Delusional Disorders: Know the Signs and Symptoms and Get Help

Delusional disorder is a subtype of psychotic disorders. The primary symptom is the presence of one or more delusions. A delusion is an unshakeable belief in something that is false. The belief is not part of the person s culture or subculture, and practically everyone else understands it to be untrue.

People with delusional disorder frequently have non-bizarre delusions. Non-bizarre delusions include events that could happen in real life, such as being watched, fooled, or loved from afar. These delusions typically include a misinterpretation of perceptions or experiences. In actuality, these scenarios are either false or greatly exaggerated.

Contrary to bizarre delusions, which comprise ideas that are not consistent with reality—for example, thinking that an organ has been removed from your body without any visible physical proof of the surgery—bizarre delusions are unreal.

With the exception of the subject of their illusion, people with delusional disorder frequently carry on with normal social lives. They don t typically exhibit peculiar or strange behavior. Contrary to this, delusions are not a sign exclusive to those with other psychotic diseases. But sometimes, delusional illness sufferers lives might be upended because they are so consumed by their fantasies.

What are the types of delusional disorder?

There are different types of delusional disorder, which are determined based on the main theme of the delusions the person experiences. The types of delusional disorder include:

Erotomanic: This kind of delusional illness causes sufferers to think that someone else—typically someone significant or well-known—is in love with them. They can make an effort to get in touch with the deluded individual and start stalking them.

Grandiose: This kind of delusional illness is characterized by an exaggerated feeling of one s own identity, power, or self-worth. They might think they ve discovered something significant or have a tremendous talent.

Jealous: Without any hard proof, people with this kind of mental illness assume that their partner or spouse is unfaithful.

Persecutory: Individuals suffering from this kind of delusional condition think that they (or someone close to them) are being mistreated, spied on, or are being attacked. Individuals suffering from this kind of delusional condition could frequently file complaints with the authorities.

Somatic: Individuals suffering from this kind of delusional condition think they have a parasite or an unpleasant stench, or some other physical or medical problem.

Mixed: People with this type of delusional disorder have two or more of the types of delusions listed above.

What is the difference between delusional disorder and schizophrenia?

Schizophrenia is a spectrum (or range) of conditions that involve psychotic symptoms, which include:

• Disorganized speech or behavior.

• Negative symptoms (a decrease in emotion in a person’s facial expressions and motivation).

• Delusional disorder is different from schizophrenia because there aren’t any other psychotic symptoms other than delusions.

In addition, in contrast to schizophrenia, delusional disorder is relatively rare, and daily functioning isn’t as impaired as it is in schizophrenia.

Who does delusional disorder affect?

Delusional disorder most often occurs in middle to late life, with the average age of onset being 40 years.

The persecutory and jealous types of delusional disorder are more common in people assigned male at birth (AMAB), and the erotomanic type is more common in people assigned female at birth (AFAB).

People who tend to be socially isolated are more likely to develop delusional disorder. These populations include:

• Immigrants who have language barriers.

• People who are deaf.

• People who are visually impaired.

• Elderly people.

How common is delusional disorder?

Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Approximately 0.05% to 0.1% of the adult population has delusional disorder.

What is the most common type of delusional disorder?

The most common type of delusional disorder is the persecutory type — when someone believes others are out to harm them despite evidence to the contrary.

Symptoms and Causes

The presence of delusions is the most obvious sign of delusional disorder, which vary based on the type.

Another characteristic of this condition is that the person often lacks self-awareness that their delusions are problematic. They’re unable to accept that their delusions are irrational or inaccurate, even if they recognize that other people would describe their delusions this way.

Anger and violent behavior may be present if someone is experiencing persecutory, jealous or erotomanic delusions.

People with delusional disorder may also develop anxiety and/or depression as a result of the delusions.

Early symptoms of delusional disorder may include:

• Feelings of being exploited.

• Preoccupation with the loyalty or trustworthiness of friends.

• A tendency to read threatening meanings into benign remarks or events.

• Persistently holding grudges.

• A readiness to respond and react to perceived slights.

What causes delusional disorder?

As with many other psychotic disorders, researchers don’t yet know the exact cause of delusional disorder. Researchers are, however, looking at the role of various factors that may contribute to the development of the condition, including:

• Genetic factors: The fact that delusional disorder is more common in people who have family members with delusional disorder or schizophrenia suggests there might be a genetic factor involved. Researchers believe that, as with other mental disorders, a tendency to develop delusional disorder might be passed on from parents to their biological children.

• Biological factors: Researchers are studying how abnormalities of certain areas of your brain might be involved in the development of delusional disorder. An imbalance of certain chemicals in your brain, called neurotransmitters, has been linked to the formation of delusional symptoms.

• Evidence suggests that delusional disorder can be triggered by stress. Alcohol use disorder and substance use disorder might contribute to the condition. Hypersensitivity and ego defense mechanisms like reaction formation, projection and denial are some psychodynamic theories for the development of delusional disorder. Social isolation, envy, distrust, suspicion and low self-esteem are also some psychological factors that may lead to a person seeking an explanation for these feelings and, thus, forming a delusion as a solution.

Diagnosis and Tests

Healthcare providers — mainly mental health professionals — diagnose delusional disorder when a person has one or more delusions for one month or more that can’t be explained by any other condition. The person must also not have the characteristic symptoms of other psychotic disorders, such as schizophrenia.

