Delusional Disorder

Delusional disorder is classified as a psychotic disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Psychotic disorders are characterized by symptoms that impact an individual’s perception and cognition, such as delusions and hallucinations.²  

Understanding delusional disorder

A person with delusional disorder often experiences one or more delusions or deeply held beliefs in untrue or unacceptable thoughts. Delusions are stubborn beliefs that don't change, even when evidence shows they're incorrect. However, people with this disorder can often function normally and socialize apart from their delusions. People with this disorder may not behave bizarrely unless they are experiencing another mental health condition with this symptom. 

Bizarre & non-bizarre delusions

There are two main categories of delusions: bizarre and non-bizarre delusions. Bizarre delusions are beliefs in scenarios that are physically impossible. Contrarily, non-bizarre delusions could theoretically happen, like thinking you're being followed when you're not. Hallucinations related to the delusion are also a symptom of this disorder. Hallucinations involve seeing, hearing, or feeling what is not present. 

OCD versus delusional disorder

The symptoms of delusional disorder are often confused with those of obsessive-compulsive disorder.³ Like people with delusional disorder, individuals with obsessive-compulsive disorder have recurring thoughts that aren’t based in reality. People with obsessive-compulsive disorder, however, are typically aware that their beliefs aren’t grounded in truth—while those with delusional disorder usually believe their disordered thoughts are correct, despite evidence to the contrary. 

Delusion types

Understanding delusional disorder can mean recognizing its various types, which may vary based on the overall theme of the delusions. Some common types of delusions include:

• Persecutory: The person believes they are being targeted, watched, or harassed.
• Jealous: The individual is convinced, without real evidence, that their partner is cheating on them.
• Erotomania: This involves the belief that someone, often a celebrity or someone of high status, is deeply in love with them. 
• Somatic: Somatic delusions are false beliefs about the body, such as thinking one has a severe illness without medical evidence.
• Grandiosity:⁴ The person believes they have extraordinary talents, wealth, or fame.
• Mixed: The person has two or more types of delusions listed above. 

The severity of delusions can vary, as some are harmless, while others may significantly disrupt daily functioning. In addition, people diagnosed with delusional disorder often do not experience other psychiatric symptoms, such as hallucinations or mania.

Behavioral symptoms of delusional disorder

While delusions are the main symptom of delusional disorder, individuals may also show other behavioral signs, including the following: 

• Agitation or irritability 
• Argumentative or defensive behavior when delusions are questioned 
• Emotional withdrawal or isolation 
• Difficulty maintaining relationships 
• Difficulty in daily activities because of a focus on delusions

Delusional disorder can be challenging because people often don't realize that their beliefs are delusional, making it difficult for them to seek help. Showing these symptoms does not necessarily mean someone has delusional disorder— other mental health conditions like schizophrenia can produce similar symptoms. Therefore, a complete evaluation by a mental health professional is recommended for an accurate diagnosis and effective treatment.

Delusional disorder has several potential causes and risk factors. One possible cause is a chemical imbalance in the brain, particularly in the areas responsible for processing and perceiving information. The chemical imbalance may affect the person's ability to accurately interpret reality, leading to delusions.

Genetics may also be another factor in the development of delusional disorder. People with a family history of psychotic disorders or mood disorders may have an increased risk of developing delusional disorder. In addition, environmental events like stress or traumatic events can cause the disorder in some individuals. 

Risk of delusional disorder

Some common risk factors that may increase the likelihood of someone developing delusional disorder include:

• Family history of mental illness: If close relatives have had mental health disorders, particularly psychotic or mood disorders, the risk may be higher. 
• Substance misuse: The misuse of drugs or alcohol can not only act as a cause but also worsen the symptoms.
• Chronic stress: Long-term stress can have an impact on mental health and may provoke delusional thinking.
• Cognitive dysfunctions: Problems with thinking, memory, and concentration can contribute to the onset of the disorder.
• Social isolation: Being removed from social support networks may aggravate mental health challenges, including delusional disorder.

Awareness of these risk factors can be crucial for prevention and early intervention. If someone shows signs of delusional disorder or has experienced multiple risk factors, it may be valuable to seek professional assistance for diagnosis and treatment. 

Treatment for delusional disorder may manage and reduce the impact of symptoms on daily life. Treatment often involves a combination of therapy and medication to control the specific type and severity of the delusions.

