Common Themes of Delusions in Psychosis

List of some delusional themes in psychosis, e.g. persecutory, religious, grandiose, delusions of reference

Delusions are a type of abnormal thought content that involve false beliefs that are firmly held despite evidence to the contrary. They are idiosyncratic and can’t be accounted for by a person’s culture, religion, or level of education. They’re considered a type of psychotic symptom, which can occur in the context of various illnesses, including schizophrenia, schizoaffective disorder, delusional disorder, bipolar disorder, and major depressive disorder. While certain themes may be more common in certain disorders, simply knowing the content of someone’s delusional beliefs isn’t enough to determine what their diagnosis is.

We probably all believe things that are false, and we may be quite attached to those beliefs, but these are based in our understanding (however flawed) of reality, whereas delusions represent a greater disconnect from reality. “Normal” flawed ideas may come from believing information from unreliable outside sources, but psychosis is an inside-the-head process. While conspiracy theories, for example, tend to be shared by groups of people, shared delusional beliefs (as occurs in folie à deux) are quite rare. The journal article Understanding Delusions explores different theoretical perspectives on what constitutes a delusion.

Characterizing delusions

Delusions are loosely categorized as being bizarre (e.g. aliens sneaking into your house through the phone line and stealing your organs while you’re sleeping) or non-bizarre (things that are within the realm of possibility but not actually happening, like your neighbour setting up cameras inside your house). In the context of mood episodes, delusions may be categorized as mood-congruent or mood-incongruent.

People who experience hallucinations, which are perceptual disturbances in any of the five senses, may have delusional beliefs associated with those hallucinations, but not all people with delusions have hallucinations, and vice versa.

Sometimes, delusions are systematized, with delusional ideas built on top of one another to form a coherent, organized, and sometimes very elaborate belief system.

Common delusional themes

Persecutory

Persecutory delusions can involve the belief that one is being followed, spied upon, harassed, ridiculed, sabotaged, or poisoned, or that others are harming or attempting to harm the self in some other way. This is a common theme for delusions.

Religious

Religion is another common theme, and these kinds of delusions can occur whether people are or are not religious when they’re well. Delusional religiosity is a different creature than the view that some people have that religion in general is a delusion. Delusions deviate from beliefs and experiences that are framed as normal within one’s culture or faith system. Someone who’s experiencing religious delusions might believe that they are God, they are Jesus, they have special powers granted to them by God, or they have special knowledge that’s been imparted to them by God, angels, or other religious figures. These beliefs are not present when they’re well.

Katie R. Dale’s book But Deliver Me From Crazy is a good example of someone who has strong religious faith at baseline, but also experiences religious delusions in the context of manic psychosis, and these deviate from her normal beliefs.

An ex-boyfriend of mine had schizophrenia, and he had recurring religious delusions that involved belief about a special connection to Jesus and knowledge about things contained in the bible. When he was particularly unwell, he would write a lot about this (as in pages and pages for hours). Jesus as the lamb came up a lot, but overall, it didn’t make any sense, and I was never clear on exactly what it was that he believed. When he was doing well, he wasn’t religious.

Grandiose

While the phrase “delusions of grandeur” is sometimes used colloquially to describe people’s overestimation of their abilities, grandiose delusions are a marked departure from reality. This theme is common among people who experience psychosis as part of bipolar mania.

Grandiose delusions have a different flavour to them than narcissism. While excessive pride might mean someone consistently believes they’re such an amazing developer that they’re someone who can make the Metaverse really happen, delusions of grandeur could involve someone with no background in computing believing out of nowhere that they gave Mark Zuckerberg the idea for the Metaverse and have been a key technical advisor every step of the way.

Control

Delusions of control refer to beliefs about outside influences controlling one’s thoughts. These can involve thought insertion (the belief that thoughts are being put into one’s head), thought withdrawal (the belief that thoughts are being taken out of one’s head), or thought broadcasting (the belief that one’s thoughts are being broadcast to others). People may or may not have a sense of where this outside control seems to be coming from.

I experienced thought insertion at one point where it felt like rules were put in my head (not from an identifiable source) for things I had to do.

Delusions of reference

Delusions of reference involve things in the environment having special meanings or messages directed towards the self. Examples include believing that someone on tv is sending coded messages to you through what they’re saying, or believing that items you see when you’re out for a walk have been placed there especially for you.

I’ve had delusions of reference before, and it’s creepy.

Somatic

Somatic delusions involve things that are going on with the body. This can involve things that are happening inside the body or on the outside of the body. This is different from health anxiety, which involves anxious concerns about things that might be happening; rather, it’s a certainty that things are happening. There may be anxiety that arises from that certainty, but anxiety is not the core issue.

Delusional parasitosis is the term for beliefs about things like critters burrowing into the skin; this may be accompanied by tactile hallucinations.

Jealousy

Delusional jealousy is the idea that one’s partner is cheating kicked up to an extreme level.

Guilt

Like delusional jealousy, delusional guilt takes a normal experience to extremes. This delusional theme is common in psychotic depression.

I’ve apparently had this before, although I don’t remember it. It doesn’t surprise me, though, as guilt can get pretty intense when I’m not decntly medicated.

Erotomanic

Erotomanic delusions involve the belief that another person, often someone famous, is in love with oneself. Acting on them can produce stalker-ish behaviour.

Rarer delusional themes

Capgras delusions

These involve the belief that familiar people have been replaced by imposters.