If someone is experiencing signs and symptoms of delusional disorder, a healthcare provider will perform a complete medical history and physical examination. Although there aren’t any laboratory tests to diagnose delusional disorder, their healthcare provider might use various diagnostic tests — such as imaging tests, a urine drug screen and blood tests — to rule out any physical conditions, medications or substances that could be causing the symptoms.

If their healthcare provider finds no physical reason for the symptoms, a consultation with a psychiatrist or psychologist will likely be made. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. They’ll ask questions about the delusions and assess the person’s mental status.

The psychiatrist or psychologist may also interview family members and friends so they can provide further details about the person’s delusions and a timeline of the symptoms.

As other mental health conditions can cause delusions, mental health professionals carefully assess the person for other symptoms. Delusional disorder can be misdiagnosed as any of the following conditions:

• Obsessive-compulsive disorder.

• Schizophrenia.

• Delirium/major neurocognitive disorder.

• Bipolar disorder.

• Personality disorders, especially borderline personality disorder and paranoid personality disorder.

Management and Treatment

Treatment for delusional disorder most often includes psychotherapy (talk therapy) and medication, but delusional disorder is highly resistant to treatment with medication alone.

People with delusional disorder often don’t seek treatment for the condition on their own because most people with delusional disorder don’t realize their delusions are problematic or incorrect. It’s more likely they’ll seek help due to other mental health conditions such as depression or anxiety.

People with severe symptoms or who are at risk of hurting themselves or others might need to be admitted to the hospital until the condition is stabilized.

Psychotherapy for delusional disorder

Psychotherapy is a term for a variety of treatment techniques that aim to help people identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to the person and their family.

Through therapy, people with delusional disorder can learn to manage their symptoms, identify early warning signs of relapse and develop relapse prevention plans. Types of psychotherapy include:

• Individual psychotherapy: This type of therapy can help a person recognize and correct the underlying thinking that has become distorted.

• Cognitive Behavioral Therapy (CBT): This is a structured, goal-oriented type of therapy. A mental health professional helps people take a close look at their thoughts and emotions. They’ll come to understand how their thoughts affect their actions. Through Cognitive Behavioral Therapy (CBT) , they can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

• Family-focused therapy: This therapy can help people with delusional disorder and their families. This treatment involves psychoeducation regarding delusional disorder, communication improvement training and problem-solving skills training.

Medications for delusional disorder

The primary medications used to help treat delusional disorder are called antipsychotics (neuroleptics). Medications include the following:

• First-generation (“typical”) antipsychotics: Healthcare providers have used these medications to treat mental health conditions since the mid-1950s. These medicines work by blocking dopamine receptors in your brain. Dopamine is a neurotransmitter believed to be involved in the development of delusions. First-generation antipsychotics include chlorpromazine (Thorazine®), fluphenazine (Prolixin®), haloperidol (Haldol®), thiothixene (Navane®), trifluoperazine (Stelazine®), perphenazine (Trilafon®) and thioridazine (Mellaril®).

• Second-generation (“atypical”) antipsychotics: These newer antipsychotics are also effective in treating the symptoms of delusional disorder. They work by blocking dopamine and serotonin receptors in your brain. These drugs include risperidone (Risperdal®), clozapine (Clozaril®), quetiapine (Seroquel®), ziprasidone (Geodon®) and olanzapine (Zyprexa®). These medications are usually better tolerated than first-generation antipsychotics.

Other medications that healthcare providers might prescribe to treat delusional disorder include anxiolytics and antidepressants. Anxiolytics might help if the person has a very high level of anxiety and/or problems sleeping. Antidepressants can help treat depression, which often occurs in people with delusional disorder.

Can delusional disorder be prevented?

There’s no known way to prevent delusional disorder. However, early diagnosis and treatment can help decrease the disruption to the person’s life, family and friendships.

What is the prognosis (outlook) for delusional disorder?

The prognosis (outlook) for people with delusional disorder varies depending on a few factors, including:

• The type of delusional disorder.

• The severity of the delusions.

• The person’s life circumstances, including the availability of support and a willingness to stick with treatment.

Delusional disorder doesn’t usually significantly affect a person’s daily functioning, but the severity of the delusion may gradually get worse. Most people with delusional disorder can remain employed as long as their work doesn’t involve things related to their delusions.

The prognosis of delusional disorder is better if the person sticks to their treatment plan. Almost 50% of people have a full recovery, more than 20% of people report a decrease in symptoms and less than 20% of people report minimal to no change in symptoms.

Unfortunately, many people with this condition don’t seek help. It’s often difficult for people with mental health conditions to recognize they’re not well. They also might be too embarrassed or afraid to seek treatment. Without treatment, delusional disorder can be a life-long condition.

What are the possible complications of delusional disorder?

If left untreated, delusional disorder might lead to:

• Depression, often as a consequence of difficulties associated with the delusions.

• Social isolation.

• Legal issues — for example, stalking or harassing the person involved with the delusion could lead to arrest.

• Self-harm or harm to others. This is more common in the jealous and persecutory types.

Living With Delusional Disorder?

If you know someone with delusional disorder, you can help by providing support and encouragement for them to seek help and treatment.

People with delusional disorder who feel pressured or repeatedly criticized by others will likely experience stress, which may worsen their symptoms. Because of this, a positive approach may be more helpful and effective.

The friends and family members of people with delusional disorder often experience stress, depression, grief and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms.