Who Are People with Psychosis Delusional about? A Study of Social Agents in the Phenomenology of Delusions.
Psychopathology January 1, 2026 Elisavet Pappa, Nichola Raihani, Vaughan Bell
Delusions often involve strong beliefs about illusory social agents, yet the nature and identity of these agents in delusions have been understudied. An analysis of 205 electronic mental health records found that 83.4% of delusions explicitly referenced illusory social agents. Across 238 instances, 220 distinct agent identities were identified, averaging 1.17 agents per record. Most agents were humans (85.1%), commonly family members (31.0%), followed by acquaintances (17.2%), religious figures (13.2%), unnamed persons (12.8%), professionals (11.8%), and cultural figures (10.9%). Hierarchical clustering revealed two groups: socially proximate and socially distant agents. The findings indicate a social gradient in delusions, with socially closer individuals appearing more frequently. This gradient may be a general feature of delusions, not limited to specific syndromes.