Is It Pathological to Believe in Conspiracy Theories?
Medscape/January 15, 2026
By Bettina Micka
About 20%-30% of the population express belief in at least one conspiracy theory, according to Thomas Fuchs, MD, PhD, psychiatrist and philosopher, Karl Jaspers Professor of Philosophy and Psychiatry at the Department of General Psychiatry, Universität Heidelberg, Heidelberg, Germany.
He explained when beliefs in a conspiracy theory fulfilled the criteria for psychopathology and which criteria were applied at the Congress of the German Association for Psychiatry and Psychotherapy, Psychosomatics and Neurology, Berlin, Germany.
“If belief in conspiracy theories were a pathological delusion, then we would need to offer psychiatric treatment rather than engage in argumentative debate with those affected,” Fuchs said.
Conspiracy theories are a long-standing and widespread phenomenon. According to a 2017 survey by the Friedrich Ebert Foundation, approximately 46% of individuals in Germany believed that secret organizations had a major influence on political decisions. Since the COVID pandemic, this proportion has risen further, reaching 60% in a 2024 survey conducted by Forsa, a prominent German market research and opinion polling firm.
Against this backdrop, Fuchs posed a central question: “Is belief in conspiracy theories a pathological delusion?” If so, he said that psychiatric care would take precedence over rational discussion.
In reality, only approximately 1% of the population has schizophrenia, a condition in which delusions are typical features. However, distinguishing conspiracy beliefs from schizophrenia is not always possible. Although paranoid, schizotypal, and narcissistic personality traits are more common among individuals who believe in conspiracy theories, clinically defined mental disorders are not significantly prevalent in this group.
Forms of False Belief
Fuchs outlined the different forms of false beliefs recognized in psychiatry, which are distinguished by increasing degrees of subjective certainty.
Error
- Remains at the cognitive level
- Is correctable
Prejudice
- A negatively biased attitude that is emotionally instigated, particularly toward groups or minorities
- Persists despite contradictory evidence
Overvalued (Fixed or Obsessive) Idea
- A fixed idea that extends beyond a single life domain and dominates a person’s thinking and feeling
- Pursued with fanatical zeal, often with a missionary impulse
- Increasing self-isolation
- Resembles delusional thinking, but beliefs remain logically coherent
- Not fundamentally uncorrectable; reality testing is preserved (examples include Ahab’s obsession in Moby Dick, religious fundamentalism, terrorism, and suicide bombers)
- Delusional idea (diagnosis: delusional disorder, formerly “paranoia”)
- Consolidates into a delusional system, such as erotomanic delusions, jealousy, querulous, or persecutory delusions
- Often linked to experiences of humiliation, frustration, or social exclusion
- Narcissistic and paranoid personality traits are often present
Schizophrenic Delusion (Primary Delusion)
- Serves to impose meaning and intrapsychic repair on a reality that has fallen apart
- Arise from typical, primary psychopathological experiences
- Includes delusional perceptions, thought insertions, manipulation of will, and third-person auditory hallucinations with commenting voices
Similarities and Key Differences
Conspiracy theories can occur in all forms of false beliefs. In most cases, however, they do not constitute delusions but rather overvalued ideas and beliefs shared with others based on emotional grounds.
The basic structure of conspiratorial worldviews can be summarized in three statements: “Nothing happens by chance.” “Nothing is as it seems.” “Everything is connected to everything else.”
The primary stance is mistrust, marked by a loss of basic confidence in the previously accepted frameworks of meaning. This loss, in turn, leads to the search for a new hidden explanation of reality. Individuals who believe in conspiracy theories commonly describe a moment of sudden insight, often expressed as the feeling that “the scales fell from their eyes.” The alleged perpetrators of the supposed conspiracy are then identified by asking the question cui bono (who benefits from the alleged event or action). These features are also observed in paranoid delusional experiences.
In addition, subjective certainty and resistance to correction among individuals who endorse conspiracy theories do not differ substantially from those of individuals with delusions. Moreover, the bizarreness or implausibility of the content does not serve as a reliable distinguishing feature. For example, claims that public figures such as Angela Merkel or other well-known personalities are reptilian beings illustrate that implausible beliefs are not unique to delusional disorders.
Beyond these similarities, the psychological functions of both phenomena are comparable in establishing orientation, meaning, and coherence in an unpredictable and uncontrollable world. Randomness and uncertainty have been replaced by intentional interpretations.
“The experience of contingency and powerlessness is thereby transformed into a sense of certainty that secret machinations have been uncovered. Indignation and anger can replace helplessness and fear. One’s own capacity for action and the possibility of resistance is restored to a certain extent,” he said.
Where Psychiatry Draws the Line
Despite these overlaps, there are characteristic differences that allow for psychiatric diagnoses.
Individuals who believe in conspiracy theories usually communicate intensively with like-minded individuals to form group identities. Promoting such theories can increase visibility and status and may satisfy the need for recognition by distinguishing oneself from the perceived “sheep” of mainstream society. A shared sense of victimhood can further strengthen group cohesion.
In contrast, delusions are marked by a loss of the ability to compare one’s own perspective with that of others or to communicate openly about it. Delusional beliefs, therefore, do not give rise to delusional communities, with the rare exception of folie à deux, delusions shared by two individuals.
“While individuals with paranoia believe that virtually everyone is after them, conspiracy ideologues believe that a few powerful actors are after almost everyone,” Fuchs said.
Subject-Centeredness in Delusion
In delusions, only the individual perceives themselves as the victim and target of others’ actions, sometimes described as a “Truman Show” experience. In contrast, in conspiracy theories, a group or society as a whole is viewed as the victim.
Fuchs cited Katharina Nocun and Pia Lamberty, who summarized the distinction in their book named Fake Facts: “While paranoid individuals believe that practically everyone is after them, conspiracy ideologues believe that a few powerful actors are after almost everyone.”
Religion and Conspiracy Thinking
One question raised by the audience was whether, under the criteria discussed, belief in God could be considered a conspiracy theory. Fuchs rejected this view, explaining that religious associations do not primarily adopt a hostile stance toward the outside world.
He noted that such groups and their internal communication tend to be more open and are not fixated on specific, overvalued thoughts or ideas. In contrast, according to Fuchs, sects — small, tightly regulated groups that often isolate themselves from mainstream religious or social institutions — can reasonably be described as communities organized around conspiracy beliefs.
None of the speakers reported having any relevant financial conflicts of interest.
- This story was translated from Medscape’s German edition.
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