Who Are People with Psychosis Delusional about? A Study of Social Agents in the Phenomenology of Delusions.
Elisavet Pappa, Nichola Raihani, Vaughan Bell
Psychopathology 2026 DOI: 10.1159/000548611 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 205 |
| Population | Electronic mental health records describing delusional content from the Clinical Record Interactive Search platform at South London and Maudsley NHS Foundation Trust |
| Topics | Philosophy of mind |
| Keywords | Delusions Illusory social agents Psychosis |
| Key findings | Most delusions (83.4%) explicitly reference illusory social agents, with a social gradient where socially proximate agents appear more frequently than distant ones. |
Abstract
Delusions frequently involve strong beliefs about, or interactions with, illusory social agents. Although such agents have been systematically described in hallucinations, few studies have investigated their nature and identity in delusions. We identified 205 electronic mental health records describing the content of delusions from the Clinical Record Interactive Search platform at South London and Maudsley NHS Foundation Trust. Delusional content was classified as non-social, implicitly social, or explicitly social. Descriptions of illusory social agents from explicitly social delusions were extracted and categorized using an upward coding analysis. A hierarchical cluster analysis identified distinct groupings of illusory social agents. Most delusions (83.4%) contained explicit references to illusory social agents. Across 238 instances, we identified 220 distinct agent identities, with a mean of 1.17 agents per record. The majority were humans (85.1%), most often identified as 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 distinct groups: one including socially proximate agents and the other more socially distant agents. These findings indicate a social gradient in delusions. Social content predominates in delusions, with patients experiencing delusions about socially closer individuals more frequently. We discuss the extent to which social gradient may not be unique to delusional misidentification syndromes but may instead represent a general feature of delusions. Better characterization of social agents in delusions could inform mechanistic accounts of these symptoms and, in clinical practice, guide family support and risk assessment.
Comparable studies
Other observational and cohort studies on philosophy of mind, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The phenomenology of near-death experiences Subjects who reported near-death experiences | 1980 | Retrospective study | n = 78 |
| Visual Phenomenology of the LSD Flashback Persons with a history of LSD use | 1983 | Observational cohort | n = 123 |
| The neurophenomenology of neutral hypnosis. Individuals of high, medium, and low hypnotizability | 2013 | Observational cohort | n = 37 |
| The Phenomenology of Acute Organic Psychosis Patients with acute organic psychosis and acute schizophrenics | 1987 | Observational cohort | n = 148 |
| EEG oscillatory states as neuro-phenomenology of consciousness as revealed from patients in vegetative and minimally conscious states. Brain-damaged patients with disorders of consciousness and healthy-conscious subjects | 2012 | Observational cohort |
Citations in the library
Cites 8
- Self, Solipsism, and Schizophrenic Delusions Philosophy, psychiatry & psychology June 1, 2001
- Phenomenological and neurocognitive perspectives on delusions: A critical overview. World Psychiatry June 1, 2015
- Voice-Hearing and Personification: Characterizing Social Qualities of Auditory Verbal Hallucinations in Early Psychosis Schizophrenia Bulletin June 19, 2020
- Rethinking Social Cognition in Light of Psychosis: Reciprocal Implications for Cognition and Psychopathology Clinical Psychological Science February 10, 2017
- The paradoxical self: Awareness, solipsism and first-rank symptoms in schizophrenia February 17, 2018
and 3 more in the library