation or sabotage your life are common themes of persecutory delusions. It is estimated that approximately 10% to 15% of the general population will experience paranoid thoughts, and in some cases these thoughts result in persecutory delusions. A majority of individuals experiencing this specific type of delusion have a preexisting psychiatric condition such as schizophrenia.

What are delusions of persecution? Definition.

To help you get a better understanding of the phrase delusions of persecution, it is important to first understand the term “delusion” as well as the term “persecution.” It is important to realize that delusions aren’t always related to persecution, and in some cases, persecution is not a delusion.

Delusion: This is a term that signifies a false belief or perception that is held with full conviction, despite significant contradictory evidence. These false beliefs or perceptions are usually refuted with legitimate science, refuting logic, or rationality.

Persecution: This is a term that refers to mistreatment, discrimination, or victimization of a person or group of people for a specific reason. In some cases, there may be a logically valid reason for persecution such as torturous imprisonment for an individual that committed a heinous crime. Most popular types of persecution are related to religious affiliation, ethnicity, and political affiliation – these are not usually justified with rationality.

Delusions of Persecution: This is a phrase combining the term delusion (a false belief held despite significant contradictory evidence), with the term persecution (mistreatment, discrimination, or victimization). It refers to a falsely held belief or thought that another entity (person, multiple people or a group) is on a mission to harm or mistreat them.

Source: http://www.ncbi.nlm.nih.gov/pubmed/17258852

What causes delusions of persecution?

It is unknown as to what specifically triggers persecutory delusions. Some experts speculate that anatomical differences of the brain may contribute, particularly injuries to various lobes. In other cases, the delusions may result from drug abuse, genetic polymorphisms, neurotransmitter concentrations, and receptor densities (of specific neurochemicals).

Brain anatomy: It is believed that among those with persecutory delusions, there may be anatomical differences of specific brain regions. Some researchers believe that there is likely dysfunction within the amygdala, fronto-striatal circuitry, and/or the parietal cortices. Dysfunction in these particular regions may result in a mismatch between experience and expectation – resulting in delusions and prediction errors.

Defective brain wiring can lead to perceptual alterations, leading to delusional perceptions that a normal, healthy individual doesn’t experience. Other researchers have hypothesized that persecutory delusions may be a result of spatiotemporal disturbances. These spatiotemporal disturbances may result in deficits in the ability to perceive the “chance nature” of events and circumstances.

This deficit in assessing “chance” could make a person conclude that others are out to persecute them, despite the chances of that being very slim. The anatomical wiring of a person’s brain, coupled with environmental inputs, may be responsible for generating specific persecutory delusions. Other research has found reduced gray matter in the prefrontal and temporal regions to cause persecutory delusions.

Brain injuries: Those that experience persecutory delusions may have experienced brain injuries. Specifically, research has shown that injuries to the temporal lobe – particularly lesions, could be responsible for delusions of persecution. In some cases, a combination of both temporal and frontal lobe injuries may be responsible for causing persecutory delusions.

Drugs: Abusing or ingesting certain drugs may provoke delusions of persecution. Those that have dealt with episodes of drug-induced psychosis may have experienced delusions of persecution. Certain drugs can increase dopamine concentrations to abnormally high amounts, leading a person to feel stimulated or euphoric.

In some cases, the stimulation becomes intensified to the point that the fear-center of the brain is triggered, and paranoia sets in. The paranoia can make an individual believe that others are out to harm them, the feds are spying on them, or that nobody can be trusted. This tends to be more common among those that exhibit stimulant psychosis, but can sometimes occur with ingestion of non-stimulatory substances.

Genetics: There is likely a genetic component that plays a role in facilitating a neurochemistry susceptible to experiencing persecutory delusions. Specifically, researchers have suggested that polymorphisms of genes responsible for dopaminergic neurotransmission may cause persecutory delusions. The DRD2, DRD3, and/or TH genes may result in heightened dopamine sensitivity, leading to paranoia, and ultimately persecutory delusions.

The “DRD” genes are responsible for regulating dopamine receptors, while the “TH” gene serves to facilitate the synthesizing enzyme for dopamine called tyrosine hydroxylase. Among those with the persecutory subtype of delusional disorder, a “dopamine psychosis” stemming from the aforementioned genes (DRD2, DRD3, TH) occurs to produce the delusions.

