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Delusional Disorder

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Delusional disorder is a serious mental condition, where the person suffers from psychosis. The affected person cannot tell the truth from imagination. Delusional disorder was previously known as paranoid disorder.

People with delusional disorder have a normal life. However, they experience non-bizarre delusions, related to circumstances involving real life. These people may be convinced that someone is trying to poison them, the government is conspiring against certain people, someone is madly in love with them or their partner is cheating them, etc. Such are their delusions that involve real-life situations. However, these delusions are mostly imagined or may be over exaggerated.

When you meet these people, they will have a normal social functioning. They won’t behave in a bizarre manner or seem mentally disturbed. In some cases, these delusions can be a symptom of an underlying psychotic disorder the person is suffering from. A few people may become obsessed with their delusion, such that it disrupts their personal life.

Delusional disorder by itself is a rare disorder. It is often seen as a symptom of schizophrenia. It is very common in women as compared to men and is seen affecting people in their middle age or late life.

Characteristics of Delusional Disorder

According to DSM IV, the criteria for delusional disorder includes presence of one or more nonbizarre delusions, that remain for more than a month (criterion A). One is not diagnosed, if the patient has never shown a symptom presentation that meets criterion A for schizophrenia (criterion B).

Auditory or visual hallucinations are not very strong, if present. However, they may suffer from tactile or olfactory hallucinations related to their delusions. Their overall behavior is neither bizarre or odd (criterion C). Mood changes, if any, occur along with their delusions, but the episode is relatively short as compared to the delusion period (criterion D). The delusion is not a result of a medical condition like Alzheimer’s disease or due to the influence of drugs like cocaine (criterion E).

Types of Delusional Disorders

There are different types of disorders one may experience. These include:

  • Erotomanic: In this type, the person believes another person, in some cases, someone famous or important, is madly in love with him/her. They start stalking that individual in most cases.
  • Grandiose: In this, the person feels grand about him/herself. They feel they are powerful, full of knowledge, very important, rich or famous. These people even believe they have special powers that can change the world or have made an important discovery in the world.
  • Jealous Type: Jealous, is a type of delusion disorder, where the affected person feels their love partner is being unfaithful or cheating on them.
  • Persecutory Type: Here, the person believes that they are or someone they know or a certain group of people are being mistreated. They may even think someone is trying to harm them or spying on them or making a plan to eliminate them. You will find these people asking for legal help repeatedly.
  • Somatic: The person affected believes they are suffering from a disease, physical defect or sickness. Whereas, in reality the person is fit as a fiddle.
  • Mixed: The affected person shows more than two types of delusions mentioned above.

Causes of Delusional Disorder

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The exact cause is unknown. It is said, genetics, environmental and biochemical factors can lead to delusional disorder. An imbalance in the neurotransmitters of the brain can lead to delusions. In some cases, social isolation, drug abuse, excessive stress, low socioeconomic status, celibacy, being married, being employed, widowhood, etc. can lead to delusional disorders.

Diagnosis of Delusion Disorder

The doctors will try to rule of other conditions such as infections, metabolic disorders, dementia, etc. are absent. The delusions need to be non-bizarre and the person should not be suffering from any type of hallucinations or if present, they should be minimal.

The patient and his/her family may be interviewed to get more information regarding them. The mental status of the patient is examined and the Peters Delusion Inventory (PDI) questionnaire is used to diagnose the condition as delusional disorder.

Treatment for Delusional Disorder

The treatment for delusional disorder includes medications and psychotherapy. The main challenge for the treatment part is that the patient does not believe to have a problem. Instead of group psychotherapy, the patient is given individual psychotherapy. It helps them relate their behavior  with their delusions, identify the symptoms as well as signs of relapse and overcome relapse, if any.

The patient is given:

  • Individual psychotherapy
  • Cognitive-behavioral therapy (CBT)
  • Family therapy

Medications prescribed include:

  • Antipsychotics or neuroleptics
  • Atypical anti-psychotics
  • Tranquilizers and anti-depressants

Complications of Delusional Disorder

Person with delusional disorder often suffers from depression. At times, their delusions make them violent or face legal actions. This further alienates them and the delusion becomes stronger causing problems with their relationships.

The outlook for people with delusional disorder varies depending on the type and severity of their delusions. The willingness to seek medical help, support from family as well as other circumstances a play a vital role in treatment.

Some people with delusional disorder recover completely. However, in the majority of cases, the affected person never seeks help. They do not believe they are sick or are embarrassed to ask for help. Early diagnosis and treatment can help overcome delusional disorder and help one save their personal, professional and family life.

Written by: Saptakee sengupta
Date last updated: April 05, 2015

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