A 72-year-old woman is brought to the PMHNP by her daughter for evaluation of persecutory delusions that began approximately four months ago. The patient believes her neighbors are secretly entering her apartment and moving her belongings. She also reports hearing muffled voices outside her door at night. Cognitive screening with the Montreal Cognitive Assessment (MoCA) yields a score of 26/30. She is well-groomed, oriented in all spheres, and her speech is organized and goal-directed. She has no prior psychiatric history and no family history of psychotic disorders. Her daughter confirms that there has been no change in the patient's ability to manage her finances, medications, or daily activities independently. The PMHNP evaluates the differential diagnosis. Which of the following best distinguishes this presentation?