Persecutory delusions can be one of the most challenging psychotic symptoms of Parkinson’s disease (PD). This is true for people living with Parkinson’s and for their family members and caregivers. It’s something that many MyParkinsonsTeam members struggle with.

“Delusions, delusions, delusions,” wrote one MyParkinsonsTeam member who is a caregiver for a relative with Parkinson’s. “Off to a bad start 🙁.”

Delusions vs. Hallucinations

Delusions and hallucinations are two symptoms of Parkinson’s disease psychosis (PDP). This is when some people with Parkinson’s have trouble distinguishing reality from things that are imagined. PDP consists of nonmotor symptoms of psychosis that affect the mind rather than the body.

In hallucinations, people perceive things that are not there. They can involve all five senses: visual, auditory, smell, taste, and touch.

People who experience persecutory delusions may exhibit outbursts of anger, agitation, or violent behavior.

On the other hand, delusions are irrational beliefs in which someone strongly believes something that is not true or evidence-based. Researchers have found that persecutory delusional beliefs are the most common type of delusion in people with Parkinson’s. They occur when someone falsely believes that others are treating them badly or taking advantage of them.

Delusions can take various forms and may include:

• Delusions of grandiosity or self-importance
• Delusions of jealousy and infidelity
• Capgras delusions (believing an imposter has replaced someone)
• Delusions of being persecuted, or persecutory delusions, in which a person believes that someone is trying to harm them or people around them

“I began to have delusions. I thought that my children were taking money from me,” one MyParkinsonsTeam member wrote.

Understanding Persecutory Delusions in Parkinson’s

It’s been estimated that 38 percent of people with Parkinson’s experience psychosis at some point in their disease. Delusions occur in 20 percent to 40 percent of people with Parkinson’s disease. However, the Parkinson’s Foundation emphasizes that everyone’s Parkinson’s journey is different, and the risk of delusions is different for each individual.

Delusions are often associated with Parkinson’s medication side effects and Parkinson’s disease progression. Cognitive impairment (trouble thinking), dementia, depression, and sleep disorders are also risk factors for delusions. Delusions can also be caused by some types of infection and other health conditions such as stroke and heart attack.

In general, persecutory delusions are more common in males than in females, according to the journal Neurological Sciences. These types of delusions can create paranoid thoughts and fearful feelings. Some people with persecutory delusions may try to involve legal authorities if they believe someone is wronging them. People with Parkinson's may have other types of delusions or hallucinations along with persecutory delusions.

“I’m the wife of a husband with advanced PD. It’s extremely difficult to deal with. He has delusions/hallucinations/paranoia. He has had PD for many years. The delusions started a little over a year and a half ago,” a MyParkinsonsTeam member wrote.

People who experience persecutory delusions may exhibit outbursts of anger, agitation, or violent behavior. People may develop delusions of persecution not only from Parkinson’s but also drug use, other health conditions, and some types of mental illness or mental disorders, such as schizophrenia, schizoaffective disorder, and bipolar disorder. Researchers have linked persecutory or paranoid delusions to low self-esteem and negative thoughts.

Examples of Persecutory Delusions

Although persecutory delusions are based on false beliefs, they tend to involve situations that could be possible in real life, as opposed to bizarre delusions that involve circumstances that would be impossible and are based on outlandish situations.

Examples of persecutory delusions include:

• A fear of being attacked
• A feeling of being harassed
• A belief that there’s a dangerous conspiracy
• A belief that people are lying
• A sense that something harmful is about to happen

One MyParkinsonsTeam member shared their experience with their husband: “He wakes up and thinks someone is grabbing him or something.”

“My mother had a severe delusional episode this morning where she accused me and the caregiver of trying to murder her.”

— A MyParkinsonsTeam member

Another member said, “My mom has Parkinson’s and has been dealing with hallucinations and delusions for over four months. They’re so bad she’s scared to live at home.”

A third member described another example of persecutory delusions with Parkinson’s: “My mother had a severe delusional episode this morning where she accused me and the caregiver of trying to murder her. We ended up taking her to an urgent care clinic where she was diagnosed with a UTI (urinary tract infection). Had to keep her from opening the car door to get out while driving her there. Fortunately, she calmed down while at the clinic, but she was so out of control. I’m not sure if her regular caregiver will stay with us for much longer.”

Managing Persecutory Delusions

If you or someone you care is living with Parkinson’s and experiencing persecutory delusions, there are steps you can take to help manage this difficult symptom.

First, it’s important to discuss delusions with a neurologist to determine whether a change in medication or other medical treatment may be warranted. A doctor can also conduct tests to find out if a person’s delusions are the result of another condition or an untreated infection.

In some cases, antipsychotic medication may be a treatment option for persecutory delusions. The first antipsychotic to be recommended by the U.S. Food and Drug Administration (FDA) to treat Parkinson’s psychosis is pimavanserin (Nuplazid). Some antipsychotic drugs are known to worsen movement and motor symptoms in Parkinson’s. A Parkinson’s specialist will help you weigh benefits versus risks of different treatment options.

When someone with PD is having a persecutory delusion, it’s best to stay calm, ask what they’re feeling, reassure them, and avoid arguing with them about the delusion.

A doctor may recommend counseling, such as psychotherapy (talk therapy) or cognitive behavioral therapy (CBT). Sometimes counseling can help a person who is experiencing persecutory delusions gain some understanding about how this symptom affects family members, caregivers, and other relationships. Your doctor can provide a referral for a mental health professional.

Counseling and support can also help psychological well-being for caregivers and family members who are tasked with managing persecutory delusions with Parkinson’s.

What To Do When Someone Is Having a Persecutory Delusion

If you’re a caregiver for someone living with Parkinson’s, here are some things you can do to help manage a persecutory delusion when it occurs:

• Stay calm and reassure them that everything will be all right.
• Avoid arguing or trying to convince them that their belief isn’t true.
• Ask them what they are feeling, and let them know you are listening to them so that they don’t feel threatened by you.
• If they become agitated or physically aggressive, remain still and calm.

When They’re Calm

You can help keep your home safer for loved ones who have persecutory delusions, especially if they’ve ever become aggressive. Keep anything that could be dangerous, such as knives or heavy objects, out of reach. Additionally, clear out clutter and obstacles that could pose tripping hazards.

When a person’s delusion has subsided, sometimes it can be helpful to talk to them and calmly ask them about the experience. If this type of conversation is disturbing for them, however, it’s best to avoid agitating them.

When a Persecutory Delusion Is an Emergency

If a situation feels dangerous and you’re worried about your safety or the safety of the person experiencing the delusion, call 911 or emergency services. EMTs are trained to perform interventions with people who may be experiencing a persecutory delusion and can help ensure that no one is harmed. In severe situations, a delusional person may require hospitalization for their mental health condition in order to be stabilized.

Find Your Team

MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. On MyParkinsonsTeam, more than 106,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s.

Have you or a loved one experienced persecutory delusions? Have you found effective ways to manage them? Share your experience in the comments below, or start a conversation by posting on your Activities page.