Persecutory delusion

Last updated

Persecutory delusion
Other namesParanoid delusion [1]
Specialty Psychiatry, clinical psychology   OOjs UI icon edit-ltr-progressive.svg
Symptoms False beliefs that one will be harmed, violent behaviour, theory of mind deficits, safety behaviours, low self-esteem, rumination
Complications Premature death, heart disease, diabetes, high blood pressure, anxiety, depression, sleep disturbance
CausesMental illness (schizophrenia, delusional disorder, schizoaffective disorder), emotional abuse, drugs and alcohol use, family history
Differential diagnosis Delusions of guilt or sin [1] and paranoid personality disorder
Treatment Antipsychotics, cognitive behavioral therapy, vitamin B12 supplements

A persecutory delusion is a type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an individual or a group of people. Persecution delusions are very diverse in terms of content and vary from the possible, although improbable, to the completely bizarre. The delusion can be found in various disorders, being more usual in psychotic disorders.

Contents

Persecutory delusion is at the more severe end of the paranoia spectrum and can lead to multiple complications, from anxiety to suicidal ideation. Persecutory delusions have a high probability of being acted upon, for example not leaving the house due to fear, or acting violently. The persecutory delusion is a common type and is more prevalent in males.

Persecutory delusions can be caused by a combination of genetic (family history) and environmental (drug and alcohol use, emotional abuse) factors. This type of delusion is treatment-resistant. The most common methods of treatment are cognitive behavioral therapy, medications, namely first and second generation antipsychotics, and in severe cases, hospitalization. The diagnosis of the condition can be made using the DSM-5 or the ICD-11.

James Tilly Matthews' illustration of a gang of spies using an "air loom" to torment him at a distance James Tilly Matthews Air Loom.jpg
James Tilly Matthews' illustration of a gang of spies using an "air loom" to torment him at a distance

Signs and symptoms

Persecutory delusions are persistent, distressing beliefs that one is being or will be harmed, that continue even when evidence of the contrary is presented. This condition is often seen in disorders like schizophrenia, schizoaffective disorder, delusional disorder, manic episodes of bipolar disorder, psychotic depression, and some personality disorders. [2] [3] Alongside delusional jealousy, persecutory delusion is the most common type of delusion in males and is a frequent symptom of psychosis. [4] [5] More than 70% of individuals with a first episode of psychosis reported persecutory delusions. [6] Persecutory delusion is often paired with anxiety, depression, disturbed sleep, low self-esteem, rumination and suicidal ideation. [3] [7] [8] High rates of worry, similar to those in generalized anxiety disorder, are present in individuals with the delusion, moreover the level of worry has been linked to the persistence of the delusion. [3] People with persecutory delusion have an increased difficulty in attributing mental states to others and oftentimes misread others' intentions as a result. [9] [5]

People who present with this form of delusion are often in the bottom 2% in terms of psychological well-being. [3] A correlation has been found between the imagined power the persecutor has and the control the sufferer has over the delusion. Those with a stronger correlation between the two factors have a higher rate of depression and anxiety. [8] In urban environments, going outside leads people with this delusion to have a major increases in levels of paranoia, anxiety, depression and lower self-esteem. [3] People with this delusion often live a more inactive life and are at a higher risk of developing high blood pressure, diabetes and heart disease, having a lifespan 14.5 years less than the average as a result. [10] [11]

Those with persecutory delusion have the highest risk of acting upon those thoughts compared to other type of delusions, such acts include refusing to leave their house out of the fear of being harmed, or acting violently due to a perceived threat. [12] [13] Safety behaviors are also frequently found — individuals who feel threatened perform actions in order to avert their feared delusion from occurring. Avoidance is commonly observed: individuals may avoid entering areas where they believe they might be harmed. Some may also try to lessen the threat, such as only leaving the house with a trusted person, reducing their visibility by taking alternative routes, increasing their vigilance by looking up and down the street, or acting as if they would resist attack by being prepared to strike out. [14]

