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.
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