Delusional Disorders: Types, Signs, Symptoms, Causes, Treatment, Epidemiology, Diagnosis

There are a number of psychotic disorders one can suffer with. Delusional disorder is classified as one psychotic disorder or a disorder where the affected individual has trouble recognizing reality. A delusion is actually a false belief that is based on an incorrect interpretation of the reality. Though delusions can occur as part of many different psychiatric disorders, but the term delusional disorder is used in cases where delusions is the most prominent symptom.

An individual having Delusional disorder holds a false belief firmly, despite clear evidence or proof to the contrary. Delusions may involve circumstances that might occur in reality even though they are unlikely, just like neighbor plotting to kill you; or they may be considered bizarre, for example, feeling controlled by an outside force or having thoughts that are inserted in to the affected person’s head. It must be noted that a religious or cultural belief that is accepted by other members of the person’s community is not a delusion.

There are numerous types of delusions, like erotic, persecutory, jealous, and many more. Individuals with delusional disorders generally do not have hallucinations or a major mood issue. When hallucinations occur, they are part of the delusional belief. For example, someone who has the delusion that his or her internal organs are rotting, may hallucinate smells or sensation that are related to that delusion.

Since those with delusional disorder are aware that their beliefs are unique, they generally do not talk about them. It must be noted that delusional disorder is diagnosed much less frequently than schizophrenia.

• Delusional disorder is a primary disorder.
• The illness is chronic and also frequently lifelong.
• Delusional disorder is a stable disorder characterized by the presence of delusions to which the affected individual clings with extraordinary tenacity.
• The delusions are constructed logically and are internally consistent.
• The delusions do not interfere with general logical reasoning and there is generally no general disturbance of behavior. In case disturbed behavior occurs, it is directly related to the delusional beliefs.
• The patient experiences a heightened sense of self-reference.

There are seven types of Delusional disorders. They include the following:

1. Erotomanic Type Delusional Disorder or Erotomania:

   These are the type of delusion that another individual, often a prominent figure, is in love with the affected individual. The affected person may breach the law as she or he tries to obsessively make contact with the desired person.

2. Grandiose Type Delusional Disorder:

   Here there is a delusion of inflated worth, knowledge, power, identity or believes themselves to be a famous person, claiming that the actual person is an impersonator or impostor.

3. Persecutory Type delusional Disorder:

   This is a common subtype of delusional disorder. This includes the belief that the affected person or someone to whom the person is close, is being malevolently treated in some way. The affected individual may believe that she or he has been spied upon, drugged, harassed and so on and may seek “justice” by making police reports, taking court actions or even violently acting.

4. Jealous Type of Delusional Disorder:

   There is another type of delusional disorder where there is a delusion that the affected individual’s sexual partner is unfaithful when it is not true. The patient may follow the partner, check emails, text messages, phone calls, etc., of the partner while attempting to find evidence of the infidelity.

5. Somatic Type of Delusional Disorder:

   Somatic type of delusional disorder is the delusion that the person has some kind of physical defect or general medical condition.

6. Mixed Type of Delusional Disorder:

   There is one more type of delusional disorder and that is mixed type of delusional disorder. In this case, there are delusions with characteristics of more than one of the above mentioned types of delusional disorders, with no one theme predominating.

7. Unspecified Type of Delusional Disorder:

   Lastly, there is another type of delusional disorder and here, there are delusions that cannot be determined clearly or characterized in any of the categories in the specific types.

Following are some of the signs and symptoms of Delusional Disorders.

• The person suffering from delusional disorder expresses a belief or an idea with unusual persistence or force.
• The idea appears to have an undue influence on the affected individual’s life, and the way of life is often altered to an inexplicable extent.
• Delusional disorder patient tends to be humorless and oversensitive, especially about the belief.
• Despite her/her profound conviction, there is often a quality of secretiveness or a suspicion when the affected individual is questioned about the idea or belief.
• An attempt to contradict the belief or idea is likely to around an inappropriately strong emotional reaction, often accompanied with irritability and hostility.
• The belief is, at the least, unlikely, and out of keeping with the affected individual’s social, cultural and religious background.
• The delusion, if acted out, often results in behaviors which are abnormal and/or out of the character, although perhaps understandable in the light of the delusional belief.
• Those who know the affected individuals, observe that the belief and behavior are uncharacteristic and alien.

