For example: a person suffering from delusions of persecution comes to the cinema, there are people around, whispering, accidentally glance at him, laugh, look at the screen. And the patient thinks that the spectators sitting in the hall are planning something bad against him and are agreeing on how to do it. The individual’s psyche is on edge, he cannot stand it and leaves the cinema without watching the film to the end.
The most famous patient with persecution mania is the great philosopher and writer Jean-Jacques Rousseau. After writing the book “Emil, or about education,” in which he proposed replacing repressive methods of education with encouragement and affection, he had serious conflicts with the church and state. Suspicious from birth, Jean-Jacques began to assume conspiracies against himself everywhere, because he believed that his acquaintances and friends were plotting evil. So, while wandering, one day he was visiting the castle, and at that time one of the servants died there. Russo demanded that the man be autopsied, confident that he was suspected of poisoning the man.
The first to describe delusions of persecution was the French psychiatrist Ernest Charles Lasegue in 1852. Physiologist Ivan Pavlov believed that its appearance is associated with such a chronic pathology as deviations in the functioning of the brain. This mental illness is considered one of the most severe and is considered in psychiatry as a manifestation of chronic psychosis - paranoia.
This disorder occurs in old age and accompanies a person until the end of his life, with alternating periods of remission and exacerbation.
The patient looks from the outside as a completely normal person, and he is aware of his actions. But he perceives reality inadequately and invents some facts. Rich imagination has nothing to do with it in this case. An individual’s “crooked logic” cannot be corrected from the outside - he does not listen to any arguments.
Paranoia develops: the patient is afraid to eat food (what if it is poisoned), cross the road (criminals in a car might hit you), etc. He seems to live in his own world, his thoughts are anxious, but his mind is quite clear. Such a person diligently hides the “gnawing” fear inside himself, but tormented by fears and obsessive thoughts, he strives in every possible way to avoid a seemingly dangerous situation and protect himself.
Pursuant delusions can be an independent disorder or a symptom of any mental disorder, among which schizophrenia and Alzheimer's disease occupy the first places.
Persecutory mania, according to WHO, is diagnosed in 44 million older people worldwide. The majority of patients live in the USA (5.3 million pensioners aged 75 to 80) and Western Europe.
What is persecution mania?
Persecution mania (also called delusion of persecution) is a mental disorder in which a person thinks that someone is watching him with the aim of causing harm. The condition has another name - persecutory delirium (from the Latin word persecutio, meaning persecution).
The patient is sure that a certain group of people wants to do something bad to him. He sees enemies in neighbors, colleagues and even friends. Sometimes they are animals or inanimate objects. According to the person, they want to kill him, poison him, rob him, or simply mock him.
Let's give an example. Let's say someone diagnosed with persecution mania comes to the cinema to see their favorite film. Other spectators are sitting around him. Naturally, they laugh, talk, and glance at their neighbors from time to time. And there is nothing strange about this. But not for the patient. It seems to him that those around him are completely absorbed in him. They not only make fun of him, but also make plans to do something bad to him. Trying to avoid this fate, the individual gives up everything and leaves the session without seeing the long-awaited picture.
This is just one example. Men and women suffering from persecution delusions are simply obsessed with the idea of bringing their enemies to light. They become withdrawn and aggressive. Moreover, patients often write denunciations against so-called ill-wishers. And they are also trying with all their might to hide, covering their tracks, changing their usual routes, external data, transport, etc.
Persecutory delusions were first mentioned by Ernest Charles Lasegue, a psychiatrist from France, in 1852. A more detailed explanation was given by physiologist Ivan Pavlov. According to him, this disease is a consequence of disruption of certain parts of the brain.
The World Health Organization considers persecution mania to be a disease. According to statistics, this diagnosis has been confirmed in 44,000,000 patients worldwide. Most of them are elderly people suffering from schizophrenia or dementia. The pathology may also be a consequence of alcohol poisoning.
Interesting Facts
Many famous people have had persecution mania. Let's remember some of them.
Jean Jacques Rousseau - writer and philosopher. He saw secret conspiracies everywhere; it seemed that all his friends and acquaintances were against him. The illness manifested itself especially strongly after the publication of his book “Emil, or on education,” which caused a serious conflict with the church.
Edgar Allan Poe also had persecution mania. He was afraid of the dark because he believed that there were monsters and otherworldly forces lurking there who wanted to kill him.
How to behave with such a person
Philophobia - what kind of disease is it?
When communicating with a person suffering from delusions of persecution, it is undesirable to try to dissuade him. In this case, he may think that his interlocutor also poses some kind of threat to him.
