Delusional Psychosis And Delusional Disorder

It can be challenging to understand how psychosis fits into diagnostic labels like delusional disorder or other psychotic disorders, like schizophrenia spectrum disorders. In this article, we’ll explore delusional disorder and how it relates to symptoms of psychosis. 

What is delusional disorder? 

People with delusional disorder may hold a strong belief based on their interpretation of external reality, disregarding evidence that refutes their interpretation. The belief must fall outside one's cultural or subcultural context to be considered a delusion. 

A diagnosis of this mental health condition may be made by a mental health professional when someone exhibits "one or more non-bizarre delusional thoughts." Non-bizarre delusional thoughts are based on situations that are not real but also not impossible and must be present for one month or more, not explained by any other condition, such as a substance use disorder. 

What is delusional psychosis? 

Psychosis may be described as an umbrella term for a range of experiences affecting emotions, perception, and behavior. Delusional psychosis may refer to psychotic symptoms, such as paranoia, but without hallucinations and personality disorganization. Delusional thinking, however, may be related to other mental health conditions, such as bipolar disorder. 

Psychosis is a cluster of symptoms and not a diagnostic label in itself. It can occur in multiple mental illnesses, including schizophrenia, schizophreniform disorder, schizoaffective disorder, bipolar I disorder, brief psychotic disorder, and other psychotic disorders. 

Difference between delusional psychosis and delusional disorder

Delusional psychosis and delusional disorder are both mental disorders where a person experiences psychosis or delusions. However, delusional psychosis is a much broader term used to describe any type of delusions and hallucinations. Delusional disorder is more specific and narrowly focused on delusions only. 

Types of delusions 

A person with delusional disorder may function in everyday life but encounter difficulties with maintaining relationships as a result of their perception of reality. Delusions can also be distressing for those who experience them. While delusional disorder does not usually involve hallucinations, delusions are considered psychotic symptoms. Delusional psychosis may refer to psychotic symptoms, such as paranoia, but without hallucinations and personality disorganization.

In some cases, people with delusional disorder may have their first encounter with a mental health worker, such as a nurse practitioner. Due to its complexity, referral to a specialist, such as a psychiatrist, can be valuable. 

Common types of delusions include believing that:

• One's partner is cheating (delusional jealousy)
• One is more extraordinary than others (grandiosity)
• One has been singled out for persecution (persecutory)
• Others can read one’s thoughts (thought broadcasting)
• Thoughts have been inserted to their mind by something or someone else (thought insertion)

Psychotic disorders

According to the National Institute of Mental Health (NIMH), psychosis refers to a group of symptoms affecting the mind "where there has been some loss of contact with reality." An episode of psychosis results in a disruption of thoughts and perceptions, often making it challenging for the affected person to differentiate between what is and what is not real.

One of the primary features of psychosis consists of delusions and hallucinations. While delusional disorder does not usually involve hallucinations, its main feature may be delusions.

Psychotic symptoms

Anyone may experience psychosis during times of prolonged or acute stress. An episode does not always stem from a mental health disorder. When it does, symptoms of psychosis can accompany many mental health conditions, including schizophrenia, schizoaffective disorders, and bipolar disorder. It may also stem from depression. Symptoms of psychosis may include:

• Incoherent speech
• Difficulty concentrating
• Anxiety
• Agitation
• Appetite changes
• Social withdrawal
• Sleep difficulties
• Lack of motivation
• Emotional dysregulation
• Reduced regard for personal hygiene or self-care
• Unusually intense ideas
• Paranoia
• Brain fog
• “Nonsense” speech
• Inappropriate behavior concerning the situation
• Confusion
• Reduced relationship with reality
• Hallucinations
• Hearing voices

Are people with psychotic disorders or bipolar disorder aware?

There's a common misconception that those who experience altered perceptions of reality are unaware of their condition, a phenomenon called anosognosia. While some people diagnosed with delusional disorder may experience anosognosia, anosognosia is not as common in people who experience symptoms of psychosis. For example, estimates indicate that less than half of people with bipolar disorder lack awareness of their condition. 

It can be possible to foster more awareness of one's mental state and build resiliency and resources for managing psychotic episodes. This process may involve the support of mental health professionals and one’s personal support system, such as family members and partners. 

Psychosis in various mental disorders

Delusions may occur when someone experiences a psychotic episode. Psychosis is associated with different circumstances and can impact different people in different ways.

Post-natal psychosis 

A psychotic episode may affect anyone in situations of acute or prolonged stress. According to findings, it's estimated postnatal psychosis affects one to two women in 1000 in the first few weeks after giving birth. When affected, a person may experience a sudden onset of symptoms, including auditory, visual, and olfactory hallucinations, delusions, and drastic mood swings. 

Those who have developed postnatal psychosis tend to have had a mental health condition in the past. Researchers also note a need for further investigation to assist in the prevention of psychosis and early detection efforts. 

Depression with psychotic features 

Some people with major depressive disorder (MDD) may also experience psychotic features. Someone experiencing severe depression may experience symptoms of psychosis, such as delusions or hallucinations. For instance, a person may hear voices that are critical or that tell them they are not worthy. Delusions may manifest as a false belief of having developed a medical condition, such as a rare disease. The risk of suicide may also be significantly higher when psychotic features are present with depression. 

Treatment for psychotic features in connection with depression often involves antipsychotic medication, antidepressants, and psychotherapy. Electroconvulsive therapy may also be recommended in certain situations. Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Psychotic features and bipolar disorder

Episodes of depression, hypomania, and mania characterize bipolar disorder. Over 50% of all people with bipolar disorder may experience psychotic symptoms at some point in their lives. Psychosis manifests in connection with episodes of mania in bipolar I disorder, but this circumstance may vary. The mood (depression versus mania) can also affect the content of the delusions and hallucinations. 

Delusions tend to be more common than hallucinations in bipolar disorder-related psychosis, which might negatively impact the course of the condition. However, psychotic features are associated with the severity of the mental illness and the rate and duration of hospitalizations. Common symptoms may manifest as "grandiose, persecutory, and referential delusions, auditory verbal hallucinations or hearing voices, and visual hallucinations." Due to the similarity of certain symptoms, bipolar disorder can sometimes be misdiagnosed as schizophrenia. 

Treating delusions, psychosis, and other mental health disorders

Methods to treat psychosis, delusional disorders, and other types of mental disorders depend on their cause. There are many ways to address and treat psychosis and delusional disorders, including antipsychotic medication, psychotherapy, self-help groups, rehabilitation programs, and other therapeutic approaches. Seeking and receiving treatment can be valuable, as it may reduce the risk of hospital admissions, alleviate symptoms, and improve one's quality of life and social functioning. 

Wondering how to cope with delusional disorder?

Talk to a licensed therapist

Support options 

If you or someone you know are experiencing symptoms of psychosis, seek a mental health specialist for physical and psychiatric evaluation. Outside of a crisis, it might be helpful to talk to a therapist to have a safe space to express thoughts and manage symptoms that affect your well-being. A therapist can also help you develop a safety plan. 

You might also try an online platform if you face barriers to attending in-person therapy. Online therapy through platforms like BetterHelp can be convenient for those who would rather speak to a therapist by phone, video, or in-app messaging. In addition, online platforms allow clients to message their therapist at any time, receiving a response as soon as the provider is available. 

One study suggests that "online interventions are both feasible and acceptable to individuals with psychotic disorders and may be effective in assisting with clinical and social outcomes." The same study noted that online therapy is associated with the reduction of psychotic symptoms.