What Is Delusional Schizophrenia? About The Disorder
Schizophrenia has historically been classified in different ways. As psychologists and researchers have gained more insight into this condition, they have identified symptoms that can be more frequent or intense in some people with schizophrenia than others. For this reason, the American Psychiatric Association outlined several subtypes of schizophrenia in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Since the publication of this manual’s fifth edition (DSM-5), the schizophrenia diagnosis has been updated to reflect the diversity of each person’s experience. Delusional schizophrenia is one term people previously may have used to refer to schizophrenia. Although it is not an official diagnosis, understanding delusional schizophrenia and delusions in general can be a step toward independence and managing daily life. Symptoms of schizophrenia can often be treated with a combination of medication and therapy.
Delusional schizophrenia
In the DSM-IV, delusional schizophrenia was not a diagnostic subtype. However, people who experienced significant delusions were often diagnosed with the “paranoid schizophrenia” subtype. In some cases, this subtype might have been colloquially referred to as delusional schizophrenia.
Criteria for the paranoid type of schizophrenia involved the following:
Preoccupation with one or more delusions
Frequent auditory hallucinations
A lack of symptoms related to disorganized speech and disorganized or catatonic behavior
An absence of flat or inappropriate affect
Other types of schizophrenia were catatonic schizophrenia, disorganized schizophrenia, unspecified schizophrenia, and undifferentiated schizophrenia. All of these subtypes were described with the release of the DSM-5.
Schizophrenia spectrum disorder and other psychotic disorders
In the DSM-5, schizophrenia has been relabeled under the “schizophrenia spectrum disorder and other psychotic disorders” category. Schizophrenia spectrum disorder generally takes into account all possible symptoms of schizophrenia and acknowledges that some individuals may experience some symptoms more than others.
Criteria for diagnosis
Because schizophrenia can be considered a spectrum, each person’s experience with the condition tends to be unique. However, there are general diagnostic criteria required for diagnosis, including the following:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms, such as flat affect or social withdrawal
In general, an individual must present with two or more of the above symptoms for at least one month (or less if successfully treated). One of these symptoms must be delusions, hallucinations, or disorganized speech.
In addition to these symptoms, an individual with schizophrenia must experience significant functional disturbance. For example, they may face challenges in multiple areas of life, such as in their relationships, career, education, and self-care.
*Paranoid schizophrenia is an outdated term for the condition schizophrenia, but paranoia is still a common part of the symptoms that people with schizophrenia experience.
What are delusions?
Delusions can be defined as firmly held false beliefs. Although delusions aren’t necessarily unique to schizophrenia, this symptom can be common in people with this disorder. Delusions can indicate an abnormality in thought patterns and a loss of touch with reality.
Types of delusions
Delusions are often based on situations that are not truly occurring. For example, an individual may believe the FBI is following them in cars or tracking their devices. They might worry that other people intend to hurt them. Some delusions, referred to as delusions of grandeur, can cause a person to believe they are extraordinarily special. Some may think they're God or a particular deity or that they have all the answers to life’s mysteries.
Delusions can accompany hallucinations, which may make them seem more real. For example, if a person hallucinates shadow figures following them, they may believe real people are persecuting them.
Other mental illnesses that can cause delusions include the following:
Bipolar I disorder (during an episode of mania)
Schizoaffective disorder
Schizophreniform disorder
Major depressive disorder with psychotic features
Postpartum psychosis
Delusional disorder
How to manage delusions caused by delusional disorder, bipolar disorder, and other mental health conditions
If you’re living with delusions, you’re not alone. These thought patterns can be difficult to manage. You might notice the delusional episode after it ends but have difficulty working through the thoughts when they are occurring. For this reason, it might be helpful to go through the following coping skills with a professional, such as a therapist, to practice them before an episode occurs.
Distract yourself
Distractions may keep you from focusing on challenging thoughts that may cause distress. Whether or not you believe these thoughts are real, a distraction can help you avoid them. Below are a few ways you can try to distract yourself:
Exercising, such as walking, swimming, or dancing
Spending time with people you love
Playing with your pets
Reading a book
Watching movies or TV shows
Running errands
Creating art
Journaling
Singing
Playing a video game
Attending a support group
Keep a tracking journal
Tracking your delusions after they occur may help you notice patterns and themes. If you’re working with a professional, you can bring this journal to therapy to discuss the potential causes of these delusions and devise ways to challenge them.
Practice self-care to the best of your ability
Schizophrenia can make it difficult to practice self-care. However, self-care may reduce the severity of your symptoms. Some people might find that taking medication as prescribed by a psychiatrist or doctor helps them focus more intently on self-care. Self-care might include the following:
Sleeping at least seven hours a night
Asking for help when you need it
Practicing personal hygiene (brushing your teeth, washing your hair, taking showers)
Eating nutritious meals
Drinking water
Exercising
Partaking in hobbies
Spending time with friends or making efforts to meet new friends
Talk to someone you trust
If you’re struggling to understand whether a thought is a delusion or a fact, consider confiding in someone you trust. Let them know you have a past of delusional thinking and would like support in identifying whether your thoughts are delusional or founded in reality. They may help you reframe your thoughts and replace them with more positive ones or find ways to distract you.
Adhere to medication
According to research, around 50% of people with schizophrenia struggle to adhere to their medication regimens, although updated evidence may be needed. However, medication can be one of the most effective ways to reduce symptoms like delusions. Work closely with your prescribing doctor to manage any side effects. If you struggle to remember to take medication due to schizophrenia symptoms, it might be helpful to sign up for a medication delivery service or work with a mental health center that can manage your medication for you.
