Psychotic Disorders: Delusional Disorder Vs. Schizophrenia

Delusions are an often distressing symptom that can signal a person has lost touch with reality and is experiencing a mental health crisis. Delusions can be a characteristic of various psychotic disorders, including delusional disorder and schizophrenia. 

Identifying psychotic disorders and supporting mental health

To understand the difference, it may be helpful to learn about identifying these conditions, discover how to differentiate between them, and explore ways to help a person experiencing a delusion. It can also be valuable to gain an understanding of the treatments and interventions available for managing psychotic disorders. 

With a firm understanding of these mental illnesses and how they’re treated, you may make an informed decision about how to positively impact the lives of those affected, helping them navigate their path to recovery and maintain stability in their day-to-day lives. If you have been impacted by one of these conditions, it may also help you have self-compassion and find ways to receive support. 

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Understanding psychotic disorders

Psychotic disorders are mental health conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association. Psychotic spectrum disorders are characterized by psychosis, which refers to an impaired relationship with reality. Common across these conditions are cognitive symptoms like a disruption to thought processes, perception, and emotional understanding, including delusions and hallucinations. According to the diagnostic criteria for chronic psychotic disorders, individuals experiencing psychotic disorders might also exhibit disorganized thinking, where their speech and thoughts become incoherent or illogical.

Delusions can be a particularly distressing symptom due to their fixed nature. As a common symptom of both delusional disorder and schizophrenia, the presence of delusions may lead one to wonder which disorder is at the root of this particular symptom if it arises. 

What are delusions?

Delusions are the defining symptom of delusional disorder and are often present in individuals with schizophrenia. A delusion is a firmly held false belief that contradicts reality. For example, a person with a delusion may believe that someone is trying to harm them despite evidence to the contrary. 

Delusions can be clinically labeled as bizarre, meaning they are highly implausible (e.g., believing that one has been abducted by aliens) or non-bizarre, which means they could conceivably happen in real life (e.g., being followed or having an affair).

Common types of delusions

Below are several of the types of delusions people may experience: 

• Persecutory delusions: These delusions involve a belief that one is being watched, followed, harassed, poisoned, or conspired against by others. People with persecutory delusions often experience a profound sense of mistrust and fear toward others, even those close to them.
• Delusion of grandeur: These delusions involve an over-inflated sense of worth, power, knowledge, identity, or a special relationship with a deity or a famous person. 
• Delusional jealousy: Delusional jealousy might involve believing that one's partner is unfaithful without substantial evidence. It can lead to significant relationship distress and obsessive behaviors.
• Somatic delusions: These delusions encompass false beliefs about one's body, such as thinking one has a serious disease or infestation or that parts of the body are functioning abnormally or changing shape. 
• Delusions of love (erotomania): Erotomania is the belief that another person, often someone of higher status or a stranger, is in love with the individual. 

Distinguishing delusional disorder vs. schizophrenia

More on the symptoms of delusional disorder vs. schizophrenia

Individuals with delusional disorder do not experience these other symptoms—their symptoms are limited to the delusions themselves. As such, they may function well in other areas. The delusions themselves may also be different—whereas delusional disorder typically involves non-bizarre delusions, those that accompany schizophrenia can be bizarre or non-bizarre.

Caring for someone who has delusions due to a psychotic disorder

Caring for someone experiencing delusions may be challenging. However, with sensitivity, understanding, and patience, it may be possible to help them receive effective treatment. Consider the following steps. 

Ensure safety

Ensuring their safety might be the first step when caring for someone experiencing these types of symptoms. Delusions, hallucinations, and other symptoms can lead to situations where a person may neglect or endanger themselves or others. 

Safety steps may include closely monitoring their activities, securing potentially dangerous items, and creating a safe environment that reduces the likelihood of harm. In addition, you can maintain open communication with mental health professionals and seek immediate help if there's a risk of self-harm or danger to others.

Validate experiences, not delusions

Try to acknowledge the real emotions and distress the person may feel because of their beliefs without confirming the delusional content. For example, you might express that you understand the fear, confusion, or frustration they seem to be experiencing. Doing so could foster trust and a sense of being heard. This approach can respect their feelings and may open pathways to more effective communication and support without reinforcing the delusion.

Approach with compassion for mental health

Supporting someone experiencing psychosis often involves a kind, empathetic, and patient approach. Aim to listen without judgment, showing that you can be relied upon for help and guidance. Building a trusting relationship can help guide the person toward treatment and successfully manage their condition.

