Delusional disorder, formerly known as paranoid delusional disorder, is a type of serious mental disorder. Patients with delusional disorder can’t distinguish between reality and imagination.
Delusions are the most common symptom of delusional disorders. It consists of unexplained, unfounded beliefs in an untrue or unreality.
Despite that, they are not entirely unrealistic. The symptoms of delusional disorder aren’t bizarre, but instead have to do with situations that might occur, such as being followed, poisoned, deceived, or loved from a distance.
A delusion involves a false perception or experience. However, in reality, the circumstances are either completely false or heavily exaggerated.
By contrast, a bizarre delusion provides something in which nothing is possible in reality, such as being cloned by aliens or having your thoughts broadcast live. If such thoughts occur, then the individual could be considered bizarrely delusional.
Typically, people with delusional disorder do not behave in an odd or bizarre manner, apart from their delusions, and tend to interact with society and function normally. Delusions are not common among people who have other psychotic disorders, who might also suffer from delusions.
In some cases, delusional disorders may lead to people becoming so consumed with their illusions that their lives become chaotic.
The delusional disorder itself is relatively uncommon even when delusions are symptoms of more common disorders, such as schizophrenia. Women are slightly more likely than men to suffer from the delusional disorder in their middle to late years.
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Types of delusions in delusional disorders
Various types of delusions occur in delusional disorders, which are typically characterized by delusional thoughts. Depending on what the delusions are about, the type of disorder is determined.
Erotomanic delusional disorder
Those suffering from this delusion think they are in love with someone who is generally more socially prominent than they are. For example, someone who believes that an actress loves them and that she is communicating with them through secret hand gestures during a TV show is undergoing this type of delusion.
Read more: What is Erotomania
Grandiose
Individuals with grandiose delusions think that they possess extraordinary talent, fame, wealth, or power regardless of evidence to support their claims. As an example, someone who believes that he or she has God’s power to save the universe completes certain tasks every day that will help the planet continue.
Persecutory
Persecutory delusional individuals believe that they are being spied on, drugged, followed, abused, cheated on, or slandered. As an example, someone may believe that their coworkers are drugged by their boss by adding something to the water cooler to make them work harder.
Jealous
People may believe that their partners are unfaithful when they are suffering from this type of delusion. People who experience this type of delusion may think that their partners meet their lovers every time they visit the restroom in public places and that they are also sending secret messages to their partners through other people (like grocery store cashiers).
Read: Hyperarousal
Somatic delusional disorder
Somatic delusional individuals believe they are experiencing very tangible sensations or bodily functions under the skin or that they have some general medical malady or defect. Somatic delusions may occur when someone believes parasites live inside of their bodies.
Mixed or unspecified
Mixed delusions mean there is no dominant theme or category to describe the subjective experience. A diagnosis of unspecified delusions means there is no clear delusion type to categorize the occurrence.
Difference between delusional disorder and schizophrenia
Schizophrenia encompasses several psychotic symptoms, including:
- Unorganized speech or behavior
- Facial expressions and motivation decrease as a result of negative symptoms
The difference between delusional disorder and schizophrenia is that delusions are the only psychotic symptoms.
Additionally, delusional disorder has a lower prevalence than schizophrenia, and daily functioning isn’t impaired as much as in schizophrenia.
Symptoms of delusional disorder
They usually consist of:
- Non-bizarre delusions — they are identified easily by their severity
- Anger, irritability, or low mood
- Experience hallucinations connected to delusion (seeing or hearing things that aren’t there). Those who have a bad odor problem might smell it when they believe they have an odor problem.
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Causes and risk factors for delusional disorder
Delusional disorder is yet to be definitively identified as the cause of many other psychotic disorders. However, researchers are studying why it is more likely to occur based on genetic, psychological, biological, or environmental factors.
Genetic
Families with members who suffer from delusional disorder or schizophrenia are likely to have genetic predispositions to the disorder. Delusional disorder is believed to be passed on to children from their parents just like other mental disorders.
Biological
Delusional disorders can go hand-in-hand with abnormal brain structures. Scientists are studying how this might happen. There may be abnormalities in brain regions controlling perception and thought that contribute to delusional symptoms.
Psychological/Environmental
Delusional disorders can be triggered by stress. It may also be linked to alcoholism or drug abuse. A delusional disorder is more likely to occur in people who are usually isolated, such as immigrants and those with poor vision and hearing.
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How can delusional disorder be diagnosed?
The doctor will likely perform a physical examination and complete your medical history if you display symptoms of delusional disorder. The delusional disorder cannot be diagnosed with a lab test; however, the doctor may recommend tests to rule out physical illness as the source of the symptoms, such as imaging studies or blood tests.
A few of these are:
- Alzheimer’s disease
- Epilepsy
- Obsessive-compulsive disorder
- Delirium
- Other schizophrenia spectrum disorders
Doctors might refer patients to psychiatrists or psychologists, healthcare professionals trained in diagnosing and treating mental illnesses if the symptoms appear to be caused by a physical condition. The person will be interviewed and assessed for psychotic disorders using diagnostic tools.
Doctors or therapists make diagnoses based on symptoms and observations of behavior and attitude. Symptoms will be assessed to determine whether a disorder is present.
