Delusions are beliefs that are not generally held by other members of a society. The major feature of delusional disorder is a persistent belief that is contrary to reality, in the absence of other characteristics of schizophrenia. For example, a woman who believes without any evidence that coworkers are tormenting her by putting poison in her food and spraying her apartment with harmful gases may have a delusional disorder.
This disorder characterized by a persistent delusion that is not the result of an organic factor such as brain seizures or of any severe psychosis. Individuals with delusional disorder tend not to have flat affect, anhedonia, or other negative symptoms of schizophrenia. Importantly, however, they may become socially isolated because they are suspicious of others. The delusions are often long-standing, sometimes persisting over several years.
Delusional disorder seems to be relatively rare, affecting 24 to 60 people out of every 100,000 in the general population. The onset of delusional disorder is relatively late: The average age of first admission to a psychiatric facility is between 35 and 55. Because many people with this disorder can lead relatively typical lives, they may not seek treatment until their symptoms become most disruptive. Delusional disorder seems to afflict more females than males (55% and 45%, respectively, of the affected population).
The Delusional Subtypes:
- Erotomanic- An erotomanic type of delusion is the irrational belief that one is loved by another person, usually of higher status. Some individuals who stalk celebrities appear to have erotomanic delusional disorder.
- Grandiose- The grandiose type of delusion involves believing in one’s inflated worth, power, knowledge, identity, or special relationship to a deity or famous person
- Jealous- A person with the jealous type of delusion believes the sexual partner is unfaithful.
- Persecutory- The persecutory type of delusion involves believing oneself (or someone close) is being malevolently treated in some way.
- Somatic- Finally, with the somatic delusions the person feels afflicted by a physical defect or general medical condition.
Diagnostic Criteria for Delusional Disorder.
A. The presence of one (or more) delusions with a duration of 1 month or longer.
B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.
D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.
Erotomanic type: This subtype applies when the central theme of the delusion is that another person is in love with the individual.
Grandiose type: This subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery.
Jealous type: This subtype applies when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful.
Persecutory type: This subtype applies when the central theme of the delusion involves the individual’s belief that he or she is being conspired against, cheated, spied on in the pursuit of long-term goals.
Somatic type: This subtype applies when the central theme of the delusion involves bodily functions or sensations.
Mixed type: This subtype applies when no delusional theme predominated.
Unspecified type: This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types (e.g., referential delusions without a prominent persecutory or grandiose component).
Causes of Delusional Disorder.
- Genetic factors: The fact that delusional disorder is more common in people who have family members with delusional disorder or schizophrenia suggests there might involve a genetic factor. 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: An imbalance of certain chemicals in your brain, called neurotransmitters, linked to the formation of delusional symptoms.
- Environmental and psychological factors: Evidence suggests that stress can trigger delusional disorder. 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. These may lead to a person seeking an explanation for these feelings and, thus, forming a delusion as a solution.
Treatment for Delusional Disorder.
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 Hospitalization until they are in a stable condition.
Psychotherapy for Delusional Disorder.
Psychotherapy is a term for a variety of treatment techniques. It aims 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.
- 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.
- 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.
David H. Barlow, V. Mark Durand. Abnormal Psychology, An Integrative Approach. (7th ed).