Look for the signs of a delusion
Not all unusual or strongly held beliefs are delusions. For example, anxiety can lead to intense thoughts like ‘Something bad is going to happen’ or ‘People are judging me,’ but these tend to shift over time and respond to reassurance. Similarly, people who have experienced actual harm or discrimination might understandably be vigilant in certain situations. And cultural, ideological or religious beliefs that seem unfamiliar to you would not be considered clinical delusions if they are widely held and meaningful within a person’s cultural group.
To understand whether a belief is a delusion rather than a more common or understandable way of thinking, clinicians look at three core features:
Conviction: how strongly the belief is held, and whether the person can consider other explanations.
Frequency and intensity: how often the belief comes up and how much it occupies the person’s attention.
Impact: how much the belief is affecting a person’s emotions, behaviour and day-to-day life.
When you are concerned about a belief that someone has, it’s natural to focus on whether the belief is true. But a more helpful approach is to consider these key features. To start, you might ask yourself: What has changed, and how is this affecting them?
You might begin to notice patterns such as:
growing certainty or difficulty considering other explanations;
the belief coming up more often or taking up more mental space;
increased fear, anxiety or urgency;
changes in behaviour, such as avoiding certain situations, withdrawing socially or heightened alertness to possible threats; or
a negative impact on school, work or relationships.
Consider a relatively common scenario: someone becomes very interested in an online conspiracy theory. They bring it up from time to time and seem to believe parts of it strongly, but they also recognise that others see it differently and they acknowledge that it is a controversial interpretation. The belief is shared by a broader online community, does not dominate their attention and is not significantly affecting their daily life. The belief may seem unusual or concerning to you, but those features would make it less suggestive of a delusion.
In contrast, consider someone who becomes convinced that posts on social media or comments made on television are sending messages specifically to them. At first, they mention it occasionally, but over time, they become increasingly certain that the messages are intentional and meant to warn them. They spend hours looking for connections, have difficulty considering that the posts or broadcasts may be unrelated to them, and begin missing school or work because they feel the need to keep monitoring the messages. Here, the strong conviction, increasing preoccupation, and disruption to daily life would be indicative of a possible delusion and potentially a need for professional help.
It is also important to look at the broader picture. A concerning belief or potential delusion may occur alongside other experiences, such as:
hearing or perceiving things that others do not;
unusually elevated or irritable mood;
disorganised speech or behaviour;
changes in thinking or memory;
severe sleep disruption;
high levels of stress; or
substance use.
These signs can provide important context and strengthen the case for seeking direct guidance from a clinical professional. At the same time, none of these features allows you to diagnose someone yourself. The goal is not to decide with certainty that a person is having a delusion, but to recognise when a pattern is concerning enough to warrant a closer look or professional support.
Prioritise your connection
If someone is showing signs of delusional thinking, it is very difficult to make progress starting from a place of conflict. Good communication strategies work best when the relationship feels safe.
In practice, this means staying connected in ways that are not centred on the belief. Spending time together, continuing shared routines or talking about everyday things can help maintain a sense of normality and trust. In many ways, the relationship itself can be a foundation for change. If someone feels judged or corrected, they are more likely to become guarded. By contrast, if they feel understood and respected, they are more likely to stay engaged, reflect on their experience and accept support. The way you show up in everyday interactions could matter as much as what you say about the belief itself.
Staying connected can be challenging if you become part of the delusional belief yourself: for example, if the person is convinced that you cannot be trusted, that you are working against them, or even that you aren’t who you say you are. In these situations, if the person can tolerate your presence, try to preserve the relationship through ordinary activities or neutral topics. But if being around you seems to increase their fear, mistrust or agitation, it may be necessary to step back and ask another trusted person in their support network to take a more active role for a time. If you ever feel unsafe, prioritise your safety and get support (see the later step Reach Out for Professional Guidance).
One of the most important principles when talking with someone about a concerning belief is to approach them with curiosity and compassion rather than confront them. Although it is very understandable to want to challenge the belief directly – especially when it’s causing distress – in most cases, a direct challenge does not help. Because the belief feels real to the person, it can lead to defensiveness, pulling away or increased distress.
Express your curiosity
Curiosity communicates that you are trying to understand the person’s experience rather than judge or correct it. You could use open-ended questions such as:
‘Can you tell me more about what’s been happening?’
‘When did you first notice this?’
‘What has that been like for you?’
For example, if someone says they believe they are being watched, you might ask them to tell you what their experience has been like. They might say that they feel they can never relax, or that several events now seem connected. You could then ask how they have been making sense of the experience. They might respond: ‘I think someone is tracking me. I keep seeing the same kinds of cars, and people seem to show up wherever I go.’ Rather than immediately challenging that interpretation, you could stay curious, asking what feels most convincing, or most stressful, about the experience. You can also check in to make sure you are correctly understanding what they mean: ‘Am I getting that right?’ And, if not, then: ‘Thank you for clarifying. I want to understand what you’re going through.’ This kind of back-and-forth can help you understand how the person is interpreting what is happening, how strongly they hold the belief and how much distress or disruption it is causing.
It is common to feel hesitant about asking these kinds of questions. In practice, though, respectful curiosity often helps the person feel less alone. Focusing on these questions can also help you avoid defaulting to rapid-fire interrogation (‘Are you sure? What proof do you have?’), which can feel like a challenge rather than an attempt to help.
Validate their emotions
Even with the best intentions, most people feel a strong pull to correct or reassure someone who’s describing a delusion. This is sometimes called the ‘righting reflex’. You might feel compelled to say things like ‘That’s not happening’ or ‘You’re overthinking this.’ These responses might come from a place of care, but they are likely to backfire. If you’re feeling this way, it can help to notice that urge without acting on it right away. You might remind yourself that you do not have to settle the question of what is true at that moment. If the person feels frightened, confused, defensive or overwhelmed, the more useful first step is usually to try to understand what they are experiencing and respond to that.
