He Persecution delirium Or persecutory delirium is a set of delusional ideas in which the person believes he is being persecuted. Thus, this psychopathological alteration is characterized by a series of irrational thoughts.
Specifically, the individual who has a delusion of persecution may believe that someone is chasing him to do him harm. Likewise, you may also believe that different people or organizations"go for it"or follow you constantly to attack you.
Delirium is often experienced with much anxiety And can totally affect the subject's life. The individual can adapt all his behavior around his delusions of persecution.
This psychotic condition is considered to be a highly serious and disabling alteration that can endanger both the life of the subject and that of others. People who suffer from it can be totally unpredictable in their actions because they are governed by delusional thinking.
For this reason, it is highly important to intervene as soon as possible by pharmacological treatment that allows attenuation or remittance of delirium. Likewise, in some cases hospital admission may be necessary to contain and protect the person.
Definition of persecution delirium
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines delirium as"a false belief based on an incorrect inference relative to external reality, which is strongly held, despite the fact that almost everyone believes and despite What constitutes evidence or incontrovertible and obvious evidence to the contrary."
In other words, the delirium Is a totally irrational belief, which is not based on any aspect that can corroborate and that is maintained firmly despite the fact that multiple evidences show their falsity.
In view of all this, the delusion of persecution constitutes a false belief of being followed, spied, tormented, deceived or ridiculed by a person or a group of people.
The delirium of persecution constitutes a serious condition, since in the thought of the person an irrational thought is inserted. This condition makes all the mental processes of the subject can function around delirium.
However, delirium itself, does not constitute a psychopathology, but is a symptom, a manifestation of some psychological alteration.
In what diseases can appear delusions of persecution?
When it is only a symptom, when a delusion of persecution appears it is necessary to observe what type of psychopathological alteration responds.
Persecutory delirium is, according to DSM-IV-TR, the most common type of delirium in the paranoid schizophrenia , And one of the main symptoms of the disease. However, it is not only in this pathology that delusions of persecution can develop.
He Schizoaffective disorder , he Delusional disorder , he Bipolar disorder Or severe depressive episodes can also lead to delusions of persecution.
Other pathologies in which these delusions can be found among their symptomatology are: delirium, dementia , Schizophreniform disorder , Brief psychotic disorder and psychotic disorder due to medical illness.
Finally, it should be noted that the use of psychoactive substances can also lead to the emergence of delusions of persecution.
In these cases, the acceleration can appear acutely only when the Effects of the drug Or develop a substance-induced psychotic disorder, in which delirium persists once they have remitted the effects of the drug.
Characteristics of persecution delirium
People suffering from delusions of persecution present alterations in the content of thought. These alterations occur due to false or distorted interpretations of external situations that have occurred.
For example, in front of a person who crosses the gaze walking down the street, the individual with delirium of persecution may believe that he is watching him. When you look around you see a person leaning on a balcony, and this adds to his delirium, believing that she is also watching him.
The associations made in the delirium of persecution can be highly disjointed and motley. Thus, no specific stimulus is required for the subject to associate directly with their delusion.
Among the most common thoughts of the delirium of persecution are:
1- Ideas of being followed
It is the most typical and is characterized by the belief that other people are constantly following.
The subject may believe that any person who observes (or is not even able to see) is constantly followed. Usually, persecution is usually associated with harm. That is, other people follow him with the aim of killing him, ending him or causing him some kind of harm.
2- Ideas to be tormented
It is also often quite common for ideas of torment or continual harm to appear in the delirium of persecution. The person may believe that people who spy on him make life impossible and constantly hurt him.
In this sense, any type of connection can also appear. The person may believe that he always loses the bus because of people who spy on him or find his wallet because they have stolen it.
3- Ideas to be spied on
Often the delirium of persecution is not limited to persecution, but transcends espionage. In fact, the most common thing is that the person who suffers from this alteration does not only think that they follow him, but also constantly spy on him.
This factor makes people feel highly insecure and very anxious. They believe that in any situation they can be controlled and spied on, which is why people with delusions of persecution often try to hide constantly.
4- Ideas to be ridiculed
The last aspect that can appear in the thought of a delusion of persecution is the possibility of being ridiculed or deceived. The person may believe that there is a plot against him and that he wants to always leave him in bad place.
Types of persecutory delirium
In general, the delusion of persecution can be divided into two main types: delirium in physical form and delirium in psychic form.
In persecutory delirium in physical form, the subject feels controlled and cornered by people who want to cause him some harm. In this case, the subject fears of people who sees (or imagines) and is convinced that they persecute him to harm him.
