What Is Delusional Disorder?
Delusional disorder, previously called paranoid disorder, is a type of serious mental illness called a psychotic disorder. People who have it can’t tell what’s real from what is imagined.
Delusions are the main symptom of delusional disorder. They’re unshakable beliefs in something that isn’t true or based on reality. But that doesn’t mean they’re completely unrealistic. Delusional disorder can involve delusions that aren’t bizarre, having to do with situations that could happen in real life, like being followed, poisoned, deceived, conspired against, or loved from a distance. These delusions usually involve mistaken perceptions or experiences. But in reality, the situations are either not true at all or highly exaggerated.
A bizarre delusion, by contrast, is something that could never happen in real life, such as being cloned by aliens or having your thoughts broadcast on TV. A person who has such thoughts might be considered delusional with bizarre-type delusions.
People with delusional disorder often can continue to socialize and function normally, apart from the subject of their delusion, and generally do not behave in an obviously odd or bizarre manner. This is unlike people with other psychotic disorders, who also might have delusions as a symptom of their disorder. But in some cases, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted.
Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Delusional disorder most often happens in middle to late life and is slightly more common in women than in men.
Delusion vs. hallucination
A person with a delusion believes something that isn't true no matter how much evidence you give to the contrary. For example, they may believe a family member is trying to poison them.
Hallucinations involve the senses – seeing, feeling, or hearing something that isn't there, for example.
Delusional disorder vs. schizophrenia
Schizophrenia is a break with reality that may involve delusions or hallucinations but includes other symptoms too. People with schizophrenia can have trouble with personal and professional relationships or with controlling their thoughts and behaviors. People with delusional disorder usually have no symptoms of mental illness other than their delusion.
The diagnostic criteria for delusional disorder, according to the American Psychiatric Association DSM 5, is a person having delusions for over a month who otherwise seems mentally and emotionally unimpaired. Types of delusional disorder are based on the main theme of the delusion:
- 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 behavior.
- 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 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 of Delusional Disorder
Symptoms usually include:
- Non-bizarre delusions – these are the most obvious symptom
- Cranky, angry, or low mood
- Anxiety or depression
- Hallucinations (seeing, hearing, or feeling things that aren’t really there) related to the delusion. For example, someone who believes they have an odor problem might smell a bad odor.
- An inability to see the delusions as false or troublesome
- A belief that others are taking advantage of them
- Mistrusting friends and family
- Outsized reactions to perceived slights or harmless remarks and incidents
- A tendency to hold grudges
To receive a diagnosis of delusional disorder, you must have delusions despite abusing drugs or alcohol, even though people with substance use disorders frequently have delusions. To heavy alcohol or drug users, delusions can seem magnified and may lead to excessive reactions or dangerous behaviors.
Causes of Delusional Disorder
As with many other psychotic disorders, the exact cause of delusional disorder is not yet known. But researchers are looking at the role of genetic, biological, environmental, or psychological factors that make it more likely.
- Genetic: The fact that delusional disorder is more common in people who have family members with delusional disorder or schizophrenia suggests genes may be involved. It is believed that, as with other mental disorders, a tendency to have delusional disorder might be passed on from parents to their children.
- Biological: Researchers are studying how delusional disorders might happen when parts of the brain aren’t normal. 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, such as immigrants or those with poor sight and hearing, appear to be more likely to have delusional disorder.
Diagnosing Delusional Disorder
If you have symptoms of delusional disorder, your doctor will likely give you a complete medical history and physical exam.
Although there are no lab tests to specifically diagnose delusional disorder, 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
- Obsessive-compulsive disorder
- Bipolar disorder
- Personality disorders
- 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 or psychologist, health care professionals 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 own observation of the person's attitude and behavior. 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 its effects, their life isn’t really affected. Their other behavior 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 for Delusional Disorder
Treatment most often includes medication and psychotherapy (a type of counseling). Delusional disorder can be very difficult to treat, in part because those who have it often have poor insight and do not know there’s a psychiatric problem. Studies show that close to half of patients treated with antipsychotic medications show at least partial improvement.
