Thought Insertion as a Persecutory Delusion

Popular two-factor accounts of thought insertion hold that this symptom of psychosis is caused by two elements working in tandem: an anomalous experience of some kind (the first factor) and a reasoning deficit or bias (the second factor). This chapter develops a very different alternative to explaining and treating thought insertion—one that views thought insertion as a form persecutory delusion. If this thesis is correct, clinical interventions for persecutory delusions may be successful for thought insertion as well. The chapter begins by presenting several difficulties for two-factor accounts of thought insertion and for two-factor accounts of delusions more generally. It then discusses positive reasons for seeing thought insertion as a form of persecutory delusion. The positive case begins with reflection on first-person descriptions of thought insertion gleaned from online discussion forums. It continues by considering ways in which clinical diagnostic tools may create the appearance of deep differences between symptoms such as thought insertion and persecutory delusions where there are none. This case is bolstered by evidence for considerable variability in the content of delusions patients present with over time. Implications for the treatment of thought insertion are then considered