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Advances in understanding and treating persecutory delusions: a review
Open accessAbstract
PURPOSE: Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an introduction to the understanding of persecutory delusions, highlight key putative causal factors that have the potential to be translated into efficacious treatment, and indicate future research directions. METHODS: A narrative literature review was undertaken to highlight the main recent areas of empirical study concerning non-clinical and clinical paranoia. RESULTS: Six main proximal causal factors are identified: a worry thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Each has plausible mechanistic links to the occurrence of paranoia. These causal factors may be influenced by a number of social circumstances, including adverse events, illicit drug use, and urban environments. CONCLUSIONS: There have been numerous replicated empirical findings leading to a significant advance in the understanding of persecutory delusions, now beginning to be translated into cognitive treatments. The first trials specifically focussed on patients who have persecutory delusions in the context of psychotic diagnoses are occurring. Initial evidence of efficacy is very promising.
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![Fig. 1 The distribution of total paranoia scores in the general population [15]](/paper-figures/87ad0b497ded46b4bfb6778576ff43c1/advances-in-understanding-and-treating-persecutory-delusions-a-review-figure-1.jpg)
![Fig. 2 The paranoia hierarchy [14]](/paper-figures/c80ae724d67c458d97361c81d531b206/advances-in-understanding-and-treating-persecutory-delusions-a-review-figure-2.jpg)
![Fig. 3 Outline of factors involved in delusion formation [31]](/paper-figures/4f71774d34e849a7ac745e505fdbf7d4/advances-in-understanding-and-treating-persecutory-delusions-a-review-figure-3.jpg)
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“Likewise, cognitive models of psychosis [23] emphasise the role of emotional processes, particularly anxiety, in the onset and maintenance cycle of psychotic symptoms [5, 24].”
From A brief CBT intervention for depersonalisation/derealisation in psychosis: Study protocol for a feasibility randomised controlled trial (2016) · cites this paper as [5]
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Metadata
- Authors
- Freeman, D., & Garety, P.
- Affiliations
- Warneford Hospital (GB)
- King's College London (GB)
- Corresponding author
- Freeman, Daniel
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2014-07-09
- Volume
- 49
- Issue
- 8
- Pages
- 1179-1189
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- PMC
- PMC4108844
- OpenAlex
- W2013939918
- Cited by
- 348
- References
- 157
- Citations by year
- 2026: 14 · 2025: 23 · 2024: 24 · 2023: 22 · 2022: 18 · 2021: 22 · 2020: 36 · 2019: 41 · 2018: 37 · 2017: 43 · 2016: 35 · 2015: 29 · 2014: 4
- FWCI
- 5.09
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research (NF-SI-0510-10121)
- King's College London
- Medical Research Council (G0902308)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Keywords
- persecutory delusions, paranoia, negative self-beliefs, interpersonal sensitivity, sleep disorders, reasoning biases, cognitive intervention, psychosis, illicit drug use, urban environment, life events
- MeSH terms
- Adult, Aged, Anxiety, Culture, Delusions, Female, Humans, Internal-External Control, Male, Middle Aged, Paranoid Disorders, Psychotic Disorders, Risk Factors, Schizophrenia, Paranoid, Severity of Illness Index, Thinking, Cognitive Behavioral Therapy
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