Validation involves showing someone that you understand what they are saying and take their experience seriously, even if you do not agree with the belief itself. For example, instead of saying ‘That’s not happening,’ you might say: ‘That sounds really frightening. I can see why you’d feel on edge.’ You might also reflect other emotions they’re feeling, such as frustration, confusion or feeling overwhelmed or unsafe. A helpful way to think about this is that, while the belief may not be accurate, the emotion is always real. Acknowledging the emotional experience helps the person feel seen and understood. Sometimes it can help to gently connect how the other person is feeling to what they are experiencing in their day-to-day life: ‘It sounds like you’ve been really on edge, and that’s why it’s been hard to go out or be around people.’
There are ways to disclose that you don’t agree with the person’s belief or interpretation of a situation while still being supportive. For example, you might say: ‘I’m not interpreting the situation the same way, but I can see how real and upsetting this feels to you.’ This allows you to be supportive without colluding with the belief or setting aside your own perspective.
When someone feels understood, they are often less defensive and more able to stay in the conversation. This creates the conditions for trust, problem-solving and greater flexibility. It makes it easier to help them consider other ways of seeing their experience (without feeling confronted) and accept support when needed. We’ll turn to these things next.
Gently explore alternatives to their belief
As your conversations continue, one goal is to support greater flexibility over time. By flexibility, I mean helping the person become less certain that there is only one possible explanation for what they are experiencing, and more able to consider other possibilities. Typically, when flexibility increases, the beliefs also become less preoccupying and disruptive for the person who holds them.
When the person feels heard and the conversation is calm, you may be able to explore other possibilities. It can help to first ask permission: ‘Would it be OK if we thought through a few possibilities together?’
You might then ask:
‘What do you think is the most likely explanation?’
‘Have there been times when it felt less certain?’
‘Have you considered any other possible explanations?’ (You could ask about the possibility that seemingly related events are a coincidence, for example.)
For example, if someone says: ‘I know those people were talking about me,’ you might ask: ‘What makes that feel like the most likely explanation?’ After listening (and reflecting and validating how they feel), you could follow with: ‘Is there any other way you could imagine that situation?’ They might say: ‘Maybe they were talking about something else, but I still think it was probably me.’ That may seem like a small change, but being able to hold even one alternative alongside the original belief can be meaningful.
Your aim is not to replace the belief with a new explanation or convince them they are wrong. Rather, it is to help create a little more room for uncertainty and reflection. A change in how someone relates to a belief often happens gradually. Rather than trying to resolve everything at once, it can help to think in terms of ‘planting seeds’ over time. A foundation of curiosity and validation usually needs to come first: the person is more likely to consider other possibilities when they feel heard, respected and less defensive. Moments of gentle reflection can build on that foundation and create space to begin to question the belief or consider alternatives.
This kind of exploration will be more useful in some situations than others. If someone is very distressed, highly certain of the belief or amid an acute episode of psychosis, they may have much more difficulty considering alternatives. In those moments, it is usually more helpful to stay calm, maintain connection through validation and help them access professional support rather than to keep pressing for a different interpretation.
Encourage support-seeking
If your concerns continue, it can help to raise the idea of seeking professional support, such as a therapist, primary care doctor or psychiatrist. Rather than focusing directly on the belief, connect the idea of seeking help to goals that you and the person both agree on, such as feeling less stressed, sleeping better, staying connected to others or getting back on track with school or work.
You might say, for example: ‘It seems like this experience has been really exhausting’ or ‘I can see how much this has been getting in the way of things you care about.’ From there, you can gently suggest support: ‘I wonder if talking with someone could help with some of that.’ Framing support in this way can feel more collaborative because it starts with the person’s own concerns and goals rather than asking them to agree that their belief is a symptom or accept a particular diagnosis.
If your loved one becomes upset or feels that you are dismissing their experience, it can help to step back from the suggestion of getting help and return first to validation. You might say: ‘I can see that this feels very stressful for you, and I don’t want you to feel like I’m dismissing what you’re going through.’ Once the person feels heard, you can leave the door open for a future conversation by adding something like: ‘If you ever want help figuring out how to make this feel less overwhelming, I’m here.’ When the person is not ready, you may need to return to the conversation at a later point.
Reach out for professional guidance
If you are worried about someone, you do not have to wait for the person to agree to seek help before reaching out for guidance yourself. You can contact a general practitioner or another primary care provider, a mental health professional, a specialised early-psychosis programme or a crisis service to describe what you are noticing and ask about next steps.
It can also be helpful to reach out to a professional for guidance about what you are noticing even when signs of possible delusional thinking are still relatively subtle. This might include various signs already discussed in this Guide, such as a loved one’s increasing distress or fear, withdrawal from others or beliefs seeming to interfere with daily life. Reaching out early can help clarify what is happening and provide support before the concerns escalate. (See the Links & Books section at the end of the Guide for examples of support-seeking resources.)
More urgent support may be needed if you notice a rapid decline in the person’s functioning, an inability to meet their basic needs, or extreme fear or agitation, or if you have concerns about safety. A local mobile crisis service may be able to provide timely assessment and support. If there is an immediate, life-threatening emergency, such as imminent harm to the person or someone else, contact local emergency services. Staying calm, giving the person space and speaking clearly can help reduce escalation while crisis support is being arranged.
In any of these situations, remember that you do not need to be certain about what is happening to take your concerns seriously or to reach out for guidance.
