Persecutorios

Persecutorios, in clinical English known as persecutory delusions, are fixed, false beliefs that one is being persecuted, harmed, spied on, or conspired against by others or by external forces, despite evidence to the contrary. They are a common symptom of psychotic disorders and can occur in schizophrenia spectrum disorders, delusional disorder, bipolar disorder with psychotic features, and substance-induced psychosis. They may also appear during severe mood or anxiety episodes.

Clinical features: The belief is held with absolute certainty and is not easily swayed by contrary evidence. Content typically involves surveillance, harassment, conspiracy, or plotting against the individual. The delusion can be non-bizarre or elaborate and often causes distress and impairment, including social withdrawal and safety concerns.

Causes and risk factors: Neurobiological factors such as dopaminergic dysregulation, genetic predisposition, and brain network abnormalities. Psychosocial stressors, trauma, and substance use (eg, cannabis, stimulants) can contribute. Co-occurring psychiatric conditions and medical illnesses may complicate presentation.

Diagnosis: Based on comprehensive clinical assessment. Differentiate persecutory delusions from cultural or religious beliefs, and from non-delusional suspiciousness. Delusional disorder requires at least one month of fixed persecutory belief without other prominent psychotic symptoms; other disorders require a broader psychotic symptomatology or mood disorder context.

Management: Pharmacologic treatment typically involves antipsychotic medication (often second-generation antipsychotics). Psychosocial interventions, including cognitive-behavioral therapy for psychosis (CBT-P), psychoeducation, and family involvement, can reduce distress and improve functioning. Address comorbid conditions, ensure safety, and support adherence.

Prognosis: Variable; some patients respond to treatment with reduced conviction and distress, while others experience persistent symptoms. Early detection and integrated care improve outcomes.