Hemispheric activation: Researchers have reported that those with neurodegenerative diseases that exhibit delusions of persecution, left lateralization is a causative factor. This means that among individuals experiencing persecutory delusions as a result of neurodegeneration, the left hemisphere of the brain is dominant, and possibly hyperactive. Whether lateralization of the left hemisphere occurs in all cases of persecutory delusions remains unknown.

Neurotransmitter concentrations: The concentrations of specific neurotransmitters likely influence whether someone experiences delusions, as well as the persecutory subtype. It is believed that stimulatory neurotransmitters, particularly that of dopamine, is likely to be an influential factor. Some research suggests that chaotic firing of dopamine in the ventral striatum region of the brain could lead to delusions of persecution.

The theory is that when dopaminergic neurons aren’t firing properly in the ventral striatum, it causes us to pay careful attention to benign, non-threatening stimuli. In other words, we become more vigilant, and may experience suspiciousness, aggression, and ultimately persecutory delusions. Others believe that an overall high dopamine concentration with deficient receptors may contribute to delusions.

Receptor densities: The densities of neurotransmitter receptors, particularly those responsible for processing dopamine are thought to cause delusions of persecution. When there are low concentrations of dopamine receptors in certain regions, the existing receptors may become bombarded or overwhelmed with processing dopamine – leading a person to experience delusions (of persecution) or hallucinations. It is this reason that atypical antipsychotics are often prescribed to treat delusions of persecution – they act as dopamine receptor antagonists.

Note: It should be mentioned that 2 people may experience persecutory delusions for completely different reasons. One may exhibit abnormal neurotransmitter concentrations, while another may have a lesion on a particular brain region.

Source: http://www.ncbi.nlm.nih.gov/pubmed/20558235

Source: http://www.ncbi.nlm.nih.gov/pubmed/19419772

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895617/

Source: http://www.ncbi.nlm.nih.gov/pubmed/12007750

Source: http://www.springerpub.com/localization-of-clinical-syndromes-in-neuropsychology-and-neuroscience.html

Conditions associated with persecutory delusions

There are several psychiatric and neurological conditions associated with persecutory delusions. Any condition that is capable of provoking or inducing paranoia should be considered as having the potential to cause delusions of persecution. The persecutory delusions may occur on an acute basis or may be a chronic symptom of a condition.

Bipolar disorder: Those with bipolar disorder are at increased risk of experiencing delusions. Since the most common delusional subtype is that of persecution, many individuals with bipolar disorder deal with persecutory delusions. Bipolar disorder involves transitioning or “cycling” between elevated and depressive moods.

During certain transitory phases of bipolar disorder, an individual may be prone to deluded thinking. This may manifest along with psychomotor agitation associated with transitioning between the two poles of “mania” and “depression.” During this transition, certain regions of the brain may become overactive, neurotransmission may become chaotic, and persecutory delusions may ensue.

Depression: While is isn’t common for people with major depression to experience comorbid delusions of persecution, it can occur. Persecutory delusions are a well-documented symptom of individuals with psychotic depression in which a person becomes so depressed, that they also experience psychosis. It should also be noted that psychiatric drug or antidepressant roulette may provoke transitory delusions of persecution among severely depressed individuals.

Drug abuse: Those that have abused drugs are likely to experience delusions of persecution. These delusions may occur during intoxication, but may also occur as unexpected side effects, or a result of long-term drug-induced brain changes. Someone that has abused a stimulant over a long-term, may have killed brain cells, damaged certain circuitry, and depleted receptors. It may take awhile (protracted withdrawal) before a person recovers from their past drug abuse.

Encephalitis: There have been case reports of delusions of persecution following acute encephalitis. Encephalitis is a condition associated with inflammation of the brain, and can cause a variety of symptoms. While most people with encephalitis will not exhibit persecutory delusions, it has been reported and therefore should be noted.

Neurodegenerative diseases: Those with neurodegenerative diseases such as Alzheimer’s, Parkinson’s, and Huntington’s disease may experience delusions of persecution upon disease onset, during treatment, or in advanced stages of the disease. These neurodegenerative diseases tend to alter regional activity and connectivity, neurotransmitter and receptor functioning, and overall brain volume. Furthermore, treatments for these conditions often involve dopaminergic drugs (i.e. Levodopa), which may induce temporary delusions of persecution as a result of heightened dopamine levels.

Other neurological conditions: Various neurological conditions such as Fahr’s disease may result in delusions of persecution. This is a disease characterized by calcium deposits within the basal ganglia, significantly affecting the globuspallidus region. In one case, a 23-year old woman developed psychosis and delusions of persecution as a result of this neurological condition.

