Shared Psychotic Disorder: Symptoms, Causes and Treatment

Shared Psychotic Disorder refers to a condition where an individual who does not have a primary mental health problem believes the delusions of another individual with a similar condition. Even if a spouse has otherwise good mental health, she could become convinced of her husband’s delusions.

Baillarger identified the psychotic disorder in 1860. It went by several different names after that. Some of these names were:

• Lasegue and Falret coined the phrase “folie imposeé” (madness shared by two)
• In 1881, Marandon de Montyel coined the term “Folie communiqueé”
• Regis coined the term “folie simultaneé” (simultaneous psychosis, where both parties experience primary delusions at the same time, transmitted from one another) in 1880; Lehman coined the term “folie induite” in 1885

It is reported that shared psychotic disorders occur rarely (1.7 to 2.6% of hospital admissions). Most cases likely do not get reported. It is unlikely that the secondary person will seek help unless the primary individual does so or acts out in a way that attracts attention.

Both people do not realize that delusions have no basis in reality.

Occasionally, psychotic disorders present in groups. This is known as “folie a plusiers” or the “madness of many.” An obvious instance would be when a cult leader has a mental illness and transfers the delusion to his or her followers. This is also referred to as mass hysteria in larger group settings.

Read: High Functioning Anxiety

Shared psychotic disorder symptoms

According to the primary diagnosis of the person with the disorder, the symptoms of shared psychotic disorder will differ. The disorder does share some features regardless of the particular case.

Secondary effects

People who live with delusions are more likely to be stressed (elevated cortisol levels) due to the stress caused by the disorder. Stress and fear may lead to additional mental health issues like anxiety and depression.

In both cases, people suffering from psychosis may be out of touch with reality and experience difficulties with aspects of daily life because of the illness.

Primary symptoms

There is no insight into the problem or awareness that what they believe is not true, neither for the one with the primary mental illness nor for the person who develops the same delusions.

It is most likely that the secondary person will gradually lose their usual doubts or skepticism over time as they develop the delusions.

Individuals experiencing primary illnesses may experience hallucinations (seeing or hearing things they do not believe are real) or delusions (believing things that are not true in spite of being shown evidence to the contrary).

It is possible to have bizarre or non-bizarre delusions, as well as moods-congruent or mood-neutral delusions (related to bipolar disorder). Delusions defined as bizarre are things that are inconceivable by definition and cannot possibly happen in the real world, while delusions classified as non-bizarre are those that are possible but highly unlikely to happen.

You may have a bizarre delusion, such as thinking that aliens are monitoring you at night, or you may have a non-bizarre perception, such as believing that the FBI is monitoring your movements.

If you are manic or depressed, you experience delusions that reflect your mood. People suffering from manic states might believe, for example, that they are about to win a large sum at the casino. An individual in a depressed state might believe that a plane accident will kill their relatives.

Other examples of delusions are as follows:

• Thinking foreign radiation is transmitting stomach upset or diarrhea to your home
• Expecting to receive a large sum of money soon
• If you suspect the FBI is tapping your phone or is following your family
• Believing your neighbors may be polluting your water supply

They tend to exhibit paranoia, fear, and suspicion in general. If their delusions are challenged, they become angry or defensive. Grandiose delusion might make someone appear euphoric.

There will be no realization that the primary person is making the other sick. Because they have no insight into their own mental illness, they think they are simply showing them the truth.

If the secondary person is fearful and requires reassurance, then they exhibit dependent personalities. People who have relatives who suffer from mental illness are often more susceptible to mental illness themselves. Dyads include husbands and wives (married or common-law), mothers and daughters, sisters and siblings, or parents and children.

Read: Parental Burnout

Shared psychotic disorder causes

How does a secondary person come to possess someone’s delusions when they are afflicted by a delusional disorder? Several factors may contribute to this:

• In an environment of social isolation, that means the primary and secondary person is isolated from the outside world (where there are no social comparisons, it is difficult to tell the difference between fact and delusion)
• Experiencing chronic stress or stressful life events can cause high levels of chronic stress
• Primary and secondary people who are in conflict. The secondary person might agree at first to keep the peace, but then begin to believe the delusion
• An intimate relationship between a primary and secondary person; these relationships are usually long-lasting (e.g., siblings, families)
• Describes someone with a neurotic, dependent, or passive personality style or someone with difficulty judging or making decisions
• Someone suffering from depression, schizophrenia, or dementia as a secondary mental illness
• The primary individual suffers from a disorder that is not treated (e.g., delusional disorder, schizophrenia, bipolar disorder)
• The primary and second person are of different ages
• An individual dependent on another due to a disability (e.g., physically or mentally)
• A woman is more likely to have a primary or secondary psychotic disorder (women share more psychotic disorders than men)

Read: Maladaptive Daydreaming

Tough relationships

It is more common for psychosis to be shared between two people in long-term relationships where one person is dominant and the other passive.

