Delusional Disorder
Delusional disorder, traditionally synonymous with paranoia, is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.
For the diagnosis to be made, auditory and visual hallucinations cannot be prominent, though olfactory or tactile hallucinations related to the content of the delusion may be present. The delusions cannot be due to the effects of a drug, medication, or general medical condition, and delusional disorder cannot be diagnosed in an individual previously - and properly - diagnosed with schizophrenia. A person with delusional disorder may be high functioning in daily life.
***PLEASE do not try to diagnose yourself or someone else with this condition. There are many factors involved in determining this Disorder and a diagnosis should always come directly from a professional. Accusing someone else as "being delusional" can be very harmful to someone who is struggling with any mental illness.***
According to German psychiatrist Emil Kraepelin, patients with delusional disorder remain coherent, sensible and reasonable. The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines six subtypes of the disorder: Erotomanic - belief that someone is in love with one Grandiose - belief that one is the greatest, strongest, fastest, richest, or most intelligent person ever Jealous - belief that one is being cheated on Persecutory - delusions that one or someone one is close to is being malevolently treated in some way Somatic - belief that one has a disease or medical condition Mixed - having features of more than one subtype.
Delusions also occur as symptoms of many other mental disorders, especially the other psychotic disorders.
Symptoms
The following can indicate a delusion:
- An individual expresses an idea or belief with unusual persistence or force, even when evidence suggests the contrary.
- That idea appears to have an undue influence on the person's life, and the way of life is often altered to an inexplicable extent.
- Despite their profound conviction, there is often a quality of secretiveness or suspicion when the person is questioned about it.
- The individual tends to be humorless and oversensitive, especially about the belief.
- There is a quality of centrality: no matter how unlikely it is that these strange things are happening to the person, they accept them relatively unquestioningly.
- An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility. They will not accept any other opinions.
- The belief is, at the least, unlikely, and out of keeping with the individual's social, cultural, and religious background.
- The person is emotionally over-invested in the idea and it overwhelms other elements of their psyche.
- The delusion, if acted out, often leads to behaviors which are abnormal, and out of character, although perhaps understandable in light of the delusional beliefs.
- Other people who know the individual observe that the belief and behavior are uncharacteristic and alien.
Additional characteristic of delusional disorder include the following:
It is a primary disorder.
It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity.
The illness is chronic and frequently lifelong.
The delusions are logically constructed and internally consistent.
The delusions do not interfere with general logical reasoning (although within the delusional system the logic is perverted) and there is usually no general disturbance of behavior. If disturbed behavior does occur, it is directly related to the delusional beliefs.
The individual experiences a heightened sense of self-reference. Events which, to others, are nonsignificant are of enormous significance to them, and the atmosphere surrounding the delusions is highly charged.
However, this should not be confused with gaslighting, where a person denies the truth, and causes the one being gaslit to think that they are being delusional.
Treatment Options
A challenge in the treatment of delusional disorders is that most patients have limited insight, and do not acknowledge that there is a problem. Most patients are treated as out-patients, although hospitalization may be required in some cases if there is a risk of harm to self or others. Individual psychotherapy is recommended rather than group psychotherapy, as patients are often quite suspicious and sensitive.
Delusional disorder is a mental illness that can be treated with a combination of psychotherapy and medication.
--Psychotherapy--
Cognitive behavioral therapy (CBT): Helps patients learn to challenge their beliefs and focus on their goals
Solution-oriented therapies: Helps patients work toward reality and increase their self-confidence
Building trust: A good doctor-patient relationship is key to treatment success
--Medication--
Antipsychotics: Can help with agitation, but medication alone is not very effective
Mood stabilizers: Can be used in addition to antipsychotics
Antidepressants: Can be used in addition to antipsychotics
--Other treatments--
Skills training: Can help patients focus on their goals
Inpatient treatment: May be needed for people with severe symptoms or who are at risk of harming themselves or others
The Feeling Safe program: A personalized program that helps patients develop new memories of safety