In the delirium of persecution in a psychic way, however, the subject considers that the people who persecute him will attack him morally to discredit him.
Thus, in an individual does not fear that people go to him to cause him some real physical damage, but believes that these people constantly perform actions to ridicule.
Manifestations of the delirium of persecution
People with this type of delirium can manifest a large number of behaviors associated with it. In general, it is maintained that individuals with delusions of persecution have the following characteristics:
- They selectively address all threatening information.
- They are constantly rushing to make their conclusions, based on insufficient or nonexistent information.
- They believe that the people who follow him know where he is going, what activities he does and what goals he has.
- Exaggerate reality in an excessive way.
- They show very high levels of anxiety.
- They are constantly upset, restless and suspicious.
- They attribute negative events to external personal causes.
- He has great difficulties in conceiving the intentions, motivations and moods of other people.
Diagnosis
Stating that a particular idea refers to a delusion can be remarkably easy to see. However, to establish the diagnosis of delirium a series of steps must be followed.
In fact, the mere appearance of an extravagant idea or rationale does not, by itself, manifest the presence of delirium.
Thus, to guide the diagnosis of a delusion of persecution, three fundamental issues must be taken into account.
1- Confirm that there is a delusional idea
This first step is basic to be able to establish the diagnosis and requires the differentiation of the delusional idea of habitual beliefs. Thus, a differential diagnosis must be made between a delusional idea and an overvalued idea.
A certain belief may possess a certain real or rational basis and, from it, discern by different ways. In these cases we talk about overvalued ideas, which must be analyzed in detail to be differentiated from delusions.
In the delirium of persecution, there is no further explanation than that provided by the subject who suffers it. In this way, as soon as one delves into rational thoughts, they are quickly rejected by the individual.
In this sense, it is important to let the patient talk and propose alternative hypotheses, in order to observe the degree of conviction that the person has over belief.
In the delusions of persecution, both the irrationality and the degree of conviction in the belief is absolute, so that these two aspects must appear in order to be able to make its diagnosis.
2- Search for the cause of the delusion of persecution
The delirium of persecution is only a symptom, so for its correct diagnosis it is necessary to know what its response responds to.
Thus, in order to diagnose a tummy ache, its cause (gastrointestinal disorder, indigestion, contusion, etc.) must be investigated in order to establish the presence of the delirium of persecution, as well as the pathology that causes it.
The patient's overall condition and symptoms should be evaluated in order to diagnose some of the psychopathologies related to delirium.
The diagnosis of schizophrenia , Schizophreniform disorder , Schizoaffective disorder , Major depression or bipolar disorder are the main ones to keep in mind.
3- Detection of changes in the mood
The delirium of persecution can vary greatly depending on whether it is motivated by mood swings or not.
In the event that delusional ideas appear exclusively during episodes of Major depression , Mixed episodes or manic episodes, the diagnosis of mood disorder with psychotic symptoms will be made.
When the delirium of persecution appears without mood alteration, we will face a psychotic disorder: schizophrenia, schizophreniform disorder, schizoaffective disorder or delusional disorder.
4- Detection of possible substances or medical pathologies.
Finally, in some cases the delirium of persecution may appear as a direct effect of a substance or a medical illness.
For this reason, it is also necessary to psychoactive substances Consumed by the subject, as well as possible ingested medications.
Finally, certain organic diseases can also provoke delusional ideas, so a medical examination is required to rule out or diagnose this condition.
Treatment
The delusions of persecution need to be addressed as soon as possible, with the aim of stabilizing the patient and getting irrational beliefs forward.
Initial treatment should always be based on pharmacotherapy, through the use of medications Antipsychotics . Haloperidol, risperidone, olanzapine, quetiapine and clozapine are the most widely used.
These drugs should be monitored by thorough medical management and a correct diagnosis of delusions of persecution.
In the event that delusional ideas are caused by substance use or the direct effects of a medical illness, it will also be essential to treat these conditions because they are the cause of delirium.
When the subject has very high levels of anxiety or agitation, drugs are also usually given Anxiolytics , Such as Benzodiazepines . Also, in the presence of frank delusions, hospitalization is usually necessary to control symptoms.
Subsequently, it is convenient to add psychological treatment to pharmacotherapy, both through individual and family psychotherapy.
He Cognitive behavioral treatment Is usually a good tool to combat delusional ideas. Training in social skills , Treatment adherence therapy and rehabilitation measures are other treatments that are applied in subjects with schizophrenia.
Finally, it is important that the subject who has suffered a delusion of persecution to perform psychological monitoring to be able to detect as soon as possible the appearance of other outbreaks or delusions.
References
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