https://doi.org/10.1177/10398562211008182 Australasian Psychiatry 2021, Vol 29(5) 535–539 © The Royal Australian and New Zealand College of Psychiatrists 2021 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/10398562211008182 journals.sagepub.com/home/apy 535 AUSTRALASIAN PSYCHIATRY A ccording to a recent report, one quarter of the general population may endorse COVID-19- related conspiracy beliefs at least to some extent. 1 A number of these beliefs are shown in Table 1. Some are a type of denial (e.g., ‘The virus does not exist’), others reflect a profound mistrust in the authorities (e.g., ‘The government has imposed the lockdown to better control the population’) and yet others suggest the malevolent intention of certain individuals, technological enhance- ments or countries (e.g. attribution of the pandemic to Bill Gates, 5G technology or China). Such diverse exam- ples suggest that the term ‘conspiracy beliefs’ is applied loosely and that the construct itself may be too hetero- geneous. Conspiracy beliefs are not a new phenomenon, but the COVID-19 pandemic proved to be a fertile soil for them because of the many uncertainties associated with the pandemic and the unprecedented restrictions that gov- ernments have imposed in response to it. In this con- text, conspiracy beliefs need to be taken particularly seriously because they decrease adherence to measures for curbing the pandemic and foster a negative attitude towards vaccination. 1 The purpose of this article is to examine the relevance of conspiracy beliefs for psychiatry, situating them on a spectrum of mistrust-related phenomena. The dynamics of trust and mistrust Humans are not born to trust unreservedly. In fact, ‘epis- temic vigilance’ 2 was suggested to denote a natural ten- dency to be cautious and guard against misinformation as a way of protecting oneself and thereby gaining an evolutionary advantage in a world that is characterised by hostility from others more than benevolence. ‘Things are not what they seem to be’: A proposal for the spectrum approach to conspiracy beliefs Vladan Starcevic Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia; and Department of Psychiatry, Nepean Hospital, Penrith, NSW, Australia Vlasios Brakoulias Western Sydney Local Health District Mental Health Service, Sydney, NSW, Australia; and School of Medicine and Translational Health Research Institute, Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia Abstract Objective: Conspiracy beliefs (also known as conspiracy theories) become more prominent at times of heightened uncertainty and inconsistent or conflicting explanations provided by the authorities for events like terrorist attacks or pandemics, such as COVID-19. This article aims to examine the relevance of conspiracy beliefs for psychiatry in the context of the dynamics of trust and mistrust. Conclusions: Conspiracy beliefs may be situated on a spectrum of mistrust-related phenomena, which extends from healthy scepticism to persecutory delusions. They can be conceptualised as unfounded and fixed beliefs held with strong conviction about harm inflicted by powerful groups on the community or another group of people, usually with preserved insight that these beliefs differ from those that most people have and with reasons for having such beliefs not necessarily being implausible. It is important for conspiracy beliefs to be distinguished from persecutory delusions. Keywords: conspiracy belief, conspiracy theory, persecutory delusion, mistrust, COVID-19 Corresponding author: Vladan Starcevic, Department of Psychiatry, Nepean Hospital, PO Box 63, Penrith NSW 2751, Australia. Email: vladan.starcevic@sydney.edu.au 1008182APY Australasian PsychiatryStarcevic and Brakoulias COVID-19