When the following conditions are present:
- There is at least one delusion that lasts for more than a month
- A person with delusions but no schizophrenia have hallucinations related to their delusions if they experience them.
- Besides the delusion and its effects, their lives aren’t affected significantly. It’s not bizarre or odd that she does other things.
- Depressive or manic episodes have if they’ve happened; they haven’t been as intense as delusions.
- Other mental disorders, medical conditions or medications are not to blame.
Read: Alice in Wonderland Syndrome
Delusional disorder treatment
The most common type of delusional disorder treatment is medication and psychotherapy (counseling). A person with delusional disorder often lacks insight and is unaware that there is a psychological problem, making treatment very difficult.
Several studies report partial or complete improvements in at least half of all patients given antipsychotic medication.
Medications
Symptoms of delusional disorder are usually treated with medications called antipsychotics. The following drugs are used:
Conventional antipsychotics
Neuroleptics are conventional antipsychotics that have been in use since at least the mid-1950s for treating mental disorders. The drugs work by preventing dopamine receptors from functioning. Delusions are believed to be caused by a neurotransmitter called dopamine.
The following are examples of conventional antipsychotics:
- Chlorpromazine (Thorazine)
- Fluphenazine (Prolixin)
- Haloperidol (Haldol)
- Loxapine (Oxilapine)
- Perphenazine (Trilafon)
- Thioridazine (Mellaril)
- Thiothixene (Navane)
- Trifluoperazine (Stelazine)
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Atypical antipsychotics
Newer antipsychotics appear to be more effective in treating symptoms of delusional disorders with fewer side effects associated with movement than older treatments. Their actions are based on blocking the brain’s dopamine and serotonin receptors.
The delusional disorder may also be associated with serotonin, a neurotransmitter. The list of drugs includes the following:
- Aripiprazole (Abilify)
- Aripiprazole Lauroxil (Aristada)
- Asenapine (Saphris)
- Brexpiprazole (Rexulti)
- Cariprazine (Vraylar)
- Clozapine (Clozaril)
- Iloperidone (Fanapt)
- Lurasidone (Latuda)
- Paliperidone (Invega Sustenna)
- Paliperidone Palmitate (Invega Trinza)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Ziprasidone (Geodon)
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Other medications
The delusional disorder can also be treated with sedatives and antidepressants for anxiety and mood symptoms. People who are very anxious or have difficulty sleeping might take tranquilizers. When delusional patients suffer from depression, antidepressants might be prescribed.
Psychotherapy
In addition to medications, psychotherapy can also be beneficial to help people better cope with the stresses they face due to their delusional beliefs. The delusional disorder can be treated with psychotherapies such as:
- The individual can benefit from individual psychotherapy by recognizing and correcting distorted thinking.
- Cognitive-behavioral therapy (CBT) allows a person to recognize and change the patterns of their thoughts and behaviors that lead to the negative feelings they are experiencing.
- Families that have a loved one with delusional disorder can use family therapy to help them cope.
The condition of patients with severe symptoms or those who may harm themselves or others is likely to require hospitalization until the condition is stabilized.
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Do delusional disorders have complications?
- The delusional disorder can lead to depressive episodes, usually as a direct result of the delusions.
- When you act on your delusions, you may also be facing legal consequences. For example, someone suffering from erotomanic delusions could be charged if they stalk or harass the target of the delusion.
- In addition, people with this disorder can experience alienation from other people, particularly if their delusions interfere with or damage their relationships.
How does delusional disorder affect the future?
Various factors determine how long it takes to recover, including the person’s health and delusional disorder as well as the person’s life circumstances, including family support and a willingness to persist in treatment.
Many people can find relief from their symptoms when they are treated properly for delusional disorder, a chronic (ongoing) condition. While some people recover fully, others have periods of remission (lack of symptoms) along with bouts of delusional beliefs.
Sadly, a large number of people with this disorder never get treatment. Mentally ill people find it hard to recognize when they are unwell. The environment or other factors may be attributed to their symptoms.
Also, they might not seek treatment because they are embarrassed. Deficiency in mental health can persist for a lifetime without treatment.
Read: General Adaptation Syndrome
Is delusional disorder preventable?
The problem with delusional disorder is that there is no known way to prevent it. An early diagnosis, however, can lessen the disruption to family and friends of a person with a mental illness.
Prognosis
Many factors affect a person’s prognosis (outlook) when they suffer from a delusional disorder, including:
- The type of delusional disorder
- Delusions’ severity
- Support and persistence are factors that can affect a person’s life circumstances
People with delusional disorders do not usually have major problems functioning on a daily basis, but their delusions can gradually get worse over time. If their jobs do not involve anything related to their delusions, most people with delusional disorder can remain employed.
Those with the delusional disorder who follow their treatment plan have a better prognosis. Almost half of the population recovers fully, more than 20% report a decrease in symptoms, and less than 20% report minimal changes.
There is a high rate of people who do not seek help for this condition. Mentally ill people sometimes find it hard to admit they aren’t well. Treatment might also be too embarrassing or too frightening for them. It is possible for delusional disorder to become a lifelong condition if not treated.
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