Somatic Delusions: Sensing The Signs

Have you ever heard someone say an athlete is "deluded" about their physical abilities? Have you ever thought that a famous performer or political figure was experiencing "delusions of grandeur"? Or maybe you've felt like a co-worker "must be delusional" if they expect to get a large raise at the end of the year. If so, you're not the only one. Many people casually use the word “delusion” daily. Very few people connect the word to its original meaning, and fewer understand that delusional disorder is a genuine medical condition that can exert a powerful influence on the mind.

One manifestation of delusional disorder, somatic delusion, can cause a person to distrust their senses and fear their bodies. These delusions can occur in several different conditions, including bipolar disorder, schizophrenia, depression, and dementia. Before delving into the specifics of somatic-type delusions and their symptoms, it can be helpful to understand the broader scope of delusional disorder. Read on to learn more about somatic delusions and discover what treatment options are available for this rare psychiatric condition. 

What is delusional disorder?

Although people often casually use the word "delusion" to refer to any incorrect or unusual belief, the psychological definition of the term refers to a "rigid system of beliefs with which a person is preoccupied and to which the person firmly holds, despite the logical absurdity of the beliefs and a lack of supporting evidence."

All delusions can be labeled either "mood-congruent" or "mood-incongruent." A "mood-congruent" delusion is consistent with a particularly depressed or manic mental state. For example, people in a depressed state may believe their loved ones are going to desert them. People in a manic state may believe, also mood-congruently, that their prodigious talents are going unrecognized and being wasted.

In contrast, "moon-incongruent" delusions feel utterly disconnected from the individuals' general mental state. Since they are so radically different from the individual's overall mood, many people who experience these types of delusions often suspect their thoughts and feelings are being placed in their minds by an outside force. They may believe that other people, groups, or supernatural entities are taking over their minds, following a belief pattern psychologists call thought insertion.

Some people experience "bizarre" delusions, which are practically implausible and may be very difficult for other people to comprehend or process. For instance, a person who has bizarre somatic delusions may believe aliens have removed the major organs from their body without leaving any scars, or that humanoid robots have replaced their family members.

However, not all somatic delusions are this far-fetched. Many common delusions, which are classified as "non-bizarre" by psychiatrists, are theoretically possible but highly unlikely. Holding on to these delusions, despite a lack of evidence, is the common theme that unites all cases of delusional disorder. Some examples of the most experienced delusions are:

• A belief that the government, police, or some other powerful entity is following you and getting information about your activities.

• A belief that the world is soon coming to an end, whether through supernatural forces, natural disasters, or human warfare.

• A belief that your significant other has been unfaithful, despite a lack of supporting evidence.

• A belief that you have unusual, unrecognized talents or accomplishments, such as an exceptional skill as a classical pianist or an unacknowledged talent for scientific research.

While these beliefs are not likely to be accurate, many of them are technically possible. Many people are unfaithful to their spouses. The police do and can track some people. Many talents and skills do go unrecognized. It is only when these beliefs develop in the complete absence of evidence that they are considered delusions. For this reason, it can be challenging to determine whether a "non-bizarre" delusion is congruent with someone's everyday experience. To outside observers, most people with these "non-bizarre" beliefs do not immediately appear to be "delusional." Many can live entirely normal lives, while for some people, their delusions are debilitating and hinder their ability to carry out normal functions.

Delusions are also classified according to their general theme. Many delusions naturally group around the themes of jealousy, persecution, and grandiosity. Somatic delusions are clustered around physical sensations, bodily disruptions, and appearance. A common belief is that a person's body is diseased, abnormal, or has been altered in some way. No matter the type and severity, most people with delusional disorder have a few common characteristics:

In contrast, some people are preoccupied with their delusions. This can cause significant distress and distraction during their day-to-day lives. In rare cases, people with delusional disorder may dramatically change their lifestyle. They may break up with a significant other, move to a new place, change their job, or even alter their appearance in an attempt to rid themselves of the delusion.

What are somatic delusions?

It is not uncommon to worry about catching a contagious disease or developing a rare illness. At some point or another, many of us have had this concern, especially when we suddenly discover a rash or find ourselves coughing a little more. However, somatic-type delusions are much more convincing, consistent, and compelling than these fleeting and temporary fears. Most people who experience them find it impossible to acknowledge they are not real, and sometimes resort to extreme measures to find a "cure" or "fix." They also tend to resist any facts that contradict or undermine their delusional belief, even if these facts can be conclusively and scientifically proven.

What causes somatic-type delusions?

Psychiatrists have struggled to identify a cause of somatic-type delusions or delusional disorder as a whole. This condition is likely dependent on a broad range of genetic, environmental, neurological, emotional, and psychological factors. While people with a family history of schizophrenia are not more likely to develop a delusional disorder, some research has suggested this condition often coexists alongside a predisposition to paranoid personality disorder.

Are somatic delusions a symptom of hypochondriasis?

In some cases, people with somatic delusions are incorrectly labeled as hypochondriacs. Interestingly, the somatic-type delusional disorder is sometimes even referred to as "monosymptomatic hypochondriacal psychosis." However, the two conditions are extremely different. Those who experience hypochondriasis are usually able to recognize their condition and, at the very least, entertain the possibility that they are not genuinely sick. Somatic-type delusions, on the other hand, are so convincing that they are nearly impossible to disregard or ignore.

