Persecutory and litigious presentations

Since the archetype of paranoia/delusional disorder is the individual who is convinced that he or she is being persecuted or harmed, and since many people believe that this is the most common form of delusional disorder, one might expect an extensive literature on the phenomenology of persecutory delusions. Certainly, that forms the basis of psychoanalytic theorising on the origin of paranoia (see Chapter 1) but, strangely, despite many references to the subject, there has been remarkably little development of these theories and virtually no systematic study on the topic. Attributions are usually to unsubstantiated hypotheses and eventually refer to anecdotal case analyses.

Nowadays, the neo-Kraepelinian descriptions of delusional disorder in DSMIV (1994) and ICD10 (1992–93) apply equally to each of the subtypes, so a patient with a persecutory subtype would, by definition, have a relatively encapsulated delusional system and a well-preserved personality, the illness being chronic and relatively unremitting. The persecutory beliefs are often associated with querulousness, irritability and anger, and the individual who acts out his anger may be assaultive at times and even homicidal. In expressing his feelings thus, the motivation for violence may be predominantly either a belief that he is defending himself or may be a desire for revenge. As will be mentioned (see pp.138–139), this behaviour may have some important legal repercussions.