A client is brought to the hospital by the spouse, who states that the client has refused all meals for the past week and accused the spouse of trying to poison the client. During the initial interview, the client's speech, only partly comprehensible, reveals that the client's thoughts are controlled by delusions that the client is possessed by the devil. A health care provider diagnoses paranoid schizophrenia. Paranoid schizophrenia is best described as a disorder characterized by: