Attempting to live with delusional disorder can be challenging without help. Unfortunately, delusional disorder is a persistent condition that adversely affects a person’s life. Those who have delusional disorder will become isolated and feel alienated from others, causing strained relationships and leaving them to fend for themselves. Due to the unique challenges they face associated with the illness, depression is another likely outcome. Depending on the subtype, it could also cause legal issues.
A delusion is a fixed belief that’s false and based on an inaccurate interpretation of reality despite being presented with evidence that proves otherwise. A diagnosis can only be made when the individual has one or more non-bizarre delusional thoughts for a month or longer that can’t be explained by any other condition. A person’s cultural beliefs will be considered before the doctor attempts a diagnosis.
Delusional disorder is an extremely rare condition that has a much later age of onset than schizophrenia. Current research does not show gender dominance, and the cause of the disorder is relatively unknown. Biological conditions that include medical conditions, substance use, and neurological conditions can cause delusions. Still, those with language barriers, who are visually impaired, deaf, and the elderly are more vulnerable to delusions.
As was mentioned above, the condition is rare. The lifetime morbid risk of delusional disorder in the general population is as low as 0.05% to 0.1%. The lifetime prevalence of the delusional disorder is about 0.02 percent. It’s much rarer than bipolar disorder, schizophrenia, and other mood disorders. However, this could be due to underreporting of the condition because those with delusional disorder may not seek mental health attention unless forced. Unlike other illnesses, the age of onset is about 40 years but can range from 18 to 90.
Although it affects a small portion of the population, it can have devastating consequences on the person suffering from it and others around them. Unfortunately, there are several variations of the condition that are important to learn about. Let’s take a look below at a more in-depth explanation about delusions and the different types of delusional disorders.
What Is Delusional Disorder?
Delusional disorder was once known as paranoid disorder, and it’s a severe type of mental illness considered a psychosis. It’s where a person can’t distinguish the difference between what’s real or what’s imagined. The primary feature of the condition is the presence of delusions, which are unshakable beliefs of something that’s not true.
Individuals with delusional disorder will experience non-bizarre delusions involving situations that might happen in real life. These include being poisoned, deceived, followed, loved from a distance, or being conspired against. The delusions typically involve the misinterpretation of experiences or perceptions. However, realistically speaking, they aren’t true at all, or they’re highly exaggerated.
Those diagnosed with delusional disorder can often continue to function and socialize normally, apart from the subject of the particular delusion, and don’t typically behave in a bizarre or odd manner, which is different from other psychotic disorders. With other types of psychotic conditions, delusions may only be one symptom of the disorder. However, in some cases, those with delusional disorder can become so preoccupied with their delusions that it interrupts their lives.
Due to its rarity, delusions are more often a symptom of more common disorders like schizophrenia. As was mentioned above, delusional disorder doesn’t present itself until later in life.
What Are the Types of Delusional Disorder?
There are different iterations of the condition based on the main theme of the delusions a person experiences. The following are different types of delusion disorder that include:
- Erotomanic: An individual with this form of delusional disorder believes that other people, typically someone of power or famous, are in love with them. The individual could attempt to contact the object of the delusion, which could lead to stalking or other potentially dangerous behaviors.
- Grandiose: An individual with this form of delusional disorder has an overinflated sense of power, worth, identity, or knowledge. They could also believe they have a great talent, are better than anyone else, or have made an important discovery. Although it’s not dangerous, it could lead to issues down the road.
- Jealous: An individual suffering from this form of delusional disorder believes that their spouse or sexual partner is unfaithful. Unfortunately, this can be dangerous if the person is violent, which could lead to stalking or other destructive actions. It’s crucial to seek immediate help if you feel that you’re being stalked by someone who is jealous with delusional disorder.
- Persecutory: Those with this type of delusional disorder believe that either themselves or someone close to them is getting mistreated. They might also feel they’re being spied on or someone is planning on hurting them. It’s common for those with this kind of delusional disorder to contact authorities frequently and make complaints.
- Somatic: A person with this form of delusional disorder genuinely believes they have a medical or physical defect. It could lead to obsessive thoughts and looking online to self-diagnose.
- Mixed: A person with mixed delusional disorder suffers from two or more types of the delusions we’ve mentioned above.
What Causes Delusional Disorder?
As was mentioned above, research on the prevalence and causes of delusional disorder is scarce. The precise cause is still unknown. However, researchers have looked at the role of various biological, genetic, and psychological or environmental factors. Although there is a lot to learn, the following can help provide a bit of clarity on the topic.
- Genetic: Since delusional disorder is more common in those with family members who have schizophrenia or delusional disorder, it suggests there could be a genetic factor involved. It’s widely believed that similar to other mental disorders, a tendency to develop delusional disorder can be passed on from parents to their children.