The primary medications used to attempt to treat delusional disorder are called antipsychotics. Drugs used include:
- Conventional antipsychotics: Also called neuroleptics, these have been used to treat mental disorders since the mid-1950s. They work by blocking dopamine receptors in the brain. Dopamine is a neurotransmitter believed to be involved in the development of delusions. Conventional antipsychotics include:
- Chlorpromazine (Thorazine)
- Fluphenazine (Prolixin)
- Haloperidol (Haldol)
- Loxapine (Oxilapine)
- Perphenazine (Trilafon)
- Thioridazine (Mellaril)
- Thiothixene (Navane)
- Trifluoperazine (Stelazine)
- Atypical antipsychotics: These newer drugs appear to help treat the symptoms of delusional disorder with fewer movement-related side effects than the older typical antipsychotics. They work by blocking dopamine and serotonin receptors in the brain. Serotonin is another neurotransmitter believed to be involved in delusional disorder. These drugs include:
- Aripiprazole (Abilify)
- Aripiprazole lauroxil (Aristada)
- Asenapine (Saphris)
- Brexpiprazole (Rexulti)
- Cariprazine (Vraylar)
- Clozapine (Clozaril)
- Iloperidone (Fanapt)
- Olanzapine (Zyprexa)
- Lurasidone (Latuda)
- Paliperidone (Invega Sustenna)
- Paliperidone Palmitate (Invega Trinza)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
Other medications: Sedatives and antidepressants might also be used to treat anxiety or mood symptoms if they happen with delusional disorder. Tranquilizers might be used if the person has a very high level of anxiety or problems sleeping. Antidepressants might be used to treat depression, which often happens in people with delusional disorder.
Psychotherapy can also be helpful, along with medications, as a way to help people better manage and cope with the stresses related to their delusional beliefs and the impact on their lives. Psychotherapies that may be helpful in delusional disorder:
- Individual psychotherapy can help the person recognize and correct the thinking that has become distorted.
- Cognitive behavioral therapy (CBT) can help the person learn to recognize and change thought patterns and behaviors that lead to troublesome feelings.
- Family therapy can help families deal with or support a loved one who has delusional disorder.
People with severe symptoms or who are at risk of hurting themselves or others might need to be hospitalized until the condition is stabilized.
Complications of Delusional Disorder
- People may develop anxiety due to their delusions.
- People with delusional disorder might become depressed, often as the result of personal or professional problems that come with the delusions.
- 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.
Delusional Disorder Prognosis
It varies, depending on the person, the type of delusional disorder, and the person's life circumstances, including the presence of support and a willingness to stick with treatment.
Delusional disorder is typically a chronic (ongoing) condition. But when properly treated, many people can find relief from their symptoms. Some recover completely, while others have bouts of delusional beliefs with periods of remission (lack of symptoms).
Unfortunately, many people with this disorder don’t seek help. It’s often hard for people with a mental disorder to know they aren’t well. Or they may credit their symptoms to other things, like the environment. They also might be too embarrassed or afraid to seek treatment. Without treatment, delusional disorder can be a lifelong illness.
Can Delusional Disorder Be Prevented?
There’s no known way to prevent delusional disorder. But early diagnosis and treatment can help lessen the disruption to a person's life, family, and relationships.
How to Help Someone Who Has Delusions
You can support friends and family members with delusional disorder and encourage them to seek treatment. The earlier they seek help, the less impact delusional disorder may have on their life.
Other things you can do:
Avoid criticism. Judgment may make a person with delusions feel anxious, alone, or depressed. Temper your tone and talk to your loved one calmly.
Learn more. You can help your loved one understand their diagnosis and decide among treatment options.
Avoid argument. Don't tell your loved one their delusions are false. They may withdraw further and resist your efforts to help.
Be prepared. Make plans for a crisis and have a plan in case your loved one is in danger of hurting themselves or others.
If you are a caregiver for a person with delusional disorder, it's important to take care of yourself as well.
It's difficult for people with delusional disorder to recognize their illness and seek help. That's because they are usually still able to function and appear to be acting normally. When people do seek treatment, it's important to stay the course. Nearly half of those who do have a complete recovery.
Delusional Disorders FAQs
What are the signs of delusional disorder?
A person may have a delusional disorder if they are totally convinced something is true that to others is demonstrably false.
What is an example of a delusional disorder?
An example of an erotomanic delusion is believing a famous person is in love with you, when in reality they don't know you.
What are two categories of delusional disorders?
Non-bizarre delusions are those that may be believable in the real world, such as suspecting your spouse is having an affair or your boss doesn't like you. They may be delusions if misperceived or not true. Bizarre delusions are those in which the idea is not possible in reality, such as a television network broadcasting thoughts into your brain.
What are the six types of delusional disorder?
- The primary types of delusional disorder are erotomanic, grandiose, jealous, persecutory, somatic, and mixed.