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.
Challenge and restructure the thoughts
Delusional beliefs can seem extremely real. However, they are generally not founded in reality, and learning to restructure these thoughts may be helpful. If you struggle to do so independently, a licensed therapist can guide you through this process and help you practice it over time.
If you trust someone in your life, you might ask them to reframe the thought for you and consider repeating the alternative to yourself whenever the delusion occurs. For example, if you often think, “Someone is poisoning my food,” it might be helpful for someone to tell you, “No one else has touched your food since you bought it, and you prepared it yourself.” Reminding yourself of reality may help you control your thoughts during a delusion.
Talk to a therapist about your mental health
Therapy is often helpful alongside medication and self-care as a way to reduce delusional thoughts. However, delusions can make it scary or difficult to attend therapy in person. In these cases, online therapy through a platform like BetterHelp may be a valuable option, although those experiencing acute psychosis may need to seek in-person support.
Online therapy for delusional schizophrenia, bipolar disorder with psychotic symptoms, and other psychotic disorders
Studies suggest that online therapy may be effective in supporting individuals with schizophrenia. More studies are likely necessary to fully understand the benefits of this type of treatment. However, in limited studies, online therapy has been shown to benefit people with schizophrenia and their family members.
Takeaway
What is an example of a schizophrenic delusion?
There are several types of schizophrenia delusions including persecutory delusions, bizarre delusions, referential delusions, grandiose delusions, somatic delusions, erotomanic delusions (in which a sexual partner is thought to be cheating despite no evidence), and nihilistic delusions. Persecutory delusions are a common delusion type, and may include a belief that a group or person is trying to hurt you in some way. Even the most benign remarks may be construed as a threat against them.
What is an example of a delusional disorder?
Delusional disorder is one of the most common disorders classified under “non-affective psychosis” which also includes schizophrenia, schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder. A delusional disorder can be recognized by the individual’s adherence to a false belief, despite lack of evidence. For example, it may manifest as an individual believing that they are in a romantic relationship with a celebrity. Unlike those with schizophrenia, those with delusional disorder are most often able to function independently, remain employed, and in many ways blend in with the general population. And while schizophrenia often shows up in early adulthood, delusional disorder more often occurs in middle age.
How do you deal with schizophrenia delusions?
To treat delusional symptoms is typically a team effort. A mental health professional will offer talk therapy, while a healthcare provider manages medications for symptoms (called antipsychotics), monitors progress, and oversees any other necessary medical attention. The individual may also attend support groups and family therapy, as well as have community support in place.
Other symptoms must also be addressed, such as disorganized thinking, cognitive dysfunction, and negative symptoms like avoidance and decreased functioning. Severe symptoms may need to be addressed with periodic inpatient hospital care. Lifelong treatment is often necessary to live the best quality of life for those living with schizophrenia.
What is the average age of onset for delusional disorder?
A systematic review of data found that the average age of onset for delusional disorder is around forty years old.
What do schizophrenic delusions feel like?
Early symptoms of schizophrenia may feel like confusion and disorganized thinking. Often social isolation takes place as a reaction to perceived slights from the people around them. A number of delusional themes may take hold, anything from persecutory delusion to fretting about their internal organs.
What is the most common paranoid delusion?
The most common paranoid delusion is that someone or some group is working against you in some way. They may read threatening meanings behind the words someone says, or believe that people are plotting against them.
Does a delusional person know they are delusional?
It isn’t often that a person recognizes that their beliefs are delusional, as the nature of a delusion is that the individual thinks that it’s real. Often a person seeks help for other mental disorders like anxiety or depression, and delusion or other psychotic symptoms are noticed by the therapist. Family members may also notice issues and encourage them to get help. In some cases, stalking behavior or other repeated complaints can lead to a diagnosis and court orders to treat delusional disorder.
To diagnose delusional disorder or one of the many other psychotic disorders, a provider will take a complete medical history, examine psychological factors, as well as a person’s life circumstances to evaluate whether the delusions are due to disorder or some medical or pharmacological cause.
According to the criteria of the diagnostic and statistical manual (DSM-5), a person must have one or more non-bizarre delusions (things that could happen in real life), for one month or more, and with no explanation by any other medical or mental health condition, or substance-induced cause.
How do you argue with a delusional person?
You don’t. While stigma would have many believe that a delusional person is subject to violent behavior, it is more in the best interest of the individual experiencing delusions that you do not fight them. The nature of the delusion is that the individual thinks that it’s true. It can be distressing to have someone disputing them and can often make them dig in deeper. The best approach is to remain calm, offer non-judgmental and empathetic listening, as well as practical help if needed. If the delusions are affecting function in their daily lives or relationships, you can encourage them to seek help.
What triggers delusional disorder?
Evidence suggests that there are a number of factors that contribute to developing delusional disorder. Low self-esteem, childhood trauma, as well as biological or genetic factors may all play a part. An important discovery in recent years, function of serotonin receptors has been linked to certain psychotic disorders; serotonin is a neurotransmitter believed to have the greatest impact on mental health. While you may not be able to prevent delusional disorder, you can work on reducing risk factors by building healthy coping mechanisms, seeking therapy for past trauma, and adhering to healthy self-care practices.
How do you snap out of psychosis?
You don’t simply “snap out” of psychosis, but you can treat psychotic symptoms. Early diagnosis can be key to the most effective treatment. Treatment options include primary medications like antipsychotics, as well as dopamine agonists (which work by blocking dopamine receptors), and mood stabilizers for any emotional symptoms affecting the person’s life. Regular therapy and social support are also important factors in managing psychosis.
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