Technology-Themed Persecutory and Related Presentations of Delusions in the Digital Age: Narrative Review

Persecutory delusions have long mirrored prevailing cultural and technological concerns. Beliefs involving implanted devices, internet surveillance, hacked smartphones, algorithmic targeting, and AI-mediated control are increasingly visible in contemporary psychosis. However, we identified no prior review dedicated specifically to synthesizing technology-themed delusional content across historical and contemporary clinical contexts.

This narrative review aimed to trace the historical evolution of technology-themed delusions, characterize their contemporary clinical phenomenology, examine relevant neurocognitive and sociocultural mechanisms, and discuss implications for psychiatric assessment and intervention.

PubMed/MEDLINE, Scopus, and APA PsycInfo were searched without date restrictions, supplemented by backward citation tracking and targeted identification of historical primary sources. Eligible sources included original research, case reports and case series, reviews, and relevant conceptual or historical publications addressing delusional content involving technology. A narrative synthesis approach informed by the Scale for the Assessment of Narrative Review Articles (SANRA) framework was used. The final search was completed on May 1, 2026.

Forty-three sources were included in the narrative synthesis, comprising 9 case reports or case series, 14 empirical studies, 8 reviews, and 12 historical or conceptual sources. Technology-themed delusions appeared as pathoplastic variants of enduring persecutory, control, and referential motifs, clustering into 5 overlapping categories: surveillance and hacking beliefs, implant and control delusions, Truman Show-type broadcast phenomena, social media-specific referential ideas, and emerging algorithmic and AI-mediated themes. In the largest contemporary cohort (228 patients with psychosis), technology-themed delusions were described by 104 of the 201 (51.7%) patients with delusional thought content, and the odds of technology-themed delusions rose by approximately 15% per admission year (odds ratio 1.15, 95% CI 1.01-1.31; P=.04). Cognitive models of persecutory ideation, the aberrant salience hypothesis, technological unfamiliarity, digital immersion, and wider sociocultural narratives all appeared relevant to these presentations. Pandemic-era conspiracy material, including 5G and vaccine-microchip narratives, further illustrated how culturally available technological explanations may scaffold delusional elaboration in vulnerable individuals.

Technology-themed delusions represent contemporary expressions of enduring delusional motifs shaped by digital culture. Their assessment requires psychiatric expertise combined with sufficient technological literacy to distinguish proportionate privacy concerns, overvalued conspiracy beliefs, and fixed delusional convictions. Future research should use prospective cohort designs, cross-cultural comparisons, and targeted evaluation of cognitive behavioral and digital literacy-informed interventions, while monitoring emerging AI-mediated phenomena.