Important! No one has yet been able to convince a person with delusions, although many of his relatives have such a dream.
With prolonged contact with a mentally ill person, you can borrow delusional experiences from him. This condition is called induced delusional disorder. If you often have to communicate with a sick person, you need to follow the rules of psychological hygiene, and also learn to track such delusional thoughts in yourself and transfer your attention to something else.
Person with fear of persecution
Otherwise, recommendations depend on the cause of the symptoms.
Causes
There is still no consensus on the reasons for the development of persecution mania. Some doctors talk about disruption of the functioning of certain parts of the brain, others associate the pathology with mental disorders.
And yet, we can identify a number of reasons that one way or another make a person feel the gaze of a pursuer everywhere:
- Genetic predisposition. If one of your relatives has delusions of persecution, the likelihood that it will appear in you also increases greatly.
- Paranoid schizophrenia, accompanied by auditory and visual hallucinations.
- Psychoses. We are talking about severe stress, loss of inner harmony, obsessive states.
- Increased anxiety. A person is so afraid of everything that he suspects everyone around him of bad intentions towards him. And bad thoughts become firmly entrenched in his head.
- Overdose of psychotropic medications.
- Drug addiction, excessive consumption of alcoholic beverages. In particularly severe cases or, conversely, with a sharp withdrawal from these substances, anxiety and excessive restlessness develop. And this is a direct path to the emergence of persecution mania.
- Age-related changes, such as senile dementia associated with Alzheimer's disease and other similar disorders.
- Atherosclerosis, which is characterized by a decrease in the patency of blood vessels.
- Traumatic brain injuries in which damage to the brain occurs. Delusions of persecution appear if the left hemisphere, associated with cognitive processes, is injured.
There are also several factors that provoke the development of persecution mania:
- Victim complex. Humiliation and criticism over a long period of time convince a person that he is always wrong in everything. This thought is so firmly fixed in his mind that he is simply afraid to do something. As a result, he not only refuses to make decisions, but also begins to blame everyone around him for his troubles. And this despite the fact that most often it’s all his own fault.
- Faith in fate. Persecution mania develops in those people who are confident that their lives are controlled by foresight, circumstances, or some supernatural forces. This is called external locus of control.
- Learned helplessness. This is a feeling of powerlessness, which is the main companion of the victim complex. The person doesn’t even take the circumstances into account. He simply convinced himself that he couldn't change anything.
Here we can add a defensive position, in which the individual perceives any words and phrases spoken to him as a threat.
Risk factors
There is a theory that one of the factors that can contribute to the development of persecutory delusions is an innate feature of the human nervous system. It manifests itself in increased sensitivity, emotionality, and a tendency to exaggerate.
Particularly susceptible to the development of the disorder are people who in childhood experienced hypercontrol in their upbringing or ignorance from loved ones, which further contributes to the development of a victim complex and delusions of persecution. Failure in the nervous system can also occur under the influence of traumatic situations.
Some researchers believe that risk factors for the disease come down not only to a person’s upbringing and traumatic events from his childhood, but also to the functioning of the brain. This theory is based on the discoveries of physiologist Ivan Pavlov, who believed that human behavior changes under the influence of pathological activity of parts of the brain.
Symptoms
Like any other mental disorder, persecution mania has its own signs and symptoms. There are several of them:
- unmotivated aggression;
- isolation;
- the desire to protect oneself from society;
- incessant anxiety;
- problems sleeping, lack of appetite;
- confidence that the people around are traitors, enemies, ill-wishers;
- search for secret meaning in any situation;
- inability and unwillingness to admit the presence of the disease.
As mentioned above, another sign is attempts to confuse pursuers by changing routes, encrypting records and other similar actions.
Types of persecution mania
There are seven types of pathology. For clarity, let's place them in the table:
| View | Manifestations |
| Damage to property | It seems to a person that the offenders want to rob him or simply ruin his things or home |
| Poisoning | Obsessive thoughts about poisoning make you wary of any food and drinks not at home |
| Querulantism | The patient fights for his rights and interests, turning to various authorities and government bodies for help. |
| Jealousy | The partner has to endure frequent scenes of jealousy, even in cases where he does not give a reason for them. Confidence in treason forces a person to arrange checks and interrogations |
| Dramatizations | Quite an interesting type of persecution mania. The patient believes that life is a theatrical stage, people are actors, and the surrounding reality is good scenery. Everything that happens to him seems to be either a funny experiment or a show in which he himself plays the main role |
| Doubles | An individual may see a friend or acquaintance in a complete stranger. And then you won’t recognize him, thinking he’s someone who has good makeup applied to him in order to deceive him |
| Accusations | The patient is confident that others evaluate and criticize his every step |
Development mechanism
Persecution mania develops in stages. At first, the patient feels only slight anxiety, distrust of others, and withdraws into himself. He avoids large crowds and does not make new acquaintances. This is the first stage, which is called primary disorders.
