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Acting on delusions. I: Prevalence

S Wessely, A Buchanan, A Reed

The British Journal of Psychiatry : the Journal of Mental Science

|July 1, 1993

Summary

Many individuals experiencing delusions engage in abnormal behaviors, with half reporting actions aligned with their delusions. Persecutory delusions were most frequently acted upon, contrary to delusions of guilt or catastrophe.

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Area of Science:

Psychiatry
Psychology
Behavioral Science

Background:

Delusions are a core symptom of several psychiatric disorders.
The link between delusional beliefs and observable behavior requires further investigation.
Previous research has not fully elucidated the prevalence and nature of actions stemming from delusions.

Purpose of the Study:

To assess the association between delusions and abnormal behavior in a clinical sample.
To quantify the extent to which individuals act upon their delusions.
To explore the relationship between specific types of delusions and associated actions.

Main Methods:

Retrospective assessment of 83 consecutively admitted deluded subjects.
Utilized a novel measure for delusional phenomenology and action, supplemented by informant interviews for 59 subjects.

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Employed clinical consensus and latent class analysis to link actions to delusions.

Main Results:

Half of the subjects reported acting in accordance with their delusions; violent behavior was infrequent.
Informant data indicated that actions were congruent with delusions in half the sample, but self-reports and informant reports did not correlate.
Latent class analysis identified three action patterns: aggressive, defensive, or none/single action.
Self-reported actions linked to catastrophe delusions, while informants identified persecutory delusions as most acted upon.
Delusions of guilt or catastrophe appeared to reduce the likelihood of acting on delusions.

Conclusions:

Actions congruent with delusions are more common than previously suggested.
Discrepancies exist between self-reported and informant-reported delusional actions.
The type of delusion influences the likelihood and nature of associated behaviors.