Amity Institute of Psychology & Allied Science

DELUSIONAL DISORDER

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Definition of Delusion:
Delusional defined as a
1. False belief based on incorrect inference about external reality
2. Firmly held despite objective & obvious contradictory proof or evidence
3. Despite the fact that other members of the culture do not share the belief.

• (FISH) A DELUSION IS A FALSE UNSHAKEABLE BELIEF, which is out of keeping with the patient’s social,
culture, religious background, or his/her level of intelligence and it is due to internal morbid process(the
fact it is false makes it easy to recognize but this is not its essential quality).
• (HAMILTON) A DELUSION IS A FALSE UNSHAKEABLE BELIEF THAT ARISES FROM INTERNAL MORBID
PROCESSES. It is easily recognizable when it is not keeping with the person’s educational & cultural
background.

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• KARL JASPERS(psychiatrist and philosopher) was the first to

define the 3 main criteria for a belief to be considered delusional
in his book (General psychopathology,1913) CRITERIA as
follows:
• (1)Certainty( Held with absolute conviction)
• (2)Incorrigibility ( Not changeable by compelling
counterargument or proof to the contrary)
• (3)Impossibility or falsity of content (implausible, bizarre or
patently untrue)

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EPIDEMIOLOGY
relatively rare (the prevalence = 0,03).
underreported - delusional patients rarely seek psychiatric help
annual incidence: 1-3 new cases per 100,000 people, about 4% of all
first admissions to psychiatric hospitals.
mean age of onset: 40 years
 range for the age of onset runs from 18 to the 90s.
The slight preponderance of female patients.
many patients are married and employed.
some association with recent immigration and low socioeconomic
status

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ETIOLOGICAL THEORIES
 Psychodynamics
Emotional development is delayed because of a lack of maternal stimulation/attention. The infant is
deprived of a sense of security and fails to establish basic trust. A fragile ego results in severely impaired
self-esteem, a sense of loss of control, fear, and severe anxiety. A suspicious attitude toward others is
manifested and may continue throughout life. Projection is the most common mechanism used as a
defense against feeling.
 Biological
A relatively strong familial pattern of involvement appears to be associated with these disorders.
Individuals whose family members manifest symptoms of these disorders are at greater risk for
development than the general population. Twin studies have also suggested genetic involvement.
 Family Dynamics
Some theorists believe that paranoid persons had parents who were distant, rigid, demanding, and
perfectionistic, engendering rage, a sense of exaggerated self-importance, and mistrust in the individual.
The clients become vulnerable as adults because of this early experience.
 Neurobiological Perspective
thought to involve an abnormality in the neural impulse transmission of the neurochemicals dopamine,
serotonin and norepinephrine. 5
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Delusions Primary
• One that occurs suddenly without any other abnormal
mental even leading to it.
• Rare
• When occur- strongly suggest schizophrenia
Secondary
• Arise from previous abnormal ideas or experience
• Hallucinations
• Mood
• Another delusion

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Other mental phenomena related to delusions

• Delusional mood
• Inexplicable feeling of apprehension that is followed before long by a
delusion that explains it.
• Delusional Perception
• Misinterpretation of the significance of something perceived normally
• Delusional memory
• Retrospective delusional misinterpretation of memories of actual events

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Behavioral Clinical Findings:

 exhibits an elaborate, highly organized paranoid delusional system
while preserving other functions of the personality
 Apart from the impact of the delusions, thinking and functioning are
not interfered with, nor is it bizarre.
 Personality function continues
 Delusions are drawn from real-life situations and have a coherent
theme. Hallucination is not prominent; if present, usually auditory and
are related to delusional theme
 A predominant theme of delusions determines type of paranoia

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Types of Delusional Disorder

(1)DELUSIONS OF PERSECUTION
(2)DELUSIONS OF JEALOUSY
(3)DELUSIONS OF LOVE
(4)GRANDIOSE DELUSIONS
(5)DELUSIONS OF ILL HEALTH
(6)DELUSIONS OF GUILT
(7)NIHILISTIC DELUSIONS
(8)DELUSIONS OF POVERTY