The second is characterized by pronounced isolation from society. The patient is easily excited and becomes aggressive, which causes problems in his personal life and at work.
The third stage of persecution mania is the peak of exacerbation. Accompanied by persistent fear for one’s life and attempts to hide from imaginary pursuers. During this period, even family and friends seem to be enemies. The main danger is the possibility of harming both yourself and those around you.
Stages
The disease develops in stages: at first there is only one imaginary enemy, but soon there is a whole district. The symptoms of persecution mania grow spontaneously, so at the first signs of paranoia you cannot remain inactive. So:
- Delusional mood. Unreasonable anxiety appears, the person withdraws into himself, strives for solitude and loneliness.
- Delusional perception. The patient becomes an antisocial person, communicates less often with relatives, stops contacts with friends, and quits work.
- Delusional interpretation. Internal fear becomes unbearable, extraneous sounds are heard, unfamiliar personalities are seen. Attacks of insanity become more frequent, and the likelihood of a suicide attempt is high.
- Crystallization of delirium. Delirium takes on a real form, and the person lives in his own limited world, full of internal fears, panic and phobias. It is impossible to get him out of this state without a course of medication.
- Attenuation of delirium. The patient gradually begins to understand the falsity of his manic thoughts and ideas, returns to a normal state, and can give an adequate assessment of life events and circumstances.
- Residual delirium. This is a residual phenomenon after former paranoia, which progresses exclusively under the influence of alcoholic beverages and the use of psychotropic substances.
A man lives in a world that is dangerous to himself, his nerves are on edge. Horrifying conversations about a potential threat become constant, crowding out other thoughts from consciousness. In order not to harm themselves and others, the patient needs a comprehensive diagnosis and hospitalization.
Consequences
Ignoring the signs of the disease and lack of proper treatment entails a lot of trouble. Here are some of them:
- inability to distinguish the real world from the fictional one;
- constant anxiety due to thoughts about imaginary danger around;
- isolation, almost complete isolation, refusal to eat, insomnia;
- aggression towards others.
In especially severe cases, for example, with an exacerbation of delusional thoughts, suicide attempts are possible.
Diagnostics
A psychotherapist or psychiatrist must make a diagnosis of persecution mania. You should consult a doctor as soon as the first alarming symptoms appear, as they will worsen over time.
First of all, the doctor will talk with the patient. He will assess your condition based on your symptoms and their severity. Typically, such patients are constrained, look around suspiciously, withdrawn and reluctant to make contact. It also happens that they flatly refuse to talk to a specialist and ask to close windows and doors in order to protect themselves.
The next stage of diagnosis is a consultation with a psychotherapist. The main goal of the event is to identify concomitant diseases, in particular, mental disorders, addiction to alcohol and drugs. Perhaps a person has real reasons to be afraid of others. We are talking about debts, past crimes, revenge, problems with the law, etc. In these cases, you may need the help of specialists in other fields, for example, lawyers.
And finally, testing. Specially selected questions help assess a person’s personal characteristics, his ability to communicate with society, and his state of mind. Typically, psychotherapists and psychiatrists use the Cattell Multifactor Questionnaire, which consists of 187 questions. In addition to it, interpretation tests, drawing tests, as well as memory and thinking tests are used.
During one of these tests, the patient is asked to consider several everyday situations with other people and describe them, coming up with a story for each. Depending on the answers, the specialist decides to make a diagnosis of “persecution mania.”
Therapy
Persecutory mania, the symptoms and signs of which must be detected in the early stages of the disease for more effective treatment, can be treated using various methods. The main method of working with patients with persecutory delusions is psychotherapy; sometimes in advanced stages of the disease the patient is prescribed medication.
Electroconvulsive therapy is an effective and safe treatment for many mental disorders, but its use is controversial. The choice of treatment method for persecutory delusions depends on the complex of therapy prescribed only by the attending physician; self-treatment can significantly worsen the patient's condition.
Psychotherapy
The most famous and effective treatment for persecutory delusions is cognitive behavioral psychotherapy. Its course can last from 7 to 20 sessions, depending on the severity of the disorder and the patient’s desire to work with a doctor.