The primary cause of delusional disorders is unknown; however, genetic, biochemical and environmental factors may play a crucial role in its development. Some individuals with delusional disorders may have an imbalance in the chemicals that send and receive messages to the brain, or the neurotransmitters. There does seem to be some familial component and social isolation, immigration, drug abuse, excess of stress, being married, being employed, low socioeconomic status, widowhood among women, celibacy among men, may also be some risk factors.

It must be mentioned that delusional disorder is at present thought to be on the same spectrum or dimension as schizophrenia; however, individuals with delusional disorder, in general, may have less symptomatology and functional disability.

As delusional disorder is pretty rare, a doctor should evaluate the possibility that another major illness like schizophrenia, a mood disorder, or a medical problem, is causing the symptoms. Medical causes must be considered, especially later in life. Individuals, who develop dementia, can also become delusional.

It is to be mentioned that a diagnosis for delusional disorder is more difficult, when the patient conceals his or her thoughts. Because the affected person is convinced of the reality of her or his ideas, she or he may not want a treatment. In case the delusional disorder patient allows it, conversations with supportive family or any close friends might help. A general medical evaluation is very much useful. In a few cases, when a medical or a neurological problem is suspected, diagnostic tests like EEG or Electroencephalogram, MRI or Magnetic Resonance Imaging, or CT Scans or Computed Tomography scans may be suggested.

Treating Delusional disorder may be really challenging. Individuals with this condition will rarely admit that their beliefs or ideas are delusions or are problematic, and will thus rarely seek out treatment. If they are in treatment, their doctor may find it quite difficult to develop a therapeutic relationship with them. Below are some of the treatment methods for delusional disorders.

Psychotherapy for individuals with delusional disorders can include cognitive therapy, which is conducted with the use of empathy. During this process of treatment, the therapist can ask hypothetical questions in a form of therapeutic Socratic questioning. This type of therapy has been mostly studied in patients with the persecutory type. Psychotherapy has been known to be the most useful form of treatment for delusional disorders, because of the trust formed in a patient and the therapist relationship.

Individual psychotherapy is recommended rather than group psychotherapy. This is because patients with delusional disorders are often quire suspicious and also sensitive.

Supportive therapy for people suffering from delusional disorder is known to be beneficial. Its goal is to facilitate treatment adherence and also provide enough education about the illness and its treatment. Furthermore, providing appropriate social skills training has been known to help many patients with delusional disorders. It can promote interpersonal competence and also confidence and comfort while interacting with those individuals perceived as a threat. Providing realistic guidance and help in dealing with problems stemming from the delusional disorder may be quite beneficial.

This therapy is rarely indicated or contraindicated; yet there are some reports of successful treatments with this therapy. The goals of the therapy are to develop therapeutic alliance, containment of projected feelings of impotence, hatred, and badness; measured interpretation and also the development of a sense of creative doubt in the internal perception of the world. The later requires empathy with the affected individual’s defensive position.

Antipsychotic medications may be used to treat delusional disorder, although research on their efficacy has been inconclusive. Antipsychotics may be more beneficial in managing agitation that can accompany delusional disorder.

Apart from all these above mentioned treatment, one can encourage the person suffering from delusional disorder to seek medical help, help from family and friends, and peer groups. It is crucial that goals be attainable, since a patient feeling pressured or repeatedly criticized by others will likely experience stress, which can even worsen the symptoms in delusional disorders.

Delusional disorders are pretty rare in psychiatric practice, though this may be an underestimation because of the fact that those afflicted lack insight and thus avoid appropriate psychiatric assessment. The prevalence of this disorder stands at about 24 to 30 cases per every 100,000 individuals while 0.7 to 3.0 new cases per 100,000 people are reported every year. Delusional disorder accounts for about 1% to 2% of admissions to inpatient mental health facilities.

Delusional disorder generally tends to appear in middle to late adult life in most individuals, and for the most part, first admission to hospital for delusional disorder occur between age 33 and 55. This condition is more common in women than men, and immigrants seem to be at a higher risk.

As we are now known to what Delusional disorders are, and known about the symptoms, causes and also the treatments for the disorder; it is very much easy to get self diagnosed well under an expert medical professional, once an individual starts experiencing any of the signs or symptoms of the disorder. Make sure to talk to your doctor about the best possible treatments for getting rid of the symptoms of delusional disorders.