Delusions are characterized as fixed and false beliefs that contradict reality. It is the persistent belief in things that are not true.
The delusions are false, and there is usually contradicting evidence to prove the delusions aren’t true.
Delusions could result from misinterpreting events, or they may involve some level of paranoia. Delusions often are a part of a psychotic disorder and can occur alongside hallucinations; such is the case for schizophrenia.
The difference between delusions and hallucinations is that while hallucinations are sensations that are not real, such as hearing voices or seeing things that are not there, delusions are strong beliefs that cannot be true. Despite being different, they are both parts of experiencing a false reality.
Delusions can be either bizarre or non-bizarre. Bizarre delusions are characterized as beliefs about something that can never happen, e.g., the belief that an individual has been abducted and cloned by aliens.
Non-bizarre delusions, however, are beliefs that could be true, such as the belief that an individual is being stalked, that someone is in love with them, or they are being cheated on by a spouse.
In This Article
What is Delusional Disorder?
Delusional disorder is a condition that is characterized by non-bizarre delusions that involve the misinterpretation of an experience or a perception. People diagnosed with delusional disorder can experience realistic delusions, such as believing they are being deceived or conspired against, but these are usually highly exaggerated or untrue.
The onset of delusional disorder is typically in middle to later life but can occur at any time. It is also more common in women than men. Often with delusional disorder, the individual will socialize and function normally and generally does not behave in an obviously unusual manner, making this condition difficult to recognize from an outsider’s perspective.
Delusional disorder, therefore, differs from other psychotic disorders where delusions are present, such as in schizophrenia, as there are other symptoms of those conditions which can affect the functioning of those individuals.
Types of Delusions
Many different types of delusions can be experienced, characterized by delusional disorder.
The type of delusional disorder is based on the main theme of the delusions being experienced.
The types are as follows:
Erotomanic
This type of delusion is the belief that someone, usually someone who is famous or of a higher social status, is in love with the individual. For instance, the person experiencing this delusion may believe that the famous person is communicating secret messages to them on the TV show they star in.
Stalking behavior is often common with this type of delusion as the individual may attempt to make contact with the person they believe loves them.
Grandiose
This delusion is the belief that the individual has an over-inflated sense of worth, knowledge, wealth, talent, power, or fame, despite a lack of evidence.
For instance, someone with grandiose delusions may believe they have made an important discovery or were sent by a religious entity to save the world.
Persecutory
This delusion is the belief that the individual, or someone close to them, is being spied on, followed, drugged, cheated on, or mistreated.
They may believe someone is planning to harm them or someone close to them and thus may repeatedly complain to legal authorities.
Jealous
This type of delusion is the belief that a romantic partner or spouse is being unfaithful, despite a lack of evidence to prove this.
The individual may believe their partner is meeting their secret lover whenever not in their presence or is sending their secret lover messages.
Somatic
This delusion is the belief that the individual is experiencing physical sensations, bodily dysfunctions, or suffering from a medical condition.
For instance, they may be convinced that they have a rare illness or parasites living underneath their skin, despite no evidence of this being the case.
Mixed
When the delusions being experienced do not fall into a single category, or there are two or more types of delusions being experienced, this would be labeled as having mixed or unspecified types of delusions.
Diagnosis
If someone is experiencing symptoms of delusions, they can be tested to see if they have a delusional disorder. Firstly, a doctor would likely investigate the medical history of the individual and perform a medical examination.
Some imaging tests, such as magnetic resonance imaging (MRI), may be used to rule out any other conditions which may explain the symptoms, such as Alzheimer’s disease or epilepsy.
If delusional disorder is still suspected, the individual may be referred to a trained psychiatrist, psychologist, or health professional who will use interview methods and assessment tools to make a diagnosis.
The professional will refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to assess the symptoms against the diagnostic criteria.
According to the DSM-IV, for a diagnosis of delusional disorder to be made, the individual would need to have the presence of non-bizarre hallucinations that have lasted for at least a month.
The individual must never have met the criteria for schizophrenia, meaning that the delusions are not accompanied by most types of hallucinations.
The overall functioning of the individual should also not be affected, except for the immediate consequences of acting on a delusional thought (e.g., if experiencing the jealous type of delusion and choosing to confront a suspected secret lover of a spouse).
The delusions must also not be a result of a general medical condition or as a result of taking drugs or medication.
Further, the delusions must be separate from any other mental health condition, meaning other conditions must be ruled out.
Finally, any disturbances in mood, if experienced at all, must be brief compared to delusions.
Causes and Risk Factors
Although there is currently no concrete explanation for what causes delusions, researchers have some ideas as to potential causes or risk factors which may contribute to the onset of delusions.
Genetics may play a part in someone developing delusions since it is more common that those with family members with a psychotic disorder with delusions are likely to develop delusions themselves.
For instance, a parent with a delusional disorder or schizophrenia is more likely to have a child who also develops one of these conditions.
Delusional disorder specifically tends to be more common among those who are more isolated, such as those with impairments in their vision or hearing.
If someone has problems with vision or hearing, they may be more likely to rely upon inaccurate perceptions of reality if they are less able to see things for how they are, although this is not the case for most of those with these impairments.