Encourage them to seek professional help

Psychotic disorders are considered serious mental illnesses that, without treatment, can lead to significant deterioration in personal, social, and occupational functioning. As such, professional help may be necessary. Early intervention and ongoing treatment can vastly improve quality of life and reduce the severity of symptoms, allowing individuals to achieve measurable improvements in their ability to maintain stability.

Support treatment and psychotic disorder management

Treatment conformity and ongoing management may help those with serious mental illnesses maintain stability, and your support might help your loved one adhere to treatment plans. Support might involve gentle encouragement, helping manage medication schedules, or helping them get to their appointments. You might also consider joining them in healthy lifestyle choices, such as exercising or sharing nutritious meals. 

Management of psychotic disorders and bipolar disorder

Treatment and management strategies for psychotic disorders and bipolar disorder are multifaceted, aiming to address the complex symptoms individuals face, improve their quality of life, and facilitate their ability to function in daily activities. Below are a few modalities to consider. 

Treatment of first episode psychosis (FEP)

When a person first begins exhibiting signs of psychosis, getting them support as soon as possible can ensure more positive outcomes. Your local public health authority may be able to connect you with an FEP program. These programs are designed to offer comprehensive care for severe mental illnesses like schizophrenia, delusional disorder, and bipolar disorder.

FEP often includes medication, psychotherapy, and support services. In some cases, a person experiencing psychotic symptoms may be temporarily hospitalized to ensure their safety and stabilize their condition before transitioning to outpatient care. This initial phase of intensive support could set the foundation for long-term recovery and management of the illness.

Medication oversight for psychotic disorders and delusions

Antipsychotic medication is often considered the cornerstone of treatment for psychotic disorders, especially for managing hallucinations and delusions. These medications work by balancing the neurotransmitters at the root of psychotic symptoms. In addition to antipsychotics, other medications may be used to address specific symptoms or co-occurring conditions, such as depression, anxiety, or mood instability.

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. In addition to antipsychotics, mood stabilizers and antidepressants may be used to treat symptoms like depression, anxiety, or mood instability in bipolar disorder.

Psychotherapy for psychotic disorders and bipolar disorder

In addition to stabilization through medication, those with psychotic disorders and bipolar disorder often benefit from psychotherapy. Cognitive-behavioral therapy (CBT), for example, can be effective in helping individuals recognize and challenge distorted perceptions and beliefs, which may reduce the impact of psychosis on daily living. 

Psychoeducation is another common type of therapy for psychotic disorders. This modality seeks to inform the individual, and often their family members, about the disorder, its symptoms, treatment options, and management strategies. The goal of treatment may be enhancing understanding and coping skills, reducing stigma, and fostering an environment that encourages adherence to treatment plans.

Family therapy can be another pillar of support for those with mental illnesses like schizophrenia and delusional disorder. Because these mental illnesses can strain relationships, this type of therapy can be beneficial for resolving conflict, improving communication, and facilitating mutual understanding among family members. 

Social rehabilitation 

Because psychotic disorders and bipolar disorder can have a far-reaching impact on a person’s life, interventions aimed at improving their ability to function may sometimes be helpful. Social rehabilitation programs could include social skills training, life skills training, and vocational rehabilitation programs, which aim to enhance social functioning and foster independence. These services may include case management, support groups, and crisis intervention teams, providing ongoing support and resources for those with psychotic disorders and their families.

Lifestyle and wellness interventions

It can be common for individuals with psychotic disorders to be diagnosed with co-occurring conditions, such as substance use disorders or depression. In such cases, it may be recommended that individuals receive care that addresses these other conditions. 

Additionally, managing mental health through positive lifestyle choices can help manage symptoms and foster well-being. Research has found that regular physical activity, nutritious eating, and adequate sleep can significantly improve outcomes for individuals with psychotic disorders.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

Therapy for caregivers 

Psychotic disorders can be difficult diagnoses for the individuals experiencing them and their families and support systems. As such, it may be helpful for those close to the affected individual to seek mental health support themselves. Caregiver stress and burnout are common concerns when caring for those with serious mental illness, and research has found that CBT can be effective in helping caregivers navigate the unique challenges of their role. 

If you are caring for someone experiencing delusional disorder or schizophrenia but struggle to find time for in-person support, online therapy may offer a way to ensure that your own needs are being met. Online therapy platforms like BetterHelp have been found to be as effective as in-person therapy. 

Online therapy platforms allow users to attend weekly sessions via live chat, phone, or video. With additional features like interactive journaling, weekly group therapy, and daily messaging with your therapist, clients can benefit from ongoing, adaptable, and cost-effective mental health support.