Fregoli delusions

These involve the belief that unfamiliar people are actually familiar people in disguise.

Nihilistic delusions

These involve beliefs about the self or parts of the self not being real. People with Cotard delusions believe that they’re already dead.


Delusions usually aren’t fun (although occasionally people do have delusions they experience in a positive way), but I find them quite fascinating. The border between “normal” skewed reality and psychotic disconnect from reality can be a blurry one sometimes, but when people are really ill, it can be quite clear to observers that reality has left the building entirely. When I was a nurse, the patient population I most enjoyed working with was people experiencing psychosis, because I just find it so interesting how the psychotic mind works.

If you’ve experienced delusional thinking before, which of these themes have your delusions tended towards?

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30 thoughts on “Common Themes of Delusions in Psychosis”

  1. I believed people arounde were acting and I was being followed and filmed for entertainment. Like the Truman show. It is not uncommon. I also had delusions of reference where everything in the media and my environment were messages. It was exhausting trying not to miss anything.

    I thought it was a special power being able to detect messages and that I would be rich. I have thought my family were imposters or controlled.

    I also have auditory hallucinations of people I know. All together it was not unpleasant for the most part but very distracting

  2. I’m not aware of being delusional myself. However, several family members experienced that and I have no idea how to respond in those situations.

    At one time my brother believed there was someone in the radio who was listening to him.

    My mother-in-law accused me of taking her boots and replacing them with an exact replica. She thought people were always talking about her in a persecutory manner.

    My daughter, who is obese, accused me of starving her and thought she was starving to death. She also believed her boyfriend’s grandma was bugging her car. At times she believed I was out to get her which was very difficult because I knew she was psychotic and needed help. When I tried to reach out to her psychiatric nurse and doctor, that furthered her belief I was trying to get her. She believed she knew special things about people just by looking at their pictures.

    I’ve had other family members with persecutory beliefs that someone is trying to hurt a pet or their significant other which may be fueled by drinking too much. But sober these people don’t seem to be delusional at all.

      1. It’s very scary as a parent. She hasn’t been delusional for a couple months now. I’m grateful for times like these. But I’m always watchful for the pendulum to swing the other way.

  3. We have persecutory delusions and ones similar to Fregoli. We see people on occasion that one of us will think is another one of us, outside the body, walking around. Usually it’s Younger people who are real that younger us’s confused as being other us’s. Quite unsettling especially when they first started.

    We do think things and people and systems and nature conspire against us when it’s late at night or we’re under-rested and can’t understand or explain our ineffectiveness

  4. When my depression was at it’s worst, I had some fleeting psychotic-type thoughts, too brief to really be sure if they were psychotic or just random thoughts. A couple of times I thought I was the Messiah and a couple of times I thought I was dead.

    This post reminded me of one of my favourite authors, Philip K. Dick, who had psychotic experiences where he thought God was talking to him, or aliens were talking to him, or both. He spent the last eight years or so of his life trying to come to terms with this in his novels, particularly Radio Free Albemuth, VALIS and The Divine Invasion. They’re weird books mixing traditional science fiction tropes with paranoid gnostic religious ideas. I like them, particularly VALIS although I think lots of people find them unreadable.

    Dick also wrote an enormous (thousands of pages long) “Exegesis” trying to work out what it all meant. Only a fraction of this has been published (there’s short excerpts in VALIS and someone published a bigger chunk, which I haven’t read). As I recall, it’s weird because he’s arguing for ideas that are clearly irrational (time stopped when the Jewish Temple was destroyed in 70CE; the Roman Empire never fell; Richard Nixon is the anti-Christ; God is about to send help via aliens from another solar system), but because he’s a good writer and it doesn’t necessarily read like stereotypically “crazy person’s” writing, stylistically. It makes a kind of internal sense, despite not corresponding to reality. And then sometimes he thinks that maybe he is psychotic after all; Dick appears as two characters VALIS, one who is sane and one who isn’t.

  5. I experience and have experienced the gamut of delusions. That’s, after all, schizophrenia. It sucks, and yes, sometimes I can get out of it. Sometimes, it’s a little more difficult too.

    My doctor has said… be like a cloud and what do clouds do?

    They pass by…

    I’m probably messing this up, but the bottom line is…

    Let your thoughts pass by.

  6. I have lived with people who had both somatic delusions and convictions that the house was overrun with vermin and to about to fall down from disrepair. Professional building inspectors were called in, and everything was clear. That was stressful enough and I can only imagine what it must be like to actually experience said delusions.

  7. I don’t have a mental illness causing delusions, but I struggle with thinking people hear my thoughts. Logically I know they can’t but I have an irrational fear they can find out somehow. I realized I have an issue when I was listening to music from my phone’s speaker held up to my ear. It was on the lowest sound setting and there was music playing from the overhead PA system so I know that no one could hear it. But when I held it up to my ear, I was sure everyone could hear it, but when I held it away, you couldn’t. It bothered me so much because I knew it was totally illogical but it just felt like if I could hear it, so could they.

    1. I have this sometimes too. I also have thoughts that I am on a TV show that the world is watching like the Trueman show. That may just be paranoia

  8. Having been diagnosed bipolar since 1985 I have lived through many of the delusions you reference. For me, I don’t like delving into them much because they are examples of my worst possible self. I do however continue to seek forgiveness of self for having these experiences though they are not really my “fault.”. They are not fun to have at all and make me doubt how much in control I am of myself. And that festers.

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