Delusion

A delusion is a belief that isn’t substantiated by sufficient proof. An individual with a delusion will typically retain the false belief despite evidence to the contrary. When a person experiencing delusions seeks help, a medical professional will often first run tests to rule out any physical causes. If none are found, then the individual will typically be referred to a mental health care provider, who may then work to determine whether the delusional beliefs are part of a psychotic disorder or some other mental health condition. Usually, a mental health professional will compare the person’s symptoms with the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

For example, to be diagnosed with delusional disorder, an individual must experience at least one delusion that has lasted for a month or more. Additionally, episodes of a mood disorder like bipolar disorder or depression must be absent or less prominent than the periods of delusional thinking. People with delusional disorder may also experience hallucinations as long as they’re associated with the delusions (e.g., hearing voices related to persecutory delusions) and aren’t pronounced.

It can be challenging to diagnose a delusional disorder, as it impacts thoughts and beliefs. A person may live what looks like a typical life, their delusions known only to themselves. Some signs that may provide evidence of a delusion can include:

• Frustration with others who refuse to hear your perspective
• Understanding that others see your views as irrational but not accepting their arguments or evidence
• Passionate arguments for your belief without evidence
• Legal issues against others or from others against yourself (i.e., restraining orders)
• Excessive communications like letter writing or social media posts to convince others of your views or to get in touch with a celebrity who you might believe to be interested
• Violent behavior in some severe cases

Delusions that are part of a delusion disorder may or may not have accompanying hallucinations or psychosis, but other mental health disorders often do. There are varying levels of delusion. Some may be harmless, while others can disrupt daily life and damage relationships. 

According to the latest version of the Diagnostic and Statistical Manual (DSM-V), there are four types of delusions. These include:

• Bizarre delusions: This is a delusion that isn’t possible in reality, such as alien abduction or that the government has harvested your organs. 
• Non-bizarre delusions: On the other hand, non-bizarre delusions are beliefs that are untrue but could plausibly happen in real life, such as a co-worker plotting to kill you or a stranger being in love with you. 
• Mood congruent delusions: These delusions may shift depending on mood. For example, an individual may feel persecuted when in a depressive state and then believe they have superpowers when they’re in a manic state. 
• Mood incongruent delusions: These delusions aren’t affected by mood and can include things like a belief that an outside force controls you or that government agencies are targeting you. 

There are also subtypes or themes to delusion. While some delusions are unspecified or do not have a dominant theme, many fall under one of these categories. 

• Somatic delusions center around sensations or functions of the body.
• Persecutory delusions focus on a belief that you’re being sabotaged, plotted against, or a target of outside forces.
• Jealous delusions are the belief that your significant other has been unfaithful despite evidence to the contrary.
• Erotomaniac delusions are false beliefs that another person or persons are in love with you.
• Religious delusion includes beliefs that you have special powers from a god or gods, are a prophet, or have been selected for some great fate or service in the name of religion.
• Nihilistic delusion is the belief that some object, parts of yourself, or your entire self is not authentic or not based on this reality.
• Guilt or sin delusion is a belief centered around extreme feelings of remorse or the idea that you’ve done something wrong.
• Thought insertion or broadcasting delusion is the belief that thoughts are being put into your mind by an outside force or that your thoughts are being broadcasted to others.

Delusion can be a sign of many different conditions, both physiological and psychological. Some physiological conditions that may cause delusions include brain injury, substance intoxication, and certain somatic illnesses that cause delirium. 

Mental health conditions that feature delusion as a possible symptom include schizophrenia, bipolar disorder, delusional disorder, obsessive-compulsive disorder (OCD), and dementia. Psychotic disorders are a class of mental health conditions in the Diagnostic and Statistical Manual of Mental Disorders that feature delusions as a main category of symptoms. Delusional disorder—which is primarily characterized by false beliefs—is one such psychotic disorder. Delusional disorder is relatively rare, affecting only 0.2% of the US population. Individuals who experience some milder forms of delusional disorder may not find that it impacts their lives in overtly unhelpful ways; other disorders that feature delusions are typically more disruptive. 

There are several potential causes of delusion, according to current research. 

• Genetic or biological: Studies find that those who have a family history of psychotic disorders may be at greater risk for experiencing delusion. Certain genes that trigger a dysregulation of dopamine in the brain can lead to symptoms of psychosis.
• Defense mechanism: Researchers have created a theory that certain delusions may be a result of attributing any negative events or situations to others to preserve an individual’s self-view. 
• Dysfunctional cognition:⁵ Some individuals may experience a false belief due to difficulty processing cognitive input or difficulty interpreting social cues.

Religious or cultural markers may also influence delusion, including the high stress associated with low socio-economic status. Delusions may also be exacerbated by visual or auditory impairments.

Delusions are treatable, and many effective treatments can help decrease or eliminate this symptom. Certain forms of medication (e.g., antipsychotics) and psychotherapy (e.g., cognitive behavioral therapy) can help people with delusional beliefs address the emotional and cognitive challenges associated with such thoughts. How these treatments are used may depend on the individual, the types of delusions present, and the root cause of the delusion(s). 

Medication

Antipsychotic medications can be effective at treating delusions in a number of mental health disorders. These are typically prescribed by a medical or qualified mental health practitioner (psychiatrist) or healthcare professional alongside other treatments like therapy and community support. 

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. The information provided in this article is not intended as medical advice; please consult a qualified healthcare professional for personalized guidance.

Treatment for conditions that feature delusion may also include assertive community treatment (ACT), which offers specialized, multidisciplinary services to the individual, family support and education, and case management services.