Causes

A study assessing schizophrenia patients with persecutory delusion found significantly higher levels of childhood emotional abuse within those people but found no differences of trauma, physical abuse, physical neglect and sexual abuse. [15] Because individuals with the disorder tend to respond to the delusion with worry instead of challenging the content of the delusion, worry is responsible in developing and maintaining the persecutory thoughts on the individuals' minds. [3] [16] Biological elements, such as chemical imbalances in the brain and alcohol and drug use are a contributing factor to persecutory delusion. Genetic elements are also thought to influence, family members with schizophrenia and delusional disorder are at a higher risk of developing persecutory delusion. [17]

Persecutory delusions are thought to be linked with problems in self-other control, that is, when an individual adjusts the representation of oneself and others in social interactions. [note 1] Because of this shortcoming, the person might misattribute one's negative thoughts and emotions onto others. [18] Another theory is that the delusional belief arises due to low self-esteem. When a threat appear the person protect itself from negative feelings by blaming others. [19]

The development of these delusional beliefs can be influenced by a past history of persecutory experiences — being stalked, drugged or harassed. [1] Certain factors further contribute to this, including having a low socioeconomic status, lacking access to education, experiencing discrimination, humiliation, and threats during early life, and being an immigrant. [1] [20] [21]

Treatment

Persecutory delusion is difficult to treat and is therapy resistant. [22] Medications for schizophrenia are often used, especially when positive symptoms are present. Both first-generation antipsychotics and second-generation antipsychotics may be useful. [23] Since these delusions are often accompanied with worry, using cognitive behavioral therapy to tackle this thought has shown to reduce the frequency of the delusions itself, improvement of well-being and less rumination. [24] When vitamin B12 deficiency is present, supplements have shown positive results in treating those patients with persecutory delusion. [25] Virtual reality cognitive therapy as a way to treat persecutory delusion, has shown a reduction in paranoid thinking and distress. Virtual reality permits patients to be immersed in a world that replicates real life but with a decreased amount of fear. Patients are then proposed to fully explore the environment without engaging in safety behaviors, thus challenging their perceived threat as unfounded. [26]

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) enumerates eleven types of delusions. The International Classification of Diseases (ICD-11) defines fifteen types of delusions; both include persecutory delusion. They state that persecutory type is a common delusion that includes the belief that the person or someone close to the person is being maliciously treated. This encompasses thoughts that oneself has been drugged, spied upon, harmed, mocked, cheated, conspired against, persecuted, harassed and so on and may procure justice by making reports, taking action or responding violently. [27]

In an effort to have a more detailed criteria for the disorder, a diagnostic table has been advanced by Daniel Freeman and Philippa Garety. It is divided in two criteria that must be met: the individual believes that harm is going to occur to oneself at the present or future, and that the harm is made by a persecutor. There are also points of clarification: the delusion has to cause distress to the individual; only harm to someone close to the person doesn't count as a persecutory delusion; the individual must believe that the persecutor will attempt to harm them and delusions of reference do not count within the category of persecutory beliefs. [20]

See also

Notes

  1. ↑ For example, when empathizing with others, one's own mental and emotional state are temporarily put aside.

Related Research Articles

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are disorganized thinking and incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety, suspicion, or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself. Paranoia is distinct from phobias, which also involve irrational fear, but usually no blame.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized variously by hallucinations, delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin during young adulthood and are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially mood disorders, anxiety disorders, and obsessive–compulsive disorder.

A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other misleading effects of perception, as individuals with those beliefs are able to change or readjust their beliefs upon reviewing the evidence. However:

Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.

<span class="mw-page-title-main">Delusional disorder</span> Mental illness featuring beliefs with inadequate grounding

Delusional disorder, traditionally synonymous with paranoia, is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.

Richard Bentall is a Professor of Clinical Psychology at the University of Sheffield in the UK.