Paranoid personality disorder (PPD): This is a condition associated with excessive suspicion and distrust of others, to the extent that they interfere with social, occupational, or other areas of functioning. Those with paranoid personality disorder are highly prone to experience delusions of persecution. This condition is generally treated with administration of atypical antipsychotics, which serve to regulate dopaminergic activity.

Schizophrenia: While there are many types of schizophrenia, the subtype most associated with delusions of persecution is paranoid schizophrenia. The persecutory delusions are considered positive symptoms, and may be directly related to hallucinations (i.e. hearing voices). For example, someone with schizophrenia may hear a voice that tells them “your friend is talking behind your back” or “your neighbor is planning to kill you.”

These delusions are treated with administration of antipsychotic agents, which reduce chaotic firing of dopamine. It should be noted that any subtype of schizophrenia could experience persecutory delusions, but the paranoid subtype seems to be most commonly associated.

Source: http://bjp.rcpsych.org/content/75/310/532.3

Source: http://www.ncbi.nlm.nih.gov/pubmed/19522881

Source: http://www.ncbi.nlm.nih.gov/pubmed/20540394

Do persecutory delusions serve a functional purpose?

Some experts have theorized as to whether persecutory delusions serve an evolutionary or functional purpose.

Attributional bias: Bentall et al. developed an theory that persecutory delusions were the result of negative events that may threaten a person’s self-esteem, and thus get attributed to others. Through attributional bias, or attributing negative events to others, it protects a person’s ego and preserves self-esteem. During pathogenesis of diseases like schizophrenia, a person may exhibit preferential recall of delusional material, resulting in psychological reinforcement of their persecutory delusion.

Automatisms: The French psychiatrist De Clerambault believed that persecutory delusions should be considered reactions of an abnormal personality to automatisms. Automatisms are essentially actions or thoughts without conscious intention or unconscious processes. De Clerambault’s theory is that hallucinations and delusions were a result of anatomical alterations to the brain, which lead to automatisms resembling psychosis. He believed that a patient with these automatisms may explain them as intentional persecution, despite the fact that they are delusions.

Emotional expression: Other experts believe that delusions are driven primarily by mood or a person’s underlying affect. Hence persecutory delusions could be considered mood-congruent in that they may stem from a paranoid, anxious, or fearful mood. Researchers have theorized that a person’s mood, gives rise to specific autobiographical memories related to that mood, which in turn influence the delusion. If someone had a past experience of persecution, they may believe that the same thing will happen as a result of the similar emotion that they’re experiencing.

Paranoid subtypes: Some researchers believe that delusions of persecution are a result of paranoid subtypes. There are different reasons for which a person may feel paranoid such as “bad me” or “poor me.” In cases of “bad me” paranoia, theorists believe that a person targets themselves with guilt or deserved blame, leading to low self-esteem.

This may result in hypervigilance of others in effort to avoid criticism, which may lead to delusions of persecution. Those with “poor me” paranoia hold the perception that they are inherently good, and believe that others may be out to compromise their reputation or persecute them. While both subtypes may manifest delusions of persecution, the thought-based mechanisms that give rise to these delusions may differ.

Spatiotemporal disturbance: For certain individuals, delusions of persecution may be a result of a single fundamental disturbance or a “trouble generator.” This is a theory developed by Minkowski in which he believes that delusions of persecution are a result of spatiotemporal disturbances. In other words, individuals with these delusions isn’t able to understand the chance occurrence of events or circumstances, leading to feelings of restriction of freedom and/or movement (spatiotemporal). The feelings of restriction of freedom and/or movement then create a delusion of persecution in which a person feels trapped.

Threat anticipation model: A model called the “threat anticipation cognitive model” is one hypothesis of what gives rise to persecutory delusions. Those that support this model believe that delusions of persecution are a result of emotional processes, anomalous experiences, and reasoning biases. This supports the idea that a person’s emotions give significant meaning to strange or coincidental experiences, and reasoning biases induce paranoia or delusions of persecution.

Source: http://www.ncbi.nlm.nih.gov/pubmed/17258852

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016695/

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278784/

Other factors that influence persecutory delusions…

Several other factors may influence whether someone experiences delusions of persecution and/or the severity of these delusions. These factors include: age, sociodemographic status, personal religiosity, and sex. It should also be considered that several of these factors may overlap with those analyzed in the causes of schizophrenia.

