Delusional disorder
Delusional disorder is an uncommon psychiatric condition in which patients present with circumscribed symptoms of non-bizarre delusions, but with the absence of prominent hallucinations and no thought disorder, mood disorder, or significant flattening of affect. For the diagnosis to be made, auditory and visual hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...

s cannot be prominent, though olfactory or tactile hallucinations related to the content of the delusion may be present.

To be diagnosed with delusional disorder, the delusion or delusions cannot be due to the effects of a drug
A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.In pharmacology, a...

, medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...

, or general medical condition, and delusional disorder cannot be diagnosed in an individual previously diagnosed with schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

. A person with delusional disorder may be high functioning
Global Assessment of Functioning
The Global Assessment of Functioning is a numeric scale used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and...

 in daily life and may not exhibit odd or bizarre behavior aside from these delusions. The Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

 (DSM) defines six subtypes of the disorder characterized as erotomanic
Erotomania is a type of delusion in which the affected person believes that another person, usually a stranger or famous person, is in love with him or her. The illness often occurs during psychosis, especially in patients with schizophrenia or bipolar mania...

 (believes that someone famous is in love with him/her), grandiose (believes that he/she is the greatest, strongest, fastest, richest, and/or most intelligent person ever), jealous (believes that the love partner is cheating on him/her), persecutory (believes that someone is following him/her to do some harm in some way), somatic (believes that he/she has a disease or medical condition), and mixed, i.e., having features of more than one subtypes. Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...

s also occur as symptoms of many other mental disorders, especially the other psychotic disorders.

The DSM-IV, and psychologists, generally agree that personal beliefs should be evaluated with great respect to complexity of cultural and religious differences since some cultures have widely accepted beliefs that may be considered delusional in other cultures.

Indicators of a delusion

The following can indicate a delusion:
  1. The patient expresses an idea or belief with unusual persistence or force.
  2. That idea appears to exert an undue influence on the patient's life, and the way of life is often altered to an inexplicable extent.
  3. Despite his/her profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.
  4. The individual tends to be humorless and oversensitive, especially about the belief.
  5. There is a quality of centrality: no matter how unlikely it is that these strange things are happening to him, the patient accepts them relatively unquestioningly.
  6. An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility.
  7. The belief is, at the least, unlikely, and out of keeping with the patient's social, cultural and religious background.
  8. The patient is emotionally over-invested in the idea and it overwhelms other elements of their psyche
    Psyche (psychology)
    The word psyche has a long history of use in psychology and philosophy, dating back to ancient times, and has been one of the fundamental concepts for understanding human nature from a scientific point of view. The English word soul is sometimes used synonymously, especially in older...

  9. The delusion, if acted out, often leads to behaviors which are abnormal and/or out of character, although perhaps understandable in the light of the delusional beliefs.
  10. Individuals who know the patient observe that the belief and behavior are uncharacteristic and alien.


The following features are found:
  1. It is a primary disorder.
  2. It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity.
  3. The illness is chronic and frequently lifelong.
  4. The delusions are logically constructed and internally consistent.
  5. 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.
  6. The individual experiences a heightened sense of self-reference. Events which, to others, are nonsignificant are of enormous significance to him or her, and the atmosphere surrounding the delusions is highly charged.


Diagnosis of a specific type of delusional disorder can sometimes be made based on the content of the delusions. The Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

(DSM) enumerates six types:
  • Erotomanic Type (erotomania)
    Erotomania is a type of delusion in which the affected person believes that another person, usually a stranger or famous person, is in love with him or her. The illness often occurs during psychosis, especially in patients with schizophrenia or bipolar mania...

    : delusion that another person is in love with the individual, quite frequently a famous person. The individual may breach the law as he/she tries to obsessively make contact with the desired person.
  • Grandiose Type
    Grandiose delusions
    Grandiose delusion or delusions of grandeur is principally a subtype of delusional disorder that can occur as a wide range of mental illness, including in two thirds of those in manic state of bipolar disorder, half those with schizophrenia and a substantial portion of those with substance abuse...

    : delusion of inflated worth, power, knowledge, identity or believes himself/herself to be a famous person, claiming the actual person is an impostor or an impersonator.
  • Jealous Type: delusion that the individual's sexual partner is unfaithful when it is untrue. The patient may follow the partner, check text messages, emails, phone calls etc. in an attempt to find "evidence" of the infidelity.
  • Persecutory Type
    Persecutory delusions
    Persecutory delusions are a delusional condition in which the affected person believes they are being persecuted...

    : This delusion is a common subtype. It includes the belief that the person (or someone to whom the person is close) is being malevolently treated in some way. The patient may believe that he/she has been drugged, spied-on, harassed and so on and may seek "justice" by making police reports, taking court action or even acting violently.
  • Somatic
    The term somatic means 'of the body',, relating to the body. In medicine, somatic illness is bodily, not mental, illness. The term is often used in biology to refer to the cells of the body in contrast to the germ line cells which usually give rise to the gametes...