<span class="mw-page-title-main">Thought disorder</span> Disorder of thought form, content or stream

A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication. Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions—all disturbances of thought content and form. Two specific terms have been suggested—content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD: a disruption of the form of thought. Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses. Disorganized speech leads to an inference of disorganized thought. Thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. One of the first known cases of thought disorders, or specifically OCD as it is known today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy."

In psychology, schizotypy is a theoretical concept that posits a continuum of personality characteristics and experiences, ranging from normal dissociative, imaginative states to extreme states of mind related to psychosis, especially schizophrenia. The continuum of personality proposed in schizotypy is in contrast to a categorical view of psychosis, wherein psychosis is considered a particular state of mind, which the person either has or does not have.

Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people who have a psychotic disorder, specifically schizophrenia.

<span class="mw-page-title-main">Intrusive thought</span> Unwelcome involuntary thought, image or idea

An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive–compulsive disorder (OCD), Tourette syndrome (TS), depression, body dysmorphic disorder (BDD), and sometimes attention deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, post-traumatic stress disorder (PTSD), other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.

An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person hears a sound or sounds that did not come from the natural environment.

<span class="mw-page-title-main">Grandiose delusions</span> Subtype of delusion

Grandiose delusions (GDs), also known as delusions of grandeur or expansive delusions, are a subtype of delusion characterized by the extraordinary belief that one is famous, omnipotent, wealthy, or otherwise very powerful or of a high status. Grandiose delusions often have a religious, science fictional, or supernatural theme. Examples include the extraordinary belief that one is a deity or celebrity, or that one possesses fantastical talents, accomplishments, or superpowers.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.

<i>Doctoring the Mind</i> 2009 book by Richard Bentall

Doctoring the Mind: Why psychiatric treatments fail is a 2009 book by Richard Bentall, his thesis is critical of contemporary Western psychiatry. Bentall, a professor of clinical psychology, argues that recent scientific research shows that the medical approach to mental illness is fatally flawed. According to Bentall, it seems there is no "evidence that psychiatry has made a positive impact on human welfare" and "patients are doing no better today than they did a hundred years ago".

In cognitive therapy, decatastrophizing or decatastrophization is a cognitive restructuring technique to treat cognitive distortions, such as magnification and catastrophizing, commonly seen in psychological disorders like anxiety and psychosis.

<span class="mw-page-title-main">Elizabeth Kuipers</span>

Elizabeth Alice Kuipers is a professor of psychology at the Institute of Psychiatry, King's College London, and was head of the Psychology Department from 2006- 2012. Kuipers is a consultant clinical psychologist and until 2012, had an honorary appointment at the South London and Maudsley NHS Foundation Trust, working as part of the psychosis community mental health team in Southwark. She is a founding director of the PICuP clinic and was the chair of the NICE Schizophrenia Guideline update 2007-9 and the Psychosis and Schizophrenia update 2011-2014

Safety behaviors are coping behaviors used to reduce anxiety and fear when the user feels threatened. An example of a safety behavior in social anxiety is to think of excuses to escape a potentially uncomfortable situation. These safety behaviors, although useful for reducing anxiety in the short term, might become maladaptive over the long term by prolonging anxiety and fear of nonthreatening situations. This problem is commonly experienced in anxiety disorders. Treatments such as exposure and response prevention focus on eliminating safety behaviors due to the detrimental role safety behaviors have in mental disorders. There is a disputed claim that safety behaviors can be beneficial to use during the early stages of treatment.

Metacognitive training (MCT) is an approach for treating the symptoms of psychosis in schizophrenia, especially delusions, which has been adapted for other disorders such as depression, obsessive–compulsive disorder and borderline over the years. It was developed by Steffen Moritz and Todd Woodward. The intervention is based on the theoretical principles of cognitive behavioral therapy, but focuses in particular on problematic thinking styles that are associated with the development and maintenance of positive symptoms, e.g. overconfidence in errors and jumping to conclusions. Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+).