Are somatic delusions a sign of schizophrenia?

Although delusional disorder may present some of the same symptoms that people with schizophrenia experience, it is an entirely distinct condition. A delusional disorder cannot be positively diagnosed once the criteria for schizophrenia have also been met. Delusions are often signs of a deeper concern, such as a psychotic disorder or another mental or physical health condition. The following are disorders associated with somatic delusions:

• Psychotic disorders (like schizoaffective disorder, schizophreniform disorder, or shared psychotic disorder)

• Bipolar disorder

• Major depressive disorder

• Delirium

• Dementia

In comparison with the prevalence of these conditions, simple delusional disorders are quite rare.

Types of somatic delusions

There are many different types of somatic delusions spanning a wide range of severity and intensity. Some examples of common delusions experienced by people are:

• Feeling like there are bugs, parasites, or worms embedded in the body. Many people report these "infestations" have bitten or stung them, left scars on their bodies, or even built nests or laid eggs under their skin. In rare cases, people with this delusion have inflicted extreme self-harm to remove the infestation. This is by far the most common somatic type of delusion.

• Believing that certain body parts are misshapen, ugly, or missing in their entirety. This somatic-type delusion can prompt people to cover up the afflicted body parts, withdraw from social situations, or even attempt to remove the offensive area of their body. Although these types of somatic delusions can be very dangerous, they are relatively uncommon.

• Other people believe their body smells unpleasant and/or has an offensive odor. Many people who experience this somatic-type delusion attempt to purge their odor issues through excessive bathing or the use of deodorant and perfume. In some cases, these delusions make it extremely difficult for individuals to leave their homes, go to work, and socialize with others for fear of ridicule.

• Some relatively rare somatic-type delusions cause sensations to depart radically from the expectations they typically entail. For example, a hot stove may feel completely cool to the touch, a soft blanket may feel prickly and rough, or a spoonful of sweet ice cream may taste bitter.

Many people who experience somatic-type delusions have a hard time accepting help or do not realize they may need psychiatric treatment since their symptoms (i.e., their delusions) feel so real and authentic. Instead, they focus on getting help for their perceived illnesses. For instance, they might go to see a dermatologist for the non-existent rash on their arm, the dentist for a tooth that appears to be missing, or even an infectious disease specialist for the illness they think they have. None of these specialists or doctors are in any position to offer them any useful advice or treat their ailments since their condition is entirely psychological, which may bring more distress to the individual. 

Treatment options for somatic delusions

If any of these unpleasant somatic-type delusions sound familiar to you, understand that what is happening in your mind may not be tied to reality. A psychologist or other mental health professional can help you determine whether your symptoms are connected to a legitimate medical ailment or a mental issue, such as delusional disorder. A wide variety of somatic-type delusions have responded positively to psychiatric and psychopharmacological treatments. Many people can achieve complete remission through a comprehensive, well-rounded therapeutic approach that includes:

• Medication – Typically, antipsychotics are used to treat delusions. The doctor may also prescribe anti-depressants and sedatives depending on the symptoms. Always consult with your doctor or primary care physician before considering any medication options.

• Psychotherapy – Counseling can be an important step in managing the symptoms of delusional disorder. Your doctor may recommend individual therapy, including cognitive behavioral therapy (CBT), to help you identify and change your thought patterns, as well as family therapy if the disorder is affecting your loved ones.

Since there are many types of delusions and psychosis, it is vital to get an accurate diagnosis from a medical professional to pinpoint how to treat your condition. The most effective ways of treating somatic delusions are usually through medication and counseling. However, there are also some healthy habits you can adopt in your daily life to improve the efficacy of your treatment. Your doctor may advise you to:

• Exercise regularly – this can boost your mood and help you function more productively both physically as well as mentally.

• Find a calming activity that helps you relax and decompress, such as yoga or meditation.

• Avoid alcohol and/or drugs - they can worsen your symptoms and make it harder for treatment to be effective.

• Ensure you get enough sleep at night - sleep is nature's way of recharging your body, so it's essential to get enough of it.

Online counseling with BetterHelp

Changing your habits can be helpful, but it is not a cure for delusions or a replacement for medical care. If you’ve been experiencing delusions but are struggling with the idea of seeing someone in person, consider seeking help from an online mental health professional through BetterHelp. Delusions can be sensitive to discuss, but the format of online counseling may help you feel safer about confiding in someone about your thoughts and feelings. You can connect in a way that feels comfortable to you whether that’s through video chats, phone calls, or in-app messaging. 

The efficacy of online counseling 

Online therapy is an effective form of treatment that has been shown to help patients with various mental health concerns. In an article published in 2018 in BMC Psychiatry, researchers found that internet-based interventions for delusion disorders could bridge treatment gaps for those in need. 100% of participants in a pilot study for online cognitive behavioral therapy reported that the program was helpful and induced no negative effects. The study’s authors also noted that online therapy can bring with it a variety of tools such as peer-to-peer support that would otherwise be difficult to implement in person and across locations.