- Biological: Researchers have been focusing on how abnormalities in specific areas of the brain could be involved in someone developing delusional disorder. Imbalances in the brain of chemicals in the brain, known as neurotransmitters, also are linked to the formation of delusional symptoms. Neurotransmitters are responsible for the nerve cells in our brains that send messages to each other. An imbalance of these chemicals interferes with the transmission of messages, causing delusional symptoms.
- Environmental/psychological: Other evidence has pointed toward delusional disorder getting triggered by stress. Drug and alcohol abuse can also contribute to the condition. As was mentioned above, those who isolate themselves, including immigrants or those with poor hearing or sight, are more vulnerable to developing delusional disorder.
What Are the Symptoms of Delusional Disorder?
The most obvious symptoms of delusional disorder are the presence of non-bizarre delusions. However, other symptoms might occur in conjunction with these and include the following:
- Hallucinations (seeing, hearing, or feeling things that aren’t there) that are related to the delusion. For example, the individual might believe they have an odor problem because of a foul odor they smell.
- An angry, irritable, or low mood.
- Believing things that aren’t true.
How Is Delusional Disorder Diagnosed?
If you experience symptoms of delusional disorder, your doctor will give you a complete medical history and a thorough physical exam. Despite no lab tests being available to make a specific delusional disorder diagnosis, the doctor could use diagnostic tests, including blood testing or imaging studies, to rule out physical illness as the cause of your symptoms. These include the following:
- Alzheimer’s disease
- Obsessive-compulsive disorder (OCD)
- Other schizophrenia spectrum disorders
If your physician finds no physical reason for your symptoms, they could refer you to a psychologist or psychiatrist or a healthcare professional trained to diagnose and treat specific mental illnesses. They’ll utilize interview and assessment tools to evaluate you for a psychotic disorder.
The therapist or doctor will base their diagnosis on your symptoms and their observation of you in a controlled environment. They’ll watch your attitude and behavior and make the final decision on if your symptoms point to a specific condition like delusional disorder. Due to its rarity, making a diagnosis can be hard for the doctor since these symptoms are similar to other conditions.
The only way a doctor can make a diagnosis and feel comfortable with their choice is based on the following:
- When physicians exhaust all resources and determine another medical, mental disorder, or medical condition is to blame.
- The individual has one or more delusions that last at least a month and persist even longer. Depending on the subtype of delusional disorder, this can have adverse effects on the individual’s life.
- The person exhibits behavior that’s bizarre or odd.
- The person hasn’t even been diagnosed with schizophrenia. If they’re dealing with hallucinations, they’re related to the theme of their delusions.
- If the individual has encountered manor or major depressive episodes, they’ve been brief when compared to their delusions.
How Is Delusional Disorder Treated?
For someone battling delusional disorder, treatment is the only option if they wish to lead a somewhat normal life. Fortunately, with the advances in modern medication, living a regular life with this kind of condition. The most common form of treatment will include psychotherapy, which is a type of counseling, and medication. Delusional disorder is challenging to treat, partially because those with the condition will have poor insight and don’t realize there’s a psychiatric issue. Studies have shown that nearly 50 percent of patients treated with antipsychotic medication showed, at the very least, partial improvement.
The most common medications used to control delusional disorder are antipsychotics and include the following medicines.
These drugs are also referred to as neuroleptics, and they’ve been administered to treat mental health conditions since the mid-1950s. These drugs work in our system by blocking dopamine receptors in the brain, which is a neurotransmitter believed to play a role in the development of delusions. The most common conventional antipsychotics used to treat delusional disorder include:
- Fluphenazine (Prolixin)
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
- Perphenazine (Trilafon)
- Loxapine (Oxilapine)
- Thiothixene (Navane)
- Thioridazine (Mellaril)
- Trifluoperazine (Stelazine)
These newer drugs, known as atypical antipsychotics, appear to help treat the symptoms of delusional disorder with less movement-related side effects than older and more traditional antipsychotics. These drugs work by blocking serotonin and dopamine receptors in our brain. Serotonin is another neurotransmitter that could be involved in delusional disorder. The most common atypical antipsychotics used to treat delusional disorder include:
- Asenapine (Saphris)
- Aripiprazole Lauroxil (Aristada)
- Aripiprazole (Abilify)
- Cariprazine (Vraylar)
- Brexpiprazole (Rexulti)
- Clozapine (Clozaril)
- Iloperidone (Fanapt)
- Lurasidone (Latuda)
- Paliperidone (Invega Sustenna)
- Paliperidone Palmitate (Invega Trinza)
- Ziprasidone (Geodon)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
Sedatives and antidepressants may also be administered by physicians to treat mood symptoms or anxiety if they occur in conjunction with delusional disorder. In severe cases of anxiety, the psychiatrist may prescribe tranquilizers to calm the individual down. It can also help someone if they’re battling insomnia or a sleeping problem. Antidepressants might also be given to treat depression, which is common in those battling delusional disorder.