References

  1. 1 2 3 4 Bentall RP, Corcoran R, Howard R, Blackwood N, Kinderman P (2001-11-01). "Persecutory Delusions: A Review and Theoretical Integration". Clinical Psychology Review. PSYCHOSIS. 21 (8): 1143–1192. doi:10.1016/S0272-7358(01)00106-4. ISSN   0272-7358. PMID   11702511.
  2. ↑ Startup H, Freeman D, Garety PA (19 June 2006). "Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence". Behaviour Research and Therapy. 45 (3): 523–537. doi:10.1016/j.brat.2006.04.006. PMID   16782048.
  3. 1 2 3 4 5 6 Freeman D, Garety P (9 July 2014). "Advances in understanding and treating persecutory delusions: a review". Social Psychiatry and Psychiatric Epidemiology. 49 (8): 1179–1189. doi:10.1007/s00127-014-0928-7. PMC   4108844 . PMID   25005465.
  4. ↑ American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. doi:10.1176/appi.books.9780890425787. ISBN   978-0-89042-575-6. S2CID   249488050.
  5. 1 2 Freeman D (May 2007). "Suspicious minds: the psychology of persecutory delusions". Clinical Psychology Review. PSYCHOSIS. 27 (4): 425–457. doi:10.1016/j.cpr.2006.10.004. PMID   17258852.
  6. ↑ Freeman D, Bebbington P (1 March 2017). "Transdiagnostic Extension of Delusions: Schizophrenia and Beyond". Schizophrenia Bulletin. pp. 273–282. doi:10.1093/schbul/sbw191. PMC   5605249 . PMID   28399309 . Retrieved 2023-07-26.
  7. ↑ Bergstein M, Weizman A, Solomon Z (2008). "Sense of coherence among delusional patients: prediction of remission and risk of relapse". Comprehensive Psychiatry. 49 (3): 288–296. doi:10.1016/j.comppsych.2007.06.011. ISSN   0010-440X. PMID   18396189.
  8. 1 2 Hartley S, Barrowclough C, Haddock G (November 2013). "Anxiety and depression in psychosis: a systematic review of associations with positive psychotic symptoms". Acta Psychiatrica Scandinavica. 128 (5): 327–346. doi: 10.1111/acps.12080 . PMID   23379898. S2CID   27880108.
  9. ↑ Craig JS, Hatton C, Craig FB, Bentall RP (July 2004). "Persecutory beliefs, attributions and theory of mind: comparison of patients with paranoid delusions, Asperger's syndrome and healthy controls". Schizophrenia Research. 69 (1): 29–33. doi: 10.1016/S0920-9964(03)00154-3 . PMID   15145468. S2CID   7219952.
  10. ↑ "Ground-breaking Treatment Offers New Hope for Patients with Persecutory Delusions". Oxford University Department of Psychiatry. 9 July 2021. Retrieved 28 October 2022.
  11. ↑ Diamond R, Bird JC, Waite F, Bold E, Chadwick E, Collett N, Freeman D (1 August 2022). "The physical activity profiles of patients with persecutory delusions". Mental Health and Physical Activity. 23: 100462. doi: 10.1016/j.mhpa.2022.100462 . ISSN   1755-2966. S2CID   250250997.
  12. ↑ Wessely S, Buchanan A, Reed A, Cutting J, Everitt B, Garety P, Taylor PJ (July 1993). "Acting on delusions. I: Prevalence". The British Journal of Psychiatry. 163 (1): 69–76. doi:10.1192/bjp.163.1.69. PMID   8353703. S2CID   45346403.
  13. ↑ Keers R, Ullrich S, Destavola BL, Coid JW (March 2014). "Association of violence with emergence of persecutory delusions in untreated schizophrenia". The American Journal of Psychiatry. 171 (3): 332–339. doi:10.1176/appi.ajp.2013.13010134. PMID   24220644.