Age: It seems as though the specific persecutory delusion of being poisoned was directly related to an individual’s age. Those that believed they were being poisoned were generally of older age. There are numerous theories as to why age may be correlated with perceived poisoning, but those who are paranoid and aging may believe that younger generations are out to extract their financial savings. It should be mentioned that parental age (age of a person’s parents) was found to be younger than average among those experiencing poison-based persecutory delusions.

Chronic vs. periodic illness: Those with more chronic illnesses experienced persecutory delusions at a greater rate than those with periodic or episodic illnesses. This makes logical sense due to the fact that chronic illnesses are more debilitating and take a greater toll on the brain. Additionally many individuals with periodic illnesses have more favorable prognoses, potentially making full or significant recoveries.

Family size: Individuals with smaller family sizes tend to experience persecutory delusions at a greater rate than those with larger families. This may be a result of lifetime or cumulative social trust or interaction minimizing activity of the brain that would lead to persecutory delusions. Additionally social isolation may be a more prevalent theme among those with smaller families.

Personal religiosity: There appears to be an link between individual religiosity and whether someone is likely to experience delusions of persecution. Those who have a faith of personal importance are less likely to experience delusions of persecution compared to atheists. The percentages compiled from research were 73% among those with faith, versus 87% among atheists.

Males vs. females: There appear to be substantial differences between males and females in regards to experiencing persecutory delusions. Females with schizophrenia tend to experience delusions of persecution at a significantly greater rate (82%) than do males with schizophrenia (67%). Therefore a logical conclusion would be that females in general are more likely to exhibit this delusional subtype than males.

Source: http://www.ncbi.nlm.nih.gov/pubmed/20516758

Delusions of Persecution Symptoms

Those experiencing delusions of persecution will exhibit a variety of symptoms. To meet a formal diagnosis for persecutory delusions, a person must meet some psychological criteria. The psychiatric term “querulous paranoia” refers to the persecutory subtype of delusional disorder, and appears in the DSM as well as ICD.

2 Primary Elements (Persecutory Delusions)

There are two primary elements that need to be present in order to meet the formal diagnostic criteria for delusions of persecution.

Believing that harm is occurring, or will occur. Believing that a perceived persecutor holds the intention of inducing harm.

In addition to these two diagnostic elements, a person will generally exhibit an exaggerated belief of other criteria.

A grossly exaggerated belief of being:

Followed : An individual believes that they are being followed by another person, multiple people, or group. This may lead a person to constantly look over their shoulder, carefully analyze their environment for potential followers, or avoid going certain places.

: An individual believes that they are being followed by another person, multiple people, or group. This may lead a person to constantly look over their shoulder, carefully analyze their environment for potential followers, or avoid going certain places. Tormented : In some cases, a person may believe that another individual is out to torment them. This tormenting may be physical, psychological, or a combination of both. Someone may believe that they are going to be poisoned, physically wounded, or psychologically manipulated.

: In some cases, a person may believe that another individual is out to torment them. This tormenting may be physical, psychological, or a combination of both. Someone may believe that they are going to be poisoned, physically wounded, or psychologically manipulated. Tricked : Certain people may believe that they are being tricked, scammed, or lied to – which could result in financial loss or an impaired reputation. They could believe that a seemingly harmless person (e.g. a little girl selling cookies) is out to steal their money, take their home, or claim their vehicle.

: Certain people may believe that they are being tricked, scammed, or lied to – which could result in financial loss or an impaired reputation. They could believe that a seemingly harmless person (e.g. a little girl selling cookies) is out to steal their money, take their home, or claim their vehicle. Ridiculed : Those with persecutory delusions may think that others are mocking them or making fun of them, usually behind their back. They may believe that others are gossiping about them, laughing at them, and doing whatever possible to harm their reputation.

: Those with persecutory delusions may think that others are mocking them or making fun of them, usually behind their back. They may believe that others are gossiping about them, laughing at them, and doing whatever possible to harm their reputation. Spied upon: Some people experiencing persecutory delusions believe that they are being spied upon. They may believe that a person is spying on them through their window, has set up video surveillance, tapped their phone, or has installed a chip in their computer or phone to track their activity.

Examples of Persecutory Delusions

Below is a list of some common examples of persecutory delusions. Keep in mind that this is a short list and that many specifics regarding delusions of persecution are subject to significant individual variation.

Being followed: A very common example of a delusion of persecution is when an individual believes they are being followed, but they really aren’t. They may claim that a person is following them, but they haven’t got a good look at them, or may perceive a random stranger that coincidentally happens to be walking behind them as a follower.

