Acting on persecutory delusions: the importance of safety seeking.
OBJECTIVE
Acting on delusions is a significant clinical issue. The concept of safety behaviours--actions carried out with the intention of reducing perceived threat--provides a new way of understanding acting on delusions. A study was conducted with the aim of examining the prevalence and correlates of safety behaviours related to persecutory delusions.


METHODS
One hundred patients with persecutory delusions were assessed for safety behaviours, acting on delusions, anxiety, depression, and psychotic symptoms. Case note data were collected on instances of serious violence or suicide attempts.


RESULTS
Ninety-six patients had used safety behaviours in the last month. Greater use of safety behaviours was associated with higher levels of distress. A history of violence or suicide attempts was associated with greater use of safety behaviours. Safety behaviours were significantly associated with acting on delusions, but not with the negative symptoms of psychosis.


CONCLUSIONS
Safety behaviours are a common form of acting on persecutory delusions. These behaviours have the consequence that they are likely to prevent the processing of disconfirmatory evidence and will therefore contribute to delusion persistence.
Freeman
Daniel
D
Department of Psychology, Institute of Psychiatry, King's College London, P.O. Box 77, University of London, Denmark Hill, London SE5 8AF, UK. d.freeman@iop.kcl.ac.uk
Garety
Philippa A
PA
Kuipers
Elizabeth
E
Fowler
David
D
Bebbington
Paul E
PE
Dunn
Graham
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001362:Avoidance Learning; D015331:Cohort Studies; D003674:Defense Mechanisms; D003702:Delusions / Q000523:psychology*; D004924:Escape Reaction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology*; D012449:Safety; D012565:Schizophrenic Psychology