  14. ↑ Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PE, Dunn G (January 2007). "Acting on persecutory delusions: the importance of safety seeking". Behaviour Research and Therapy. 45 (1): 89–99. doi:10.1016/j.brat.2006.01.014. PMID   16530161. S2CID   23653063.
  15. ↑ Ashcroft K, Kingdon DG, Chadwick P (June 2012). "Persecutory delusions and childhood emotional abuse in people with a diagnosis of schizophrenia". Psychosis. 4 (2): 168–171. doi:10.1080/17522439.2011.619012. ISSN   1752-2439. S2CID   143518253.
  16. ↑ Freeman D, Dunn G, Startup H, Pugh K, Cordwell J, Mander H, Černis E, Wingham G, Shirvell K, Kingdon D (31 March 2015). "Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis". The Lancet Psychiatry. 2 (4): 305–313. doi:10.1016/S2215-0366(15)00039-5. PMC   4698664 . PMID   26360083.
  17. ↑ "Delusional Disorder: Causes, Symptoms, Types & Treatment". Cleveland Clinic. Retrieved 17 July 2023.
  18. ↑ Simonsen A, Mahnkeke MI, Fusaroli R, Wolf T, Roepstorff A, Michael J, Frith CD, Bliksted V (2020-01-01). "Distinguishing Oneself From Others: Spontaneous Perspective-Taking in First-Episode Schizophrenia and its relation to Mentalizing and Psychotic Symptoms". Schizophrenia Bulletin Open. 1 (1). doi: 10.1093/schizbullopen/sgaa053 . hdl: 1893/31882 . ISSN   2632-7899.
  19. ↑ Bentall RP, Corcoran R, Howard R, Blackwood N, Kinderman P (November 2001). "Persecutory Delusions: A Review and Theoretical Integration". Clinical Psychology Review. 21 (8): 1143–1192. doi:10.1016/S0272-7358(01)00106-4. PMID   11702511.
  20. 1 2 Freeman D, Garety PA (November 2000). "Comments on the content of persecutory delusions: Does the definition need clarification?". British Journal of Clinical Psychology. 39 (4): 407–414. doi:10.1348/014466500163400. PMID   11107494.
  21. ↑ Fuchs T (1999). "Life Events in Late Paraphrenia and Depression". Psychopathology. 32 (2): 60–69. doi:10.1159/000029069. ISSN   0254-4962. PMID   10026450. S2CID   28553128.
  22. ↑ Fried EI, Koenders MA, Blom JD (August 2021). "Bleuler revisited: on persecutory delusions and their resistance to therapy". The Lancet. Psychiatry. 8 (8): 644–646. doi: 10.1016/S2215-0366(21)00240-6 . hdl: 1887/3447591 . PMID   34246325. S2CID   235796615.
  23. ↑ Garety PA, Freeman DB, Bentall RP (2008). Persecutory delusions: assessment, theory, and treatment. Oxford [Oxfordshire]: Oxford University Press. p. 313. ISBN   978-0-19-920631-5.
  24. ↑ Freeman D, Dunn G, Startup H, Pugh K, Cordwell J, Mander H, et al. (April 2015). "Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis". The Lancet. Psychiatry. 2 (4): 305–313. doi:10.1016/S2215-0366(15)00039-5. PMC   4698664 . PMID   26360083. S2CID   14328826.
  25. ↑ Carvalho AR, Vacas S, Klut C (April 2017). "Vitamin B12 deficiency induced psychosis–a case report". European Psychiatry. 41 (S1): S805. doi:10.1016/j.eurpsy.2017.01.1557. S2CID   79628360.
  26. ↑ Freeman D, Bradley J, Antley A, Bourke E, DeWeever N, Evans N, et al. (July 2016). "Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction". The British Journal of Psychiatry. 209 (1): 62–67. doi:10.1192/bjp.bp.115.176438. PMC   4929408 . PMID   27151071.
  27. ↑ "MB26.07 Persecutory delusion". ICD-11 for Mortality and Morbidity Statistics. World Health Organization. 1 January 2022. Retrieved 25 October 2022.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.