By: Bhaveeshika Charun
What is Delusional Disorder?
Delusional disorder, previously known as paranoid disorder, is a type of psychotic disorder. People who have it can’t tell what’s real and what’s not.
Delusions are the main symptoms of delusional disorder. They’re unshakable beliefs in something untrue or based on reality. But that doesn’t mean they’re completely unrealistic.
Those delusions involved bizarre ones and non-bizarre ones.
● Non-bizarre ones relate to situations that could happen in reality such as being followed, deceived, attacked, conspired against or being poisoned.
● On the other hand, bizarre ones are those that could never happen in real life such as getting kidnapped by aliens or someone reading your thoughts.
People with this disorder can interact and socialise normally as anyone else and generally do not behave oddly. But in certain cases, people with delusional disorder might be so engrossed with their delusions that it might disrupt their lives.
Delusional disorder most often happens in middle to late life and is more common in women than in men.
Types of Delusional Disorder
There are different types of delusional disorder which varies according to the theme of the person’s delusions. The types of delusions include:
● Erotomanic: The person believes someone is in love with them and might try to contact that person. Often, it’s someone important or famous. This can lead to stalking behaviour.
● Grandiose: This person has an over-inflated sense of worth, power, knowledge, or identity. They could believe they have a great talent or made an important discovery.
● Jealous: A person with a delusional disorder jealous type believes their spouse or sexual partner is unfaithful.
● Persecutory: Someone who has this believes they (or someone close to them) are being mistreated, or that someone is spying on them or planning to harm them. They might make repeated complaints to legal authorities.
● Bizarre: These delusions involve believing something impossible in our reality, such as aliens taking over your friend's body.
● Somatic: They believe they have a physical defect or medical problem.
● Thought broadcasting: The idea that your thoughts are being transmitted and heard through public mediums like TV, radio, or the internet.
● Thought insertion: The idea that thoughts are being imposed on you by outside forces.
● Mixed: Two or more of the types of delusions listed above.
● Unspecified: The primary type of delusion cannot be identified. Symptoms
Symptoms usually include:
● Non-bizarre delusions - most common ones
● Cranky, angry or low mood
● Anxiety or depression
● Hallucinations related to the disorder
● Inability to see the delusions as false or troublesome
● A belief that people are taking advantage of them
● Mistrusting family and friends
● A tendency to hold grudges
● Outsized reactions to perceived slights or harmless remarks and incidents
● Aggressiveness either towards a specific person or to others
● Unusual or abnormal behaviour such as removing “insects” on the skin that are not there in reality
● Believing that the body has a foul smell or is being invaded by insects
● Believing that someone is out to harm the individual
● Believing that the individual has achieved great things or is popular
● Consistent tension in romantic situations
Causes
● Genetic: Delusional disorder is more common in people who have family members with delusional disorder or schizophrenia suggesting that genes may be involved. It is believed that it tends to be passed on from parents to their children.
● Biological: Abnormal brain regions that control perception and thinking may be linked to the delusional symptoms.
● Environmental/psychological: Evidence suggests that stress can trigger delusional disorder. Alcohol and drug abuse also might contribute to it. People who tend to be isolated or those with poor sight and hearing, appear to be more likely to have delusional disorder.
Diagnosis
If you have symptoms of delusional disorder, the doctor is most likely to give you a complete medical history and physical exam.
Differential Diagnoses
The doctor might use diagnostic tests, such as imaging studies or blood tests, to rule out physical or other psychiatric illnesses as the cause of the symptoms. These include:
● Alzheimer’s disease
● Epilepsy
● Obsessive-compulsive disorder
● Bipolar disorder
● Personality disorders
● Delirium
● Other schizophrenia spectrum disorders
Uncovering A Diagnosis
If the doctor finds no physical reason for the symptoms, they might refer the person to a psychiatrist, psychologist or health care professional trained to diagnose and treat mental illnesses. They’ll use interview and assessment tools to evaluate the person for a psychotic disorder.
The doctor or therapist bases the diagnosis on the person's symptoms and their observation of the person's attitude and behaviour. They’ll decide if the symptoms point to a disorder.
A diagnosis of delusional disorder is made if:
● The person has one or more delusions that last a month or longer.
● The person has never been diagnosed with schizophrenia; hallucinations, if they have them, are related to the themes of their delusions.
● Apart from the delusions and their effects, their life isn’t affected. Their other behaviour isn’t bizarre or odd.
● Manic or major depressive episodes, if they’ve happened, have been brief, when compared with the delusions.
● There isn’t another mental disorder, medication, or medical condition to blame.
Treatment
Treatment most often includes medication and psychotherapy. Delusional disorder can be difficult to treat and studies have shown that close to half the patients treated with antipsychotic medications show at least a partial improvement.
Medications used include:
● Conventional antipsychotics: They work by blocking dopamine receptors in the brain. Dopamine is a neurotransmitter that is believed to be involved in the development of delusions.
● Atypical antipsychotics: They work by blocking dopamine and serotonin receptors in the brain. Serotonin is another neurotransmitter believed to be involved in the development of delusions.
● Tranquillizers might be used if the person has a very high level of anxiety or problems sleeping.
● Sedatives and antidepressants are also used if the person is dealing with anxiety or mood swings
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● Individual psychotherapy can help the person recognise and correct their distorted thinking.
● Cognitive Behaviour therapy (CBT) can help the person to recognise and change their thought patterns and behaviours.
● Family therapy can help the family of an individual deal with or support them.
● People with severe symptoms or at risk of hurting themselves might need to be hospitalised.
● Acting on the delusions also can lead to violence or legal problems. For example, a person with an erotomanic delusion who stalks or harasses the object of the delusion could be arrested.
● People with this disorder can become alienated from others, especially if their delusions interfere with or damage their relationships.
References:
1. Cleveland Clinic. (May, 2022) “Delusional Disorder” Cleveland Clinic https://my.clevelandclinic.org/health/diseases/9599-delusional-disorder
2. WebMD Editorial Contributors. (Jan., 2024) “Delusional Disorder: Types, Symptoms and Treatment” WebMD https://www.webmd.com/schizophrenia/delusional-disorder
3. Belmont Behavioral Health System. “Causes, Signs and Effects of Delusional Disorder” Belmont Behavioral Health System https://www.belmontbehavioral.com/disorders/delusional/causes-effects/
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