Fear and anger in delusional (paranoid) disorder: the association with violence

We report a series of 15 patients with delusional (paranoid) disorder as defined in DSM-III-R. All were supervised by a forensic psychiatry service after violent or threatening acts. We hypothesised that delusions and actions in these patients would be congruent with an abnormal mood characterised by fear and anger. Informants and the patients indicated a pervasive and persistent abnormality of mood (fear and defensive anger), with delusions and actions that were congruent with this mood during the offence and for over a month before. Other behaviours, such as fleeing or barricading to avoid delusional persecutors, were also consistent with congruence of mood and delusions. In all cases, violent acts and mood were congruent, but in three cases the violent act was unrelated to delusions. Although a study such as this does not demonstrate that the mood abnormality is primary, we believe moods of fear and anger in delusional disorder are not sufficiently recognised as part of the disorder.