Perspectives on the onset of delusions

There are many descriptions in the research literature of the onset of delusions in psychosis: it is still not clear however whether there is one specific pathway to delusions or in fact several, and the role of social difficulties remains controversial. In this research we wished to explore the first person perspective of participants who had developed delusions. Interpretative phenomenological analysis was used to interview and analyse themes from 28 participants. An additional matrix analysis of themes was used to examine the importance of social difficulties in relation to types of onset and diagnoses. Our results suggest 3 types of onset: an eruptive sudden transformation of self or world; a slow progressive onset characterised by interconnected changes in meaning and experience; and onset beginning in childhood experience. Social difficulties were mentioned spontaneously by 17 participants in describing onset and a further 9 discussed social difficulties when explicitly asked. One feature that appears to be present both in the progressive and childhood onset is negative emotion about, and preoccupation with, a difficult interpersonal topic over long periods of time. The descriptions given suggest that certain ideas or images could take hold of a person and become interwoven in his or her thinking and perhaps even begin to influence the way the person experienced the world or self. We suggest that it may be important for therapeutic work with delusions to articulate a narrative of onset.