Disorder deep dive

Delusional Disorder

A thought disorder

What is it?

It’s not uncommon for people to believe in strange or fanciful things. However, there’s a big difference between entertaining some quirky theories, and having delusions. Delusions are false  beliefs that a person considers true no matter how aggressively they’re disproved.

Delusional disorder is a condition in which a person experiences one or more non-bizarre delusions for at least one month. Non-bizarre delusions are false beliefs that could be feasible in real life. Meaning that they aren’t that farfetched. For example, being convinced that you’re about to get fired. A bizarre delusion, would be thinking that your family members are actually aliens.

No other alarming symptoms occur alongside the delusions, which is why many people with the condition lead outwardly normal lives. It’s considered very rare, with only 0.2% of the population being estimated to have it at some point. It is equally common in men and women.

What are the symptoms?

The primary symptom of delusional disorder is experiencing delusions. In some cases, a person might exhibit anger, irritability, jealousy or low mood if their delusions are rooted in themes that trigger those emotions. They may also experience hallucinations related to their theme. To be diagnosed, one or more delusions must be present for at least one month.

There are seven different types of delusions: 

  • Erotomanic: A person thinks that someone is in love with, often a celebrity or person of high social status. They may make attempts to get in contact with this person. 
  • Grandiose: A person believes that they have some form of unrecognized power insight including an amazing talent, special piece of knowledge, or a unique relationship with an important person/figure, such as God. 
  • Jealous: A person is convinced that their romantic partner has been unfaithful in some way. 
  • Persecutory: A person believes that someone is trying to harm them or a loved one in some way. This includes being cheated on, spied on, drugged, kidnapped, murdered, slandered or stalked. They may make reports to law enforcement about these perceived threats. 
  • Somatic: A person believes they’re experiencing some sort of physical sensation or medical problem, such as having bugs crawl on their skin, or having cancer. 
  • Mixed: A person has delusions that are a combination of the above themes. 
  • Unspecified: A person has delusions that don’t fall into the above categories. 

People with this condition fully believe their delusions and do not try and disprove them.

What are some common warning signs?

Delusional disorder can be hard to spot. Most people with the condition function normally at home, work and in their social lives. The disorder does not come with other noticeable psychotic symptoms, such as strange speech patterns, a lack of hygiene or bizarre emotional reactions. This is one of the key differentiators between delusional disorder, and conditions like schizophrenia.

If you think a loved one might be experiencing delusions, pay close attention to the concerns they express, whether they be about their job, their romantic partners, their health or other facets of their life.

Ask yourself the following questions: 

  • Do they believe they’re connected to people they don’t know? 
  • Are they convinced that they’re in danger, without having done anything to make themselves a target? 
  • Do they believe they hold some sort of job or title that is unrealistic?
  • Are they overly jealous in their relationships, and often expressing romantic concerns that seem unfair or unwarranted? 
  • Do they talk about physical symptoms or disorders that don’t appear to exist? 
  • Most importantly, do they hold onto these beliefs even after being presented with ample evidence that they aren’t real? 

If so, they may be experiencing delusions and you should find time to talk to them about their symptoms.

What causes Delusional Disorder?

The exact causes of delusional disorder are unknown. Doctors believe a range of factors play a role in its development, including:

  • Genetics: People are more likely to develop delusional disorder if they have a family history of the disorder or other forms of psychosis.
  • Brain chemistry: Issues with certain neurotransmitters or brain circuits have been linked to the condition. 
  • Environmental: It’s thought that being put under tremendous stress may trigger the condition. 
  • Substance Abuse: Some studies show a correlation between heavy drug use and psychosis.

How is it treated?

Treating delusional disorder can be very challenging. Most people with the condition don’t see their delusions as problematic, which makes convincing them to seek help quite hard.

When people are willing to seek help, it’s recommended that their treatment plan is created based on their individual needs. Generally speaking, some combination of psychotherapy and medication is recommended, with psychotherapy being the first line of treatment. Using medication alone to treat the condition is often not successful. 

Psychotherapy is a broad term that refers to a range of therapeutic approaches. Common models for coping with Delusional Disorder are: 

  • Individual psychotherapy: One-on-one sessions that help people better understand and manage their symptoms. 
  • Cognitive behavioral therapy (CBT): A therapeutic model that challenges negative thinking patterns and behaviors. In CBT, a therapist will help a person establish healthy coping mechanisms for their delusions, hallucinations.
  • Family therapy: A model that teaches family members how to deal with their loved ones condition and empower recovery. 

When it comes to medication, antipsychotics are the most commonly recommended type. 

There are two classes of antipsychotics — first generation (conventional) and second generation (atypical). First generation antipsychotics are older, cheaper and come with more substantial side effects. Second generation are newer and come with less. 

  • First generation/conventional: Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol), Loxapine (Oxilapine), Perphenazine (Trilafon), Thioridazine (Mellaril), Thiothixene (Navane)Trifluoperazine (Stelazine)
  • Second generation/atypical: Aripiprazole (Abilify), Asenapine (Saphris), Brexpiprazole (Rexulti), Cariprazine (Vraylar), Clozapine (Clozaril), Iloperidone (Fanapt), Lurasidone (Latuda), Olanzapine (Zyprexa), Paliperidone (Invega), Quetiapine (Seroquel), Risperidone (Risperdal), Ziprasidone (Geodon)

In some cases, antidepressants may be used to treat corresponding depression, or tranquilizers will be used to address anxiety/sleep problems. 

It’s important to remember that treatment plans are personalized. If you’re seeking help, make sure you work one-on-one with a doctor to create a plan that fits your needs. Just because a medication or therapy helps someone else recover, doesn’t mean it’ll be the right solution for you. Don’t ever feel guilty about asking for help, taking meds or going to therapy. Addressing your mental health is a productive and courageous thing to do.

How can I help a loved one with Delusional Disorder?

It can be hard to know how to react when someone you love isn’t doing well. Do they want to talk about it, or would they prefer to keep their experiences private? Will you push them away by starting the conversation?

There are no easy answers to these questions. Every person handles their mental health differently. That said, we all want to feel loved and supported. Showing someone that you’re invested in their wellbeing can make a world of difference. Here are some ways to do so:

  • Educate yourself: Read up on symptoms, treatment options, and healthy living recommendations. Try and understand what your loved one is going through so you are better equipped to talk to them about it. This will also make you a valuable resource when it comes time to find treatment. 
  • Advocate treatment: Asking for help can be hard. Societal stigma often keeps people from opening up to others about their symptoms. Support your loved one by helping them research different treatment methods, or doctors in their area. If they’d like, go to a few sessions with them. Remind them that there’s nothing weird about getting help, and that you’re proud of them for following through. 
  • Use empathy: The delusions and hallucinations associated with delusional disorder feel very real. Try and refrain from snapping at them when they are in the midst of an episode. Stay calm and remember what they’re going through. Remind them that you’re there for them and that you love them. 
  • Be patient: Don’t take it personally if they lash out at you. They are battling something that’s very hard to overcome. Their distance has nothing to do with who you are as a person. Keep showing up for them even when it feels like it’s not helping. The act alone lets them know that they have people in their life who care. 

Remember to take care of yourself. Find counseling of your own if you are struggling to cope with their condition.

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