People in these relationships usually have strong emotional connections to each other. however, they have weak social ties aside from that.

Groups of people who are closely related to someone who suffers from a psychotic disorder can also experience shared psychotic disorders, commonly referred to as folie à plusiers. It is possible for followers to adopt the delusions of a psychotic leader in a cult.

Researchers aren’t sure what causes this. Their view is that social isolation and stress play an important role in its development.

Diagnosis

Is it possible to diagnose shared psychotic disorder? According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), it is first described as “shared paranoid disorder”.

Then, in the DSM-IV, the shared psychotic disorder was given the new nomenclature “psychotic disorder with schizophrenia.” In the most recent DSM-5, the shared psychotic disorder is no longer considered a separate diagnosis. Rather, it is described as part of Section 298.9: Other specific schizophrenia spectrum disorder and other psychotic disorders. Detailed information is provided below:

“Delusional symptoms in partner of individual with delusional disorder: In the context of a relationship, the delusional material from the dominant partner provides content for delusional belief by the individual who may not otherwise entirely meet criteria for delusional disorder.”

Furthermore, this illness is labeled induced delusional disorder in the International Classification of Diseases (ICD-11).

Mental illnesses such as this tend to remain undiagnosed or unnoticed because neither person truly understands what is going on. It typically takes the acting out of a delusion by the primary person to bring the case to light. People who have paranoid delusions about a neighbor might attack that neighbor.

It may be the case that even when the primary person presents for treatment, treatment providers are unaware of the presence of a second individual. Due to this reason, these kinds of cases can remain undetected for an extended period of time.

An individual with this disorder must have delusions that develop as a result of interaction with the primary individual, have delusions that are similar to those of the primary individual, and have their symptoms not be explained by other problems, such as medical conditions or drug abuse, in order to be diagnosed as having this disorder.

The final step in diagnosing involves:

• It is possible to rule out other health problems with tests such as brain imaging, MRI scans, blood tests, and urine toxicology screens, although there are no tests specifically for this illness.
• An evaluation of mental status.
• It is important that a third party verify the reporting.

Read: Persecutory Delusions

Shared psychotic disorder treatment

The primary person for whom this disorder is treated often goes undiagnosed due to the disorder’s often being undiagnosed. A team approach may be required once the secondary individual is identified. Team members might include medical professionals as well as nurses, pharmacists, mental health professionals, etc.

There are no standard treatment protocols for this disorder since it is rare. However, as a first measure, it is conventional to separate the secondary person from the primary. The secondary person typically suffers fewer delusions when this occurs.

Some examples of specific treatments include:

• Psychotherapy aims at easing emotional distress and providing insight into dysfunctional thinking patterns.
• Therapy with the family helps the secondary person develop interests outside of the relationship, encourage healthy social relationships, and encourage medication adherence.
• There are other medications that may be used depending on the symptoms of each individual, such as antipsychotics, tranquilizers, antidepressants or mood stabilizers.

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Coping

Most people cannot successfully overcome shared psychotic disorder without professional assistance due to its nature. There are some things to remember regarding this illness, however, if you are just recovering from it:

• It is imperative that you adhere to any treatment regimen prescribed by your doctor.
• It is crucial to get better that you establish a strong relationship with and trust with your therapist as part of treatment. Even if it’s difficult at first, seeing a therapist is important.
• Last but not least, if left untreated, the condition will end up being chronic and will not improve. In case you know someone, who has a psychotic disorder or you yourself have one, you should seek help.

Possible outcomes

It is essential to treat shared psychotic disorders if you wish to prevent them from recurring. Delusional individuals are often unaware of the severity of their condition and refuse to take the medications prescribed to them.

Treatment may improve the chances of recovery for an individual with a shared psychotic disorder.

Is it possible to prevent shared psychotic disorders?

No. In order to minimize their impact on the person, their family, and their friends, it is important to recognize and treat them as soon as possible.

Read: How Optical Illusions Trick Our Brains

Bottom line

It can be difficult to disengage from the situation and determine what is real versus what is fantasy if you suspect that you or someone you know is suffering from shared psychotic disorder. Especially if you feel dependent on the primary person in the relationship and are the secondary person, you’d be wise to seek help.

Leaving shared psychotic disorder untreated for long periods of time may cause chronic stress as well as lasting effects on you and your loved ones’ physical and mental health.

A professional should be forthcoming about the effect your illness has on those around you if you are the sole person in a situation of shared psychosis. If you aren’t forthcoming about how the secondary person is involved and how that persons’ situation is similar to yours, the secondary person is unlikely to receive assistance.

In the end, living with delusions can be frightening and unsettling; however, seeking help, starting to establish social ties outside of the narrow relationship, and receiving therapy and/or medication as necessary are the only ways to improve the situation. When you have taken these steps, you will probably see your situation improve.

Children or dependents who are unable to raise themselves and need help are especially likely to require others to step in and recognize the situation so that they can offer assistance.