Familial threats: There are episodes in which people believe that their family members are plotting against them in some way. This may result in the individual thinking that their family is attempting to steal their money, get them killed, or poisoned. Familial delusions have been reported, and can be highly distressing for the individual with delusions to see their family; especially on a daily basis.

Government spy: Some people are convinced that a government spy has set up cameras inside their house, car, and work to monitor their behavior. In addition to video surveillance, a person may believe that their TV and phone are bugged with microphones to hear every word they speak. They may see a man in a suit with glasses and believe that he works for the government and is on a special mission to monitor their life.

Murder attempts: In extreme cases of persecutory delusions, some people may believe that others have hired a hit-man to murder them. In other cases, they may believe that their own family or work colleagues are conspiring to have them killed. This results in paranoid behavior such as constantly checking who’s behind them, being careful of the food that they eat (for fear of poisoning), and looking out for traps.

Obstruction: In other cases, people think that others are deliberately attempting to inhibit them from accomplishing certain goals. Someone may think that their boss is trying to prevent them from getting a deserved raise. In other cases, they may believe that road construction was an operation to prevent them from making it to work on time.

Phone tap: Due to the fact that the government has actually tapped phones of individuals that may pose a security risk to the country, paranoid individuals get the idea that their phones have been tapped. They believe that their phone is being tapped to collect personal information that will be used against them. They believe that everything they say during a phone conversation will be used to harm their reputation.

Poisoning: A fairly common theme that individuals with delusions of persecution may experience is that of being poisoned or drugged. They may believe that a worker at a fast-food chain deliberately put arsenic in their sandwich in effort to poison them. In other cases, a person may believe that someone has spiked their water with a lethal dose of drugs, despite the fact that no one even touched it.

Police interest: Some themes of persecutory delusions involve individuals believing that they are being followed, watched, or are a special person of interest to the police. Each time a person sees a police officer and/or squad car, they may believe that the police were stationed in a particular area to stealthily monitor them.

Stalked: In many cases, people feel as if they are being stalked by someone, despite the fact that there’s no actual stalker. They may claim that their neighbor is spying on them and watching their every move, or that each time they go to the grocery store, they are being followed. They may even believe that someone is taking pictures of them in the grocery store and tracking each of the food items they purchase.

Talking behind your back: You may believe that people are talking behind your back, conspiring to get you fired from your job or harm your reputation. In some cases, the perception of persecution may become so vivid that people are saying mean things behind your back, that you may end up confronting them with anger and anxiety.

Source: http://www.ncbi.nlm.nih.gov/pubmed/13340385

Delusions of Persecution Treatment

There are several methods that can be used to treat delusions of persecution. The most common method involves prescribing an antipsychotic medication to reduce delusional occurrences. In addition, cognitive-behavioral interventions may help an individual learn effective coping strategies for when medications may not work effectively.

Antipsychotics: The most common medication utilized to treat delusions of persecution is that of an antipsychotic. Generally the newer, atypical antipsychotics are administered over typical (older) antipsychotics due to favorable side effect profiles and safety. These are drugs that tend to act as dopamine receptor antagonists, meaning they effectively bind to these receptors, without triggering the response that dopamine would produce. Hence they inhibit the effect of dopamine in the brain, reducing the likelihood of delusions – especially as a result of schizophrenia.

CBT: Cognitive behavioral therapy (CBT) is often a helpful intervention for teaching a person how to react when they find themselves fearing persecution. Although CBT may not be as much help for those with chronic psychiatric illnesses or severe schizophrenia, for others it may help teach them ways in which they can effectively cope with their faulty perceptions (delusions). In addition, CBT can be used in conjunction with antipsychotics to target cognitive and/or behavioral components of delusions.

Treating underlying medical condition: Those with conditions such as neurodegenerative diseases often benefit from treating their underlying medical condition. For example, someone experiencing delusions of persecution as a result of Parkinson’s disease may require a certain combination of medications to improve their mental well-being and functionality, which in turn may reduce delusions of persecution. Other neurological conditions should be properly treated, and in many cases, the persecutory delusions will subside.

Source: http://jnnp.bmj.com/content/76/suppl_1/i31.full

Have you (or someone you know) experienced delusions of persecution?

If you (or someone you know) have dealt with delusions of persecution, feel free to share the experience in the comments section below. To help others better understand the particular case, you may want to mention any specific themes that emerged from the delusion and what you believe was the causative factor for the persecutory delusion (e.g. mental illness, drugs, etc.). Also discuss how you (or the person you know) coped or overcame the persecutory delusion.

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