    : delusions that the person has some physical defect or general medical condition (for example, see delusional parasitosis
    Delusional parasitosis
    Delusional parasitosis is a form of psychosis whose victims acquire a strong delusional belief that they are infested with parasites, whereas in reality no such parasites are present...


(Lippincott, 2008).
  • Mixed Type: delusions with characteristics of more than one of the above types but with no one theme predominating.
  • Supernatural Type: The individual or group believe in the presence of an unidentifiable force or higher power, the individuals may become hostile if their beliefs are challenged, this type of the spectrum is considered the most common.

A diagnosis of 'unspecified type' may also be given if the delusions fall into several or none of these categories.


When delusional disorders occur late in life they suggest a hereditary predisposition. Researchers also suggest that these disorders are the result of early childhood
Childhood is the age span ranging from birth to adolescence. In developmental psychology, childhood is divided up into the developmental stages of toddlerhood , early childhood , middle childhood , and adolescence .- Age ranges of childhood :The term childhood is non-specific and can imply a...

 experiences with an authoritarian family structure. According to other researchers, any person with a sensitive personality is particularly vulnerable to developing a delusional disorder.

A common theory of the prevalance of delusional disorders is simply false information being taught to an individual and due to basic instinct of tribal survival the individual takes these "facts of life" to be true, an example can be a child being born into a religious family and thus believing in a "God", even with the understanding of such a thing cannot exist many billions do consider a supernatural entity, this however has been put down to the lack of provisional support for those suffering from the disorder.

Although its exact cause is unknown, it is believed that genetic
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....

, biochemical and environmental factors play a significant role in the development of delusional disorder.


The symptoms expressed by a delusional disorder can also be part of a much more serious problem, such as bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

 or schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

, therefore diagnosing the delusional disorder is conducted partially by process of elimination. This occurs because delusions can be part of many other illnesses including dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...

, schizophrenia and schizoaffective disorder
Schizoaffective disorder
Schizoaffective disorder is a psychiatric diagnosis that describes a mental disorder characterized by recurring episodes of elevated or depressed mood, or of simultaneously elevated and depressed mood, that alternate with, or occur together with, distortions in perception.Schizoaffective disorder...

. They may also be part of a response to physical, medical conditions, or reactions when drugs are ingested.

Interviews are useful tools to obtain information about the patient's life situation and past history to help identifying the delusional disorder. Clinicians may review earlier medical records, with the patient's permission. Clinicians also interview the patient's immediate family
In human context, a family is a group of people affiliated by consanguinity, affinity, or co-residence. In most societies it is the principal institution for the socialization of children...

. This is a very helpful measure in determining the presence of delusions. The mental status examination is used to assess the patient's memory
In psychology, memory is an organism's ability to store, retain, and recall information and experiences. Traditional studies of memory began in the fields of philosophy, including techniques of artificially enhancing memory....

, concentration
In chemistry, concentration is defined as the abundance of a constituent divided by the total volume of a mixture. Four types can be distinguished: mass concentration, molar concentration, number concentration, and volume concentration...

, and understanding the individual's situation and logical thinking.

Another psychological test used in the diagnosis of the delusional disorder is the Peters Delusion Inventory (PDI) which focuses on identifying and understanding delusional thinking. However, this test is more likely used in research than in clinical practice.


Treatment of delusional disorders includes a combination of drug therapy and psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

 although it is a challenging disorder to treat for many reasons such as the patient's denial that they have a problem of a psychological nature.

Atypical antipsychotic
Atypical antipsychotic
The atypical antipsychotics are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia...

 medications (also known as novel or newer-generation) are used in the treatment of delusional disorder as well as in schizophrenic disorders. Some examples of such medications are risperidone
Risperidone is a second generation or atypical antipsychotic, sold under the trade name . It is used to treat schizophrenia , schizoaffective disorder, the mixed and manic states associated with bipolar disorder, and irritability in people with autism...

 (Risperdal), quetiapine
Quetiapine , is an atypical antipsychotic approved for the treatment of schizophrenia, and bipolar disorder....

 (Seroquel), and olanzapine
Olanzapine is an atypical antipsychotic, approved by the FDA for the treatment of schizophrenia and bipolar disorder...

 (Zyprexa). These medications work by blocking postsynaptic dopamine receptors and reduce the incidence of psychotic symptoms including hallucinations and delusions. They also relieve anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

 and agitation. When these drugs are tried but the symptoms do not improve, other types of antipsychotics may be prescribed. Some examples are: fluphenazine decanoate and fluphenazine enanthate. One very effective drug in delusional disorders is also pimozide
Pimozide is an antipsychotic drug of the diphenylbutylpiperidine class. It was discovered at Janssen Pharmaceutica in 1963. It has a high potency compared to chlorpromazine . On a weight basis it is even more potent than haloperidol. It also has special neurologic indications for Tourette syndrome...