While medication is proven effective, using it alongside psychotherapy can provide the best results. It can help the individual manage and cope with the stresses related to their delusional beliefs and help them deal with the daily impact on their lives. The following psychotherapies are helpful when combatting delusional disorder and include the following:
- Individual psychotherapy: Individual psychotherapy allows the individual to recognize and correct the thoughts that have become distorted due to the condition. Sometimes, we bottle up our emotions and keep how we’re feeling to ourselves. By speaking to an outside person who understands the disorder, they can help guide your thoughts and help get you back on track.
- Cognitive Behavioral Therapy: Cognitive behavioral therapy (CBT) has emerged as one of the best forms of treatment for a person with delusional disorder. It helps a person understand, recognize, and change thoughts, patterns, and behaviors that cause troublesome feelings. It’s also used to treat substance use disorders and other mental health conditions.
- Family Therapy: Getting family on board with the condition is helpful in many ways. When your family has no idea what’s going on, they might get angry or frustrated by the way you act because they don’t understand it. Family therapy is the perfect option to help not only the individual, but the families as well to get on the same page.
Delusional disorder can cause severe symptoms, meaning people dealing with them might be at extreme risk of hurting themselves or others. For this reason, the individual might need to be hospitalized until they’re stable. Delusions can make you believe things that aren’t true, leading to anger and harming others.
What Are the Complications of Delusional Disorder?
Unfortunately, there are many complications associated with delusional disorder. For example, a person diagnosed with the condition will likely become depressed because of the difficulties attached to the delusions. When you don’t feel like you’re understood or can’t connect with others, it’ll take its toll on your mental health.
Acting on these delusions can also lead to legal issues, violence, or getting hurt. For example, someone with erotomanic delusions who harasses or stalks someone because they were the object of their delusions can end up getting arrested and thrown in jail. Even worse, the delusions could lead to severe crimes.
Also, the likelihood of isolating and alienating yourself from others because of delusional disorder is common, especially if these delusions interfere with or damage relationships. Isolation can be bad no matter the situation, and if you’re taking care of someone with delusional disorder, you must pay attention to their behavior.
What’s the Outlook for Someone with Delusional Disorder?
The outlook for someone with delusional disorder depends. While a person can be treated with medication and therapy and have a positive outlook, the life circumstances of others can cause problems. For example, a person who chooses not to accept help or won’t stick to their treatment regimen isn’t going to get better.
Like other mental health conditions, delusional disorder is a persistent or chronic condition. However, when adequately treated, many people will find relief from their symptoms. While some recover completely, others will have bouts of delusional beliefs with a lack of symptoms. For this reason, if you’re prescribed medication, you must keep up with your regimen and regularly attend doctor’s appointments.
Unfortunately, a majority of those with the condition won’t seek the help they so desperately need. It’s challenging for those with mental health conditions to know they aren’t doing so well. In other cases, they may blame the symptoms on outside factors, such as their environment. They could also be embarrassed to seek out treatment. Without getting the help they need, delusional disorder is a lifelong illness that’ll cause significant hardships.
Can Delusional Disorder Be Prevented?
Unfortunately, there isn’t a way to prevent delusional disorder. However, diagnosing the condition early on and getting treatment can prevent significant disruption in the individuals, family, and friends lives.
How to Treat Someone With Delusional Disorder
When caring for someone with delusional disorder, it’s important to keep a few factors in mind to ensure the person with the condition doesn’t become overwhelmed.
- Be aware of your tone: When talking to someone that’s been diagnosed with delusional disorder, be aware of your tone and choice of words. You must try to come across as non-confrontational and stay calm. You must express concern instead of judgment as it’s the best way to speak with your loved one. Remember, if they’re amid a delusion, you shouldn’t try to talk with them.
- Stay neutral: You should never try to convince your loved one their delusions aren’t real. It can lead to explosive arguments and behavior. The conflict can also cause them to isolate further. You might also have an impulse to agree with them, but don’t buy into their delusions and become a part of the psychosis. You can express thoughts toward how they feel about the delusion but never state you believe in the delusion. This can validate their feelings, leading to further paranoia that you’re part of the conspiracy that’s out to get them.
- Give them space: If the individual is in a delusional state or suffering from an episode, you must give them space and stay mindful of your body movements to prevent them from becoming agitated. Although it may be an instinct to hug them or hold them, this can be misinterpreted and lead to violence. Stay calm and give them space.
- Offer help and support: Help that you offer to a loved one when they’re not experiencing a delusional episode can come in various ways. This includes accompanying them to a doctor’s appointment, helping them take their medication, assisting with chores or errands, going on walks and exercising with them, or visiting them when they feel depressed.
If you know of someone experiencing any of the symptoms we’ve listed above, it’s important to visit a doctor and weigh your options. Help is available and can offer you or someone you love to get their lives back on track.