Recent theoretical and experimental work indicates a close connection between anxiety and paranoia. Cognitive processes that lead to the persistence of anxiety disorders may have a similar role in persecutory fears. One factor identified as important in anxiety disorders are intrusive mental images. These negative images are common in anxiety disorders, and associated with symptom persistence. The aim of the current study was to examine intrusive mental images in individuals with persecutory delusions. The prevalence and characteristics of self-reported paranoia-related intrusive images, and relationships between image ratings and clinical symptoms were examined in 40 patients with persecutory delusions. It was found that 73% (n = 29) of patients reported paranoia-related, recurrent intrusive images (e.g. being attacked with a knife). The degree to which the images provoked anxiety was associated both with greater general anxiety and with more distressing persecutory delusions. It is concluded that intrusive images may be relatively common in patients with persecutory delusions and may contribute to the distress of paranoid experiences. Re-scripting such images and their associated memories might be a way of developing cognitive behavioural therapy for psychosis.