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Conspiracy Theories Aren't Delusions

Part 1: Conspiracy theories in clinical practice.

Key points

  • Conspiracy theories aren't delusions, but they can cause psychological distress.
  • The phrase "not mentally ill, but not mentally healthy" often applies to those who believe in conspiracy theories.
  • Mistrust and vulnerability to misinformation lie at the root of conspiracy theory beliefs.
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“Each one of us here today will at one time in our lives look upon a loved one who is in need and ask the same question: We are willing to help, Lord, but what, if anything, is needed? For it is true we can seldom help those closest to us. Either we don't know what part of ourselves to give or, more often than not, the part we have to give is not wanted. And so it is those we live with and should know who elude us.” —A River Runs Through It

Last year, after I published a three-part series about why people fall down the QAnon rabbit hole, how to assess just how deeply they’ve fallen, and how families and loved ones might help them climb back out, I’ve been getting a steady stream of e-mail from readers and interview requests from journalists asking about how mental health professionals might be able to help those with conspiracy theory beliefs. In this installment of Psych Unseen, I’ll be sharing how we can understand, and potentially treat, conspiracy theory beliefs in the context of mental health care. In Part 1 of this two-part series, I'll start by distinguishing conspiracy theory beliefs from delusions. Then in Part 2, I'll discuss how psychotherapy might be able to help.

In order to understand how conspiracy theory beliefs relate to mental health, we have to first acknowledge just how common and therefore normal conspiracy theory beliefs are. Surveys have consistently demonstrated that at least half the population around the world believes in at least one. A 2018 YouGov poll found that this proportion to be as high as 64% in the US.1 If a substantial majority believes in at least one conspiracy theory, we must accept that such beliefs aren’t pathological and shouldn’t be conflated with symptoms of mental illness.

While conspiracy theory beliefs are unsubstantiated and often false or even outlandish so that they can be grouped under the broader heading of “delusion-like beliefs,”2,3 they resemble other types of political, religious, and ideological beliefs that fall short of actual delusions for several reasons. First, unlike delusions which are defined by their falseness, conspiracy theories do occasionally turn out to be true and cease to be theories. In addition, conspiracy theories are typically shared beliefs based on information that’s out there in the world, whereas delusions are typically idiosyncratic beliefs based on subjective experience with a self-referential component about the believer.4,5 For example, the shared belief that there’s a Satanic pedophile ring operating the “Deep State” isn’t a delusion; but the belief that Q has been sending you private messages saying that you have been chosen to assassinate a political leader would be.

There’s little to no evidence that conspiracy theory beliefs are associated with mental illnesses like schizophrenia, bipolar disorder, or major depression. Although a recent report by the National Consortium for the Study of Terrorism and Responses to Terrorism (START) has claimed that 68% of “QAnon offenders” who have committed crimes based on QAnon conspiracy theory beliefs (e.g. those arrested at the US Capitol riots in January) had “mental health concerns” including schizophrenia, bipolar disorder, and post-traumatic stress disorder, that claim should be taken with a grain of salt for two reasons.6 First, it only applies to a small subsample of QAnon adherents who committed crimes, not the much larger number of people who merely endorse QAnon beliefs. Second, the statistic was based on statements from court records following criminal arrest, where claims about mental illness might very well be embellished or over-endorsed to escape criminal culpability. Without evidence from actual medical records or psychiatric assessments, that’s hardly convincing.

For run of the mill conspiracy theory believers who don’t commit crimes, an extensive body of research has instead revealed consistent associations between conspiracy theory belief and a variety of psychological needs (like needs for certainly, control, and uniqueness) and cognitive quirks (like teleologic bias, “bullsh*t receptivity,” and lower levels of analytical thinking).7 But these associations represent quantitative not qualitative differences, meaning that may be heightened among those that belief in conspiracy theories, but are found in all of us to some degree. We all have needs for certainty or control, just as many of us have less than perfect analytical thinking skills. We can expect that the extent to which such quirks account for conspiracy theory beliefs will vary across individuals and according to specific conspiracy theory beliefs (e.g. it’s likely that needs for control are more relevant to COVID-19 than to beliefs in a flat Earth).

Since conspiracy theory beliefs aren’t delusions or “mass delusions” as is sometimes claimed, and since a substantial majority of people in the world believe them, we need a more normalizing and humanizing framework to understand them. I have proposed a “two-component socio-epistemic model” that, simply put, involves “epistemic mistrust” or mistrust in authoritative sources of information leaving us vulnerable to belief in the misinformation and disinformation that’s ubiquitous out there in the world.8

Although the familiar term “conspiracy theorist” is often used pejoratively to invoke images of a “paranoid crank” wearing a tin foil hat, that term and image fail to accurately characterize most conspiracy theory believers. The vast majority aren’t so much theorizing as they are “doing their own research” by seeking out and finding conspiracy theory narratives that are out there in the world that counter authoritative accounts and reinforce their mistrustful worldview. And while belief in conspiracy theories has been found to be associated with paranoia in some studies, this refers to a subthreshold or subclinical cognitive style characterized by suspiciousness, not persecutory delusions proper. The tendency to believe in conspiracy theories—what psychologists call “conspiracist ideation” and “conspiracy mentality”—is probably just tautological to this kind of suspiciousness, meaning that they're simply two facets of the same construct. I prefer “epistemic mistrust” as a much less loaded and more humanizing term.

It’s been said that “insanity is a sane response to an insane society." While that familiar aphorism is overused and unjustified when referring to actual mental illness, it’s not a bad way to characterize conspiracy theory beliefs. Inasmuch as conspiracy theory beliefs stem from mistrust and misinformation that is pervasive in the world today, they can be thought of as more a reflection of a sick society than individual mental illness.

Read Part 2 of this two-part series on Conspiracy Theories in Clinical Practice:


1. YouGov. Conspiracy theories. YouGov Poll; August 13-23, 2018. Available at:

2. Pierre JM. Integrating non-psychiatric models of delusion-like beliefs into forensic psychiatric assessment. Journal of the American Academy of Psychiatry and the Law 2019; 47; 171-179.

3. Pierre JM. Forensic psychiatry versus the varieties of delusion-like belief. Journal of the American Academy of Psychiatry and the Law 2020; 48; 327-334.

4. Pies RW, Pierre JM. Believing in conspiracy theories is not delusional. Medscape Psychiatry; February 4, 2021 and Clinical Psychiatry News; February 5, 2021.

5. Pierre JM. Conspiracy theory or delusion? 3 questions to tell them apart. Current Psychiatry 2021; 20:44,60.

6. National Consortium for the Study of Terrorism and Responses to Terrorism. QAnon offenders in the United States.

7. Douglas KM, Uscinski JE, Sutton RM, Cichocka A, Nefes T, Ang CS, Deravi F. Understanding conspiracy theories. Political Psychology 2019; 40(Suppl 1):3-35.

8. Pierre JM. Mistrust and misinformation: A two component, socio-epistemic model of belief in conspiracy theories. Journal of Social and Political Psychology 2020; 8:617-641.

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