Are Conspiracy Theories Delusional?

The distinctions between conspiratorial ideation and delusion-proneness are murky. Indeed, according to the diagnostic criteria for delusional disorder in the Diagnostic and Statistical Manual-5 (DSM-5), the “distinction between a delusion and a strongly held idea is sometimes difficult to make” (p. 87). Studies also indicate that conspiratorial ideation is strongly positively related to delusion-proneness.

If conspiratorial ideation and delusion-proneness are theoretically and empirically related, how might we distinguish them? Although there is no single answer to this question, research studies point to a few potential ways in which we might distinguish between a strongly held conspiracy theory and a clinical delusion.

Herein, I provide a brief checklist for distinguishing between conspiracy theories and clinical delusions. Note that this checklist is by no means a comprehensive review of the complexities in this area of research and hence should be treated as a broad overview.

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Rates of Conspiracy Theories vs. Clinical Delusions

Conspiratorial ideation manifests at high rates in the American population. Some surveys suggest that over half of Americans believe at least one conspiracy theory. Even conspiracy theories that seem eccentric, such as the notion that the government is intentionally putting chemicals into the environment that are visible to the naked eye, are endorsed by up to 5% of the American population.

In contrast, clinical delusions are far less common. Delusional disorder, for instance, which reflects experiencing persistent delusions without other symptoms of schizophrenia/psychosis for at least one month, is estimated to manifest in only .2% of the American population.

Based on these statistics alone, it seems highly unlikely that conspiracy theories are the same as clinical delusions. Otherwise, over half of Americans would be delusional! This is not to say, however, that conspiracy theories are always non-clinical, as a conspiracy theory can be a delusion.

Level of Impairment

For many individuals, conspiracy theories do not control their lives, determine all of their activities, or cause severe emotional disturbance. Instead, they may be experienced as bothersome or mildly depressing, but they are not debilitating. When thinking of someone who holds a “pet conspiracy theory,” he/she may even be intrigued or fascinated to learn more and debate with others about this belief. From this perspective, a conspiracy belief may be somewhat enjoyable, as an individual may feel he/she possesses secret knowledge.

In contrast, delusions are associated with reduced social, personal, and occupational functioning. On self-report measures of delusion-proneness, clinical and community samples can be differentiated by ratings of distress, preoccupation, and conviction, even when there is overlap in the endorsement of delusions. For example, Peters and colleagues (2004) found that the item “Do you ever feel as if some people are not what they seem to be?” was endorsed by healthy and clinical subjects at similar rates; nevertheless, the clinical subjects were more distressed by the belief, spent more time engaging with the belief, and were more certain of the belief compared with healthy subjects.

Delusions can consume a person’s life to the point that an individual no longer can take care of him/herself or function appropriately in society. Again, conspiracy theories perhaps can manifest with such intensity and severity in certain individuals, reflecting pieces of a delusional framework. Nevertheless, for many people, conspiracy theories do not derail their lives.

Level of Certainty

Returning to this idea of a “pet conspiracy theory,” many people who endorse a conspiracy theory do not necessarily believe it with 100% certainty. Research examining conspiracy beliefs, for instance, is often conducted in community (non-clinical and non-student samples) and undergraduate samples; scores on self-report measures of conspiratorial ideation rarely reach the maximum, and the averages (means) tend to be far below the maximum scores. These results indicate that many people are not wholeheartedly dedicated to a particular conspiracy theory.

Delusions, however, are held with 100% conviction. There is no room for another viewpoint. Any attempts to challenge a delusion are likely to be rebuffed and ignored.

Hence, it may be easier to challenge a conspiracy theory than a delusion, and more people are likely to be less certain of a conspiracy theory than a clinical delusion. That being said, conspiracy theories are also notoriously hard to challenge, as disconfirmatory information can be readily turned around — “You’re just afraid of the truth!” Conspiracy theories, like delusions, are often unfalsifiable.

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Are the Beliefs About “Me” or “Us?"

Conspiratorial ideation can also be distinguished from delusions based on the specificity of the belief to the individual. Delusions typically pertain to the individual across themes. For instance, persecutory delusions are beliefs “that one is going to be harmed, harassed, and so forth by an individual, organization, or other group” and referential delusions are beliefs that “certain gestures, comments, and cues are directed at oneself” (APA, 2013, p. 87).

In contrast, conspiracy beliefs include interpersonal elements — hostile coalitions of outgroup members are conspiring against someone’s ingroup. Thus, instead of perceiving that others are out to get them personally, people who believe in conspiracy theories perceive that others are conspiring against society or their ingroup (e.g., their political party). For instance, most COVID-19 conspiracy theories refer to a large group of victims, perhaps Americans or even the whole globe.

Summary

Research provides preliminary insights into the differences between conspiracy theories and delusions. Yet, there is no one way to distinguish between a strongly held conspiracy theory, or even a strongly held belief for that matter, and clinical delusions. Future research is needed to clarify whether and when conspiracy theories turn into delusions and whether they exist on the same continuum (with conspiracy theories being on the mild end of the spectrum and delusions being on the severe end of the spectrum).