Is the content of persecutory delusions relevant to self-esteem?

Background: Persecutory delusions are often associated with low self-esteem, depression and emotional distress. However, some patients acknowledge that their beliefs positively impact on their well-being which has been linked to non-adherence with medication. The present study aimed to investigate the moderators for the relationship of subjective well-being and persecutory delusions.Method: We recruited 43 patients with acute (n = 33) or remitted (n = 10) persecutory delusions and 33 healthy participants. Following a self-esteem measure and the assessment of psychopathology we conducted a semistructured interview with the patients to assess the contents of persecutory delusions (e.g. power of the persecutor).Results: Patients displayed significantly lower global self-esteem than healthy controls. In the acutely deluded sample (n = 33) patients with special abilities had significantly lower scores of depression and emotional distress than patients with normal or lower-than-normal abilities. A feeling of powerlessness towards the persecutor was associated with lower self-esteem and higher depression. Delusions which imparted the patient with special importance and delusions of being desired by someone else were significantly associated with higher levels of self-esteem.Conclusions: We conclude that the content of delusions is important when planning medical and psychological treatment. Clinicians are advised to take the associations between specific convictions and subjective well-being into account.