There could also be some biological causes that produce the onset of delusions. Joyce (2018) investigated the pathobiology of delusions using case studies of patients who had experienced strokes.
It was found that some of those who had focal strokes to the right lateral prefrontal cortex developed delusions. This part of the brain is known to have connections to the basal ganglia and the limbic system, as well as receiving input from the midbrain dopamine neurons.
Dopamine is a neurotransmitter that plays a role in motivation, pleasure, and reward. Dysregulated dopamine has been found to have associations with schizophrenia and those at risk of psychosis, thus suggesting that faulty dopamine signaling could be a precursor of delusion formation.
A further study by Devinsky (2009) found significant associations between the bilateral frontal lobe in the right cerebral hemisphere with delusions.
Damage to this area, a brain region that controls perceptions and thinking, can result in left hemispheric overactivity. The researchers suggested this can result in the left language centers ‘creating a story’ which cannot be compared to reality, corrected, and self-monitored due to damage on the right side.
This can therefore be confused for reality, and delusional resistance can occur.
Environmental triggers such as high amounts of stress could also be a potential risk factor for the onset of delusions.
A study by Nygaard, Sonne, and Carlsson (2017) found that a significant number of those who developed posttraumatic stress disorder (PTSD) also developed delusions, specifically of the persecutory type. Although not the case for most people who have PTSD, this implies there could be a causal link between trauma and stress with the onset of delusions.
As well as delusional disorder, delusions could be a symptom that is triggered by another mental health condition, such as:
- Dementia
- Mood disorders
- Parkinson’s Disease
- Schizophrenia
- Postpartum psychosis
- Substance-induced psychotic disorder
Treatments
It may be challenging to initially treat someone who is experiencing delusions since the individual may not recognize that what they are experiencing is not real, and this may present some resistance to treatment.
Similarly, since with delusional disorder, there may not be much disruption to everyday life and functioning is normal, individuals may not believe they will require any treatment.
Often it may be that a nonconfrontational and sensitive approach by family or close friends may be recommended to encourage the person experiencing delusions to seek treatment.
The primary treatments for those experiencing delusions are medication and psychotherapy. The main type of medication recommended is antipsychotics. These have shown effectiveness in that many people with delusions who take antipsychotics showed partial improvement to their symptoms.
Typical antipsychotics are medications that are used to block the dopamine receptors in the brain, which is a neurotransmitter believed to be involved in the development of delusions.
These have been used to treat mental health conditions since the 1950s, and some of these include:
- Chlorpromazine (Thorazine)
- Fluphenazine (Prolixin)
- Thiothixene (Navane)
- Perphenazine (Trilafon)
- Haloperidol (Haldol)
- Trifluoperazine (Stelazine)
Atypical antipsychotics are a newer type of medication that are also used to treat delusional disorders but with fewer side effects than the typical antipsychotics.
These work by blocking dopamine and serotonin receptors in the brain and appear to be more effective in treating the symptoms of delusional disorder. Some of these medications include
- Clozapine (Clozaril)
- Aripiprazole (Abilify)
- Asenapine (Saphris)
- Iloperidone (Fanapt)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Cariprazine (Vraylar)
- Ziprasidone (Geodon)
Some other medications which may be used to treat delusional disorder are antidepressants and tranquillizers.
Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can be used to treat the depressed or anxious feelings experienced alongside the delusions.
Tranquilizers may be used with individuals who are experiencing very high levels of anxiety or are having trouble sleeping due to the delusions being experienced.
Finally, psychotherapy can also be helpful alongside medications to help individuals manage and cope with the stress that goes alongside their delusions.
Cognitive behavioral therapy (CBT) is a common psychotherapy that aims to help a person recognize their thought patterns and behaviors so they can change to more realistic types of thinking.
This can be helpful for individuals with delusional disorder to recognize the unhelpful thoughts they are experiencing and view their delusions from another perspective. Likewise, family therapy can be a part of treatment as well.
The aim of involving the family is so that they can learn how to support someone who is experiencing delusions, which may make an impact on the severity of the delusions being experienced.
Do you or a loved one need mental health help?
USA
Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/
1-800-273-8255
UK
Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; email jo@samaritans.org .
Available 24 hours a day, 365 days a year (this number is FREE to call):
116-123
Rethink Mental Illness: rethink.org
0300 5000 927
References
Devinsky, O. (2009). Delusional misidentifications and duplications: right brain lesions, left brain delusions. Neurology, 72(1), 80-87.
Drake, M. E. (n.d.). Delusional Disorder DSM-5 297.1 (F22). Theravive. Retrieved 2021, August 18, from: https://www.theravive.com/therapedia/delusional-disorder-dsm–5-297.1-(f22)
Joyce, E. M. (2018). Organic psychosis: the pathobiology and treatment of delusions. CNS neuroscience & therapeutics, 24(7), 598-603.
Nygaard, M., Sonne, C., & Carlsson, J. (2017). Secondary psychotic features in refugees diagnosed with post-traumatic stress disorder: a retrospective cohort study. BMC psychiatry, 17(1), 1-11.