In some cases agitation may occur as a response to severe or harsh confrontation
Confrontation is a tactical fantasy miniature wargaming in which the combatants are represented by metal figures in 28 mm scale. For comparison purposes, the system's figures are slightly larger than those of Games Workshop or The Foundry....

 when dealing with the existence of the delusions. If agitation occurs, different antipsychotics can be administered to conclude its outbreak. For instance, an injection of haloperidol
Haloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....

 (Haldol) can decrease anxiety and slow behavior, it is often combined with medications including lorazepam
Lorazepam is a high-potency short-to-intermediate-acting 3-hydroxy benzodiazepine drug that has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant, antiemetic and muscle relaxant...


In cases when severely ill patients do not respond to standard treatment, Clozapine
Clozapine is an antipsychotic medication used in the treatment of schizophrenia, and is also used off-label in the treatment of bipolar disorder. Wyatt. R and Chew...

 may be prescribed although it may cause drowsiness, sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...

, excessive salivation, tachycardia
Tachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...

, dizziness
Dizziness refers to an impairment in spatial perception and stability. The term is somewhat imprecise. It can be used to mean vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness....

, seizures and agranulocytosis
Granulopenia, also known as Agranulosis or Agranulocytosis, is an acute condition involving a severe and dangerous leukopenia , most commonly of neutrophils causing a neutropenia in the circulating blood. It represents a severe lack of one major class of infection-fighting white blood cells...


To treat long term symptoms, an oral novel antipsychotic is often prescribed on a daily basis. Antidepressants and anxiolytics are also prescribed to control associated symptoms.

Psychotherapy for patients with delusional disorder include cognitive therapy
Cognitive therapy
Cognitive behavioral therapy is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present...

 which is conducted with the use of empathy
Empathy is the capacity to recognize and, to some extent, share feelings that are being experienced by another sapient or semi-sapient being. Someone may need to have a certain amount of empathy before they are able to feel compassion. The English word was coined in 1909 by E.B...

. During the process, the therapist asks hypothetical questions in a form of therapeutic Socratic dialogue
Socratic dialogue
Socratic dialogue is a genre of prose literary works developed in Greece at the turn of the fourth century BC, preserved today in the dialogues of Plato and the Socratic works of Xenophon - either dramatic or narrative - in which characters discuss moral and philosophical problems, illustrating a...

. This therapy has been mostly studied in patients with the persecutory type.The combination of pharmacotherapy with cognitive therapy integrates treating the possible underlying biological problems and decreasing the symptoms with psychotherapy as well. Psychotherapy has been said to be the most useful form of treatment because of the trust formed in a patient and therapist relationship. The therapist is there for support and must not show any signs that implicate that the patient is mentally ill.

Supportive therapy has also shown to be helpful. Its goal is to facilitate treatment adherence and provide education about the illness and its treatment.

Furthermore, providing social skills training has been applicable to a high number of persons. It should focus on promoting interpersonal competence as well as confidence
Confidence is generally described as a state of being certain either that a hypothesis or prediction is correct or that a chosen course of action is the best or most effective. Self-confidence is having confidence in oneself. Arrogance or hubris in this comparison, is having unmerited...

 and comfort
Comfort may refer to:*Comfort , by the rock group Failure*Comfort *Comfort Air, German airline*Comfort food*Comfort noise, artificial background noise used in radio and wireless communications to fill the silent time in a transmission*Comfort object, an object used to provide psychological...

 when interacting with those individuals perceived as a threat
Threat of force in public international law is a situation between states described by British lawyer Ian Brownlie as:The 1969 Vienna convention on the Law of Treaties notes in its preamble that both the threat and the use of force are prohibited...


Reports have shown successful use of insight-oriented therapy although it may also be contraindicated for delusional disorder. Its goals are to develop therapeutic alliance, containment of projected feelings of hatred
Hatred is a deep and emotional extreme dislike, directed against a certain object or class of objects. The objects of such hatred can vary widely, from inanimate objects to animals, oneself or other people, entire groups of people, people in general, existence, or the whole world...

, impotence, and badness; measured interpretation as well as the development of a sense of creative doubt in the internal perception of the world. The latter requires the empathy with the patient's defensive position.

Further reading

  • Sims, A. (1995) Symptoms in the mind: An introduction to descriptive psychopathology. Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1.
  • American Psychiatric Association
    American Psychiatric Association
    The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

    . (2000). Diagnostic and Statistical Manual of Mental Disorders
    Diagnostic and Statistical Manual of Mental Disorders
    The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

    , (4th ed., text revision). Washington, DC: American Psychiatric Association. ISBN 978-0-89042-024-9

External links

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