Insights into Psychology

What Is… Delusional Disorder

Characteristics of delusional disorder

In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is delusional disorder.

Delusional disorder falls within the DSM-5 group of psychotic disorders, which also includes schizophrenia and schizoaffective disorder. However, it’s different, in that its effects are much more compartmentalized.

In delusional disorder, the delusional beliefs are focused on one area of the individual’s life, and don’t really bleed over into other areas. The delusions are non-bizarre, meaning they’re at least somewhat within the realm of possibility (e.g. being harassed by the neighbours rather than having aliens come down to the chimney to implant listening devices in one’s stomach), but they are still delusional. Typically, hallucinations aren’t present, but if they are, they relate to the delusional themes.

Functioning is generally preserved in areas that aren’t directly related to the delusions. This means that other people might have no idea no idea that the individual was unwell if their interactions didn’t venture into the topic area related to the delusions.

Delusional disorder subtypes

There are several subtypes based on the nature of the delusions:

  • erotomanic: delusions revolve around the belief that someone else is in love with them, and the delusional individual may end up stalking/harassing that person as a result
  • grandiose: these beliefs about having special attributes or abilities are to the intensity and extent that they’re delusional
  • jealous: these delusions tend to focus on the delusional individual’s partner being unfaithful, even when there’s no evidence to indicate that they are
  • persecutory: paranoid beliefs about others harming them, which may lead to pursuing litigation or criminal charges against the person that’s believed to be responsible; this is the most common subtype
  • somatic: these delusions relate to something being wrong with one’s body

It’s worth noting that while delusional disorder is subtyped based on the type of delusions it presents with, the delusions themselves can occur in any type of disorder with psychosis, including schizophrenia or mood disorders.

Other characteristics

Delusional disorder typically arises well into adulthood, with the average onset at age 40. Sometimes it will develop in people who already have paranoid personality disorder. It’s less common than schizophrenia, occurring in only 0.1–0.2% of the population. It doesn’t tend to occur more in one sex than the other, although females are more likely to have the erotomanic subtype, while males are more likely to have jealous or persecutory delusions.

Psychological factors, including social isolation, envy, suspicion, and low self-esteem may contribute to people developing delusional explanations for their inability to cope. A number of potential biological factors have been identified, but nothing clear-cut has been established.

Some of the associated factors with delusional disorder(note: correlation does not equal causation) include being married, being employed, having recently immigrated, low socioeconomic status, being celibate (for men), and being widowed (for women).

Treatment

Anosognosia (lack of insight) is typical with this condition, and can make treatment and establishing a therapeutic relationship difficult. The focus may be to prevent destructive behaviours related to the delusions. Antipsychotics may help, and sometimes mood stabilizers are used as an adjunctive treatment. However, delusional disorder tends to be much less responsive to medications than other psychotic conditions.

The prognosis is better for females, those whose illness begins before age 30, and those who have a sudden onset of symptoms.


I had a few patients with delusional disorder over the years, but the one I got to know best was my patient at a community mental health team. He had the persecutory subtype, and believed there was a group of people harassing him. While he had zero insight, he was very bright and cognitively intact. He accepted medication primarily because it helped with sleep, and he was willing to accept mental health support in relation to the stress he experienced secondary to the harassment. There would have been no hint of psychosis if the conversation didn’t venture into the area of this perceived harassment. Had we tried to work on insight with him, I’m quite sure that would have been the end of him agreeing to see us. It’s quite the fascinating disorder, although certainly not something that would easy to live with.

Is delusional disorder something you’ve ever heard of or encountered?

Sources

The Psychology Corner: Insights into psychology and psychological tests

The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.

36 thoughts on “What Is… Delusional Disorder”

  1. Interesting. I hadn’t heard of it. I see this trait in various public figures, though who knows if it rises to the level of clinical. Denial seems to be part too. A very interesting read: thank you. 😊

    1. That’s more of a paranoid personality flavour. Delusional disorder is very focused and doesn’t have that same pervasiveness. It’s like highly compartmentalized crazy, which is pretty unusual.

      1. The wordpress app has officially pissed me off. Subscribing by email so you may not see me commenting as much but I’ll definitely keep reading

  2. I’m pretty sure my friend has paranoid dilusions. she has even called police on me saying I was threatening her when I wasnt. She’s very unstable but she also has paranoid personality disorder. I would think its a horrible disorder to live with. <3

      1. This same friend stop talking to me last October out of the blue no reason why she didn’t give me any reason she just quit talking to me and blocked me

  3. I have persecutory delusions, but I am able to cope. Still, I find my “beliefs” needing to be challenged a lot. I am working on making fewer assumptions, because I have learned that I am better off not doing that. As an aside, so is everyone else!

  4. Ashley, I am always amazed with how you capture and share so much is such a concise and informed way. This is such a difficult diagnosis to understand and treat. I really appreciate the insight around treatment not being aimed at insight. I think many clients who can genuinely benefit from the therapeutic relationship and sometimes eyes on (for safety) don’t stay. And, this brings a whole host of other issues. Thank you for sharing this.

  5. Ashley, I am always impressed with how you capture and share such relevant information is such a concise and informed way. This is such a difficult diagnosis to understand and treat. I really appreciate the insight around treatment not being aimed at insight. I think many clients who can genuinely benefit from the therapeutic relationship and sometimes eyes on (for safety) don’t stay. And, this brings a whole host of other issues. Thank you for sharing this.

  6. I had erotomanic delusions, for sure, seeing the impact of it on me in those few years. I was performing okay at work. Despite the rejections, I just could not get out of it at all. I hope someone could have stepped in and helped me but no one cared even though I did open up. Eventually, I managed to move on after starting my new journey in doing PhD for better understanding mental health.

      1. Yes luckily. I am indeed blessed. I was so addicted to the false beliefs. Some helpful things help me to move on and be more careful not to have any relapse.

  7. Hmm… now you’ve explained erotomanic, that sounds a lot like what a relative did a while back… wouldn’t surprise me!

    1. Yeah, erotomanic delusions can be interesting. There’s an erotomanic subtype to delusional disorders, but erotomanic delusions can happen in any illness with psychosis, including bipolar.

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