During the sessions, the doctor tries to explain to the patient his incorrect perception of the world around him, which causes a feeling of fear and a sense of persecution and anxiety. As a result of therapy, the patient learns the mechanisms by which his feelings arise and learns to control his feelings.
There is also a psychoanalytic approach that sees the problem of the emergence of panic, anxiety and fear in a person’s intrapersonal conflicts. To recognize the patient’s internal conflict, the doctor uses the technique of projection and transference, and after identifying the necessary elements of subconscious contradictions, he tries to show them to the patient.
As a result of therapy, the patient develops self-awareness, understanding and the ability to analyze the motives of his actions. In this way he learns to control his emotions and know the source of their occurrence.
Family therapy and art therapy are also effective. These methods are additional, but quite effective for working through your emotions and relationships with people.
Delusion of persecution is a difficult disease for the patient’s loved ones to accept, so family therapy will help establish contact between the patient and his family. Art therapy is a way for the patient to express his emotions through creativity, which is an important additional part of basic psychotherapy.
Use of medications
The use of medications during persecutory delusions depends on whether the illness is a consequence of another mental disorder or abnormality. Also, the taking of medications is influenced by the individual characteristics of the patient, the severity of delirium and the adequacy of the patient, so medications are prescribed exclusively by the attending physician.
The most commonly prescribed drugs during the treatment of persecutory delusions and related diseases:
- Phenazepam. The drug is prescribed in the early stages of the disease and helps relieve symptoms such as anxiety, tension and depression.
Phenazepam is a sedative pill that relieves anxiety symptoms associated with persecutory mania. - Alimemazine, thioridazine, quetiapine. These antipsychotics should be used only during acute attacks of panic attacks and anxiety. They perform only the function of suppressing anxiety, without relieving other symptoms. Neuroleptics have side effects such as lethargy, lethargy and hormonal changes.
- Risperpet. The drug is prescribed only for acute forms of schizophrenia and inhibits the active development of symptoms of the disease, eliminates hallucinations, delusional states, increased aggression and depression.
- Clonazepam, oxazepam. The drugs can quickly relieve the patient of anxiety symptoms and are used at the very beginning of treatment. Remedies are not the only drugs prescribed; they are used in combination and in special dosages with other antidepressants, which is associated with the likelihood of the patient becoming dependent on tranquilizers.
- Lithium preparations. Psychotropic lithium drugs are taken during periods of mania. Its action is aimed at reducing impulsivity and aggression, but the effect begins to appear only on the 5th day of administration, so the drug is used as an additional remedy in combination with other medications.
- Cyclodol. The medicine is taken to eliminate the patient’s motor disorders, which often occur during an exacerbation of schizophrenia. Cyclodol is prescribed for the treatment of muscle stiffness, tremors and various spasms.
- Fluoxetine, Zoloft, Prozac. The drugs are classified as antidepressants and are most often prescribed during periods between exacerbations of the disease. Medicines are necessary to improve mood, eliminate sleep problems and generally improve the patient’s psychological state.
Electroconvulsive therapy
Electroconvulsive therapy (ECT) has at various times been considered a violent, unsafe way to treat mentally ill patients. Despite this, ECT is now considered effective in treating severe mental disorders.
Indications for electroconvulsive therapy are:
- depression (severe forms of the disease, suicide attempts);
- bipolar disorder (a disease with rapidly alternating cycles of depression and mania, psychotic symptoms, suicidal tendencies);
- schizophrenia (acute schizophrenia in combination with severe psychosis, catatonic syndrome (motor disorder)).
Electroconvulsive therapy can be effective in treating persecutory delusions, most often when they are combined with symptoms of schizophrenia.
The mechanism of action of ECT is not fully understood, but the therapy is known to affect components of the central nervous system. After a therapy session, the neurotropic factor of the brain changes, that is, a human protein that acts on certain neurons of the central and peripheral nervous systems, as a result of which its level changes.
Contraindications for electroconvulsive therapy:
- diseases of the field of cardiology (volumetric intracranial processes);
- neurological abnormalities (angina pectoris, heart failure, arterial hypertension, ventricular arrhythmias);
- mental disorders (obsessive-compulsive disorder);
- autonomic failure;
- diabetes;
- metabolic disorders;
- chronic obstructive pulmonary disease;
- renal failure;
- gastroesophageal reflux disease.
Side effects of electroconvulsive therapy:
- memory loss;
- convulsive attack;
- sinus tachycardia;
- hypertensive attacks;
- headache;
- mania;
- sleep disorder;
- disturbances of consciousness.
