Delusional disorder

Delusional disorder is a psychiatric diagnosis denoting a psychotic mental disorder that is characterized by holding one or more non-bizarre delusions^[1] in the absence of any other significant psychopathology. Non-bizarre delusions are fixed beliefs that are certainly and definitely false, but that could possibly be plausible, for example, someone who thinks he or she is under police surveillance. In order for the diagnosis to be made auditory and visual hallucinations cannot be prominent, although olfactory or tactile hallucinations related to the content of the delusion may be present.^[2] To be diagnosed with delusional disorder, the delusion or delusions cannot be due to the effects of a drug, medication, or general medical condition, and delusional disorder cannot be diagnosed in an individual previously diagnosed with schizophrenia. A person with delusional disorder may be high functioning in daily life and may not exhibit odd or bizarre behavior aside from these delusions. The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines six subtypes of the disorder characterized as erotomanic, grandiose, jealous, persecutory, somatic, and mixed, i.e., having features of more than one subtypes.^[2] Delusions also occur as symptoms of many other mental disorders, especially the other psychotic disorders.

Indicators of a delusion

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The following can indicate a delusion:^[3]

1. The patient expresses an idea or belief with unusual persistence or force.
2. That idea appears to exert an undue influence on his or her life, and the way of life is often altered to an inexplicable extent.
3. Despite his/her profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.
4. The individual tends to be humorless and oversensitive, especially about the belief.
5. There is a quality of centrality: no matter how unlikely it is that these strange things are happening to him, the patient accepts them relatively unquestioningly.
6. An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility.
7. The belief is, at the least, unlikely, and out of keeping with the patient's social, cultural and religious background.
8. The patient is emotionally over-invested in the idea and it overwhelms other elements of his or her psyche.
9. The delusion, if acted out, often leads to behaviors which are abnormal and/or out of character, although perhaps understandable in the light of the delusional beliefs.
10. Individuals who know the patient will observe that his or her belief and behavior are uncharacteristic and alien.

Features

The following features are found:^[3]

1. It is a primary disorder.
2. It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity.
3. The illness is chronic and frequently lifelong.
4. The delusions are logically constructed and internally consistent.
5. The delusions do not interfere with general logical reasoning (although within the delusional system the logic is perverted) and there is usually no general disturbance of behavior. If disturbed behavior does occur, it is directly related to the delusional beliefs.
6. The individual experiences a heightened sense of self-reference. Events which, to others, are nonsignificant are of enormous significance to him or her, and the atmosphere surrounding the delusions is highly charged.

Types

Diagnosis of a specific type of delusional disorder can sometimes be made based on the content of the delusions. The Diagnostic and Statistical Manual of Mental Disorders (DSM) enumerates six types:

• Erotomanic Type (see erotomania): delusion that another person is in love with the individual.
• Grandiose Type: delusion of inflated worth, power, knowledge, identity, or special relationship to a famous person
• Jealous Type: delusion that the individual's sexual partner is unfaithful (see delusional jealousy).
• Persecutory Type: delusion that the person (or someone to whom the person is close) is being malevolently treated in some way.
• Somatic Type: delusions that the person has some physical defect or general medical condition (for example, see delusional parasitosis).
• Mixed Type: delusions with characteristics of more than one of the above types but with no one theme predominating.

A diagnosis of 'unspecified type' may also be given if the delusions fall into several or none of these categories.^[2]

See also

• Monothematic delusions
• Paranoia

References

Further reading

• Sims, A. (1995) Symptoms in the mind: An introduction to descriptive psychopathology. Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1
• APA.(2000) "Diagnostic and Statistical Manual, Fourth Edition, Text Revision". Washington DC: American Psychiatric Association. ISBN 978-0890420249

External links

• Mental Health Matters: Delusional Disorder
• Psych Forums: Delusional Disorder Forum