Medication for delusional disorder

Medications may be prescribed to manage specific symptoms of delusional disorder. Commonly prescribed medications for the treatment of delusional disorder might include might include:

• Antipsychotic drugs: These medications might reduce the intensity and frequency of delusional thoughts. Examples of antipsychotic medications are risperidone, olanzapine, and quetiapine.
• Antidepressants: In some cases, delusional disorder occurs alongside depression or anxiety. In these cases, antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) may be prescribed to alleviate the symptoms.
• Mood stabilizers: For individuals experiencing mood swings or mania alongside their delusions, certain medications like lithium or valproate may be effective in managing these additional symptoms.
• Anxiolytics: These medications may be prescribed to help manage anxiety or agitation associated with delusional disorder. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. In addition, the above information is not a replacement for medical advice or diagnosis. 

Other delusional disorder treatment

In some cases, other treatments may be helpful for individuals with delusional disorder. Some of these treatments can focus on improving social and life skills that may have been affected by the disorder. The following are methods that can complement conventional treatment for delusional disorder: 

• Social skills training: Social skills training may be a valuable tool for individuals with trouble in social situations due to delusions. They might learn improved ways to communicate and solve problems to enhance their relationships and the quality of their social interactions.
• Occupational therapy: For some, delusional disorder can make regular tasks or work responsibilities challenging to complete. Occupational therapy may help individuals regain the life skills to manage day-to-day activities. 
• Vocational rehabilitation: Vocational rehabilitation focuses on returning individuals to the workforce by teaching them how to adapt to the job environment despite their disorder.

Self-care

In addition to medication and therapy options, individuals with delusional disorder can practice self-care strategies like the following: 

• Establish a routine: Maintaining a daily routine may provide structure, reduce stress, and help individuals manage their symptoms more effectively.
• Exercise regularly: Physical activity can reduce stress and improve overall mood.
• Stay connected: Friends, family, and support groups may provide emotional and practical support.
• Adequate sleep: Getting adequate sleep may improve mental clarity and contribute to overall physical and mental health.

A combination of therapy, medication, and self-care can help individuals with delusional disorder manage their symptoms and maintain a functional life.

Resources are available to support those with delusional disorder and their loved ones. Online therapy platforms, such as BetterHelp, may provide a convenient way to connect with licensed therapists. Mental health organizations may also offer support groups and resources tailored to individuals with delusional disorder. For example, the United Brain Association provides information about the disorder and resources to help those affected better understand their condition.

Another valuable resource is the National Alliance on Mental Illness (NAMI), which provides support, education, and advocacy for individuals living with different mental illnesses, including delusional disorder. Individuals can get information on support groups, educational programs, and local events through their website.

Mental Health America (MHA) also offers a comprehensive overview of delusional disorder, including causes, symptoms, types, and treatment options. The organization provides a solid foundation for those seeking to learn more about paranoia and delusional disorder, as well as the available treatments.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Researchers have conducted various studies to better understand the causes and potential treatments of delusional disorder. One study examined how the brain is involved in delusional disorder using magnetic resonance images (MRI). 

The brain & delusional disorder

Specifically, researchers studied a specific part of the brain called the corpus callosum. They compared 20 patients with delusional disorder to 20 healthy people of the same age and gender. The researchers found that although the size of the CC was similar between the two groups, there were differences in how it looked in different areas for the DD patients. This result suggests that DD may be related to changes in certain areas of the brain. 

Treating delusional disorder

Another study explored the effectiveness of current treatment options for delusional disorder. The research found that using standard antipsychotic medications, typically at low doses, may effectively manage the symptoms of delusional disorder. However, it can be challenging to ensure patients adhere to their treatment. In addition, cognitive therapy is another beneficial treatment option, although it may require a significant amount of time and resources. 

More research is needed to understand which treatment options could treat delusional disorder. Despite the challenges, there is hope for successfully treating the disorder as new research becomes available.

50% of delusional disorder cases show a positive response to treatment

There have been several advances in delusional disorder treatment, showing promise in the reduction of more severe symptoms. A study in the Canadian Journal of Psychiatry found that 50% of all patients in the study responded positively to medication-assisted treatment. ¹

¹The Canadian Journal of Psychiatry

Below are more statistics on delusional disorder: 

• Delusional disorder makes up approximately 1% to 4% of all psychiatric hospital admissions, with a first admission rate of one to three per 100,000 per year. While not as common as other mental health conditions, this condition still impacts many individuals.
• Men are more likely to be diagnosed with schizoaffective disorder or delusional disorder than women (58.1% of the total sample in one study). In addition, women with schizophrenia have a lower risk of being admitted to the hospital, while men with delusional disorder have a higher risk of more extended hospital stays.
• In one study, almost half (46%) of the people with delusional disorder had been diagnosed with another mental health disorder in their lifetime. The most common diagnoses alongside delusional disorder were depressive disorders (32.6%) and anxiety disorders (14%).

Somatic Delusions

Persecutory Delusions