Anomalous experiences and the contents of persecutory delusions during acute psychotic episodes

Criteria for judging the presence of persecutory delusions, and theoretical distinctions between different kinds of persecutory delusions, depend on the identification of the contents of such delusions. The first aim of this study was to assess whether contents can be assessed reliably. It has been suggested that anomalous experiences are involved in the formation and maintenance of delusions. The second aim of this study was to assess whether independent judges could agree when persecutory delusions depend on such experiences. Twenty-two inpatients suffering from acute psychotic episodes were recruited. Two independent raters categorized the contents of their delusions in terms of the timing, agent, intention, motivation, type, and severity of harm using information from a variety of sources. Agreement between the raters was adequate for all content areas and for judgments of associations with anomalous experiences. Using ideas of reference as evidence for the persecution was associated with believing that the harm is already very severe, that multiple types of harm are occurring, and that worse persecution is imminent. Theoretical explanations need to be elaborated to account for the variety of contents that can be identified reliably. Associations with anomalous experiences might guide such elaborations.