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1. Delusional of Persecution
• Result of epiphanous experiences, auditory hallucinations, bodily hallucinations and
experiences of passivity. Can take many forms:
Delusions of reference: The patient knows that people are talking about him,
slandering him or spying on him. The belief that they or their loved ones are about to
be killed.
Being robbed or deprived of their just inheritance. Have special knowledge which the
persecutors want to take.
Being poisoned – these are often explanatory delusions or based on hallucinations of
smell and taste.
Delusions of influence: are logical results of experiences of passivity, which are
diagnostic of schizophrenia.
• DELUSIONS OF PERSECUTION ARE SEEN IN :
• (1) SCHIZOPHRENIA
• (2) DEPRESSIVE ILLNESSES
• (3) PSYCHOGENIC REACTIONS 10
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2. Delusion of Jealousy
• The term is a misnomer Often the pt. has been suspicious,
sensitive and mildly jealous before the onset of the illness or
psychogenic reaction. The severity of the condition fluctuates
in the course of time, so sometimes it seems to be a series of
psychogenic reactions.
• DELUSION OF JEALOUSY(INFIDELITY) are seen in :
• (1) Alcohol addiction • (2) Schizophrenia • (3) Affective
psychosis

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3. Delusion of Love
• Also called as “the fantasy lover” & “erotomania” • Patients are convinced that some
person is in love with them although the alleged lover may never have spoken to them.
• They are seen in :
• (1) Abnormal personality development. • (2) Schizophrenia (early cases).
4. Delusion of Grandiose
• The expansive delusions may be supported by hallucinatory voices(voices telling the
patient that he is important).
• They may be supported by confabulations when the patient gives a detailed account
of his coronation or of her marriage to king.
• It may be a part of fantastic hallucinosis in which all forms of hallucination occur.
• GRANDIOSITY has to be differentiated from mania(absence of well held expansive
delusion).
• GRANDIOSE DELUSION are seen in : • (1) Organic brain syndrome • (2) Drug
dependence • (3) Schizophrenia • (4) General paresis • (5) Happiness psychosis 12
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5. DELUSIONS OF ILL-HEALTH
• Characteristic picture of DEPRESSIVE ILLNESS- the result of an uncovering of the patients
worries.
• DEPRESSIVE DELUSIONS of ill-health may involve the patient’s spouse & children (post-
partum psychosis).
• Moderately depressed patients believe that they are becoming incurably insane (therefore,
hesitate to take medical help)
• DELUSIONS OF ILL-HEALTH may also be seen in : • (1) Schizophrenia - early stages secondary
to depression; chronic cases due to somatic hallucination. • (2) Personality development
6. DELUSIONS OF GUILT
• Mainly seen in DEPRESSIVE ILLNESSES.
• MILD DEPRESSION- patient is self-critical & self- reproachful (this differentiates true
depression from reactive depression)
• SEVERE DEPRESSION- (delusion of guilt) patient believes he is wicked sinner who has ruined
his family - this may take on a somewhat grandiose character- “wickedest man in the world will
be punished for eternity”.
• DELUSIONS OF GUILT CAN GIVE RISE TO DELUSIONS OF PERSECUTION. 13
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7. NIHILISTIC DELUSIONS
• Also known as DELUSION OF NEGATION (as patient denies the existence
of his body, his mind, his loved ones & the world around him.)
• Sometimes they may be associated with DELUSION OF ENORMITY when
the patient believes that he can produce a catastrophe by some action.
• NIHILISTIC DELUSIONS are seen in: • (1) Severe agitated
depression(Involutional melancholia) • (2) Subacute delirious state • (3)
Schizophrenia
8. DELUSION OF POVERTY
• Patient is convinced that he is impoverished and believes that
destitution is facing him & his family.
• They are commonly seen in: • DEPRESSION
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COURSE AND PROGNOSIS

 Some research data indicate that identifiable psychosocial stressor often
accompanies the onset of the disorder (eg. recent immigration, social conflict with
family members or friends, social isolation etc.)
 Sudden onset is more common than insidious one.
 Person with delusional disorder is likely to be below average in intelligence and the
premorbid personality of such person is likely to be extroverted, dominant and
hypersensitive.
 Delusional disorder is thought to be the life-long, stable diagnosis.
 Factors that correlate with a good prognosis are high levels of occupational, social,
and functional adjustments, female sex, onset before age 30, sudden onset, short
duration of illness and the presence of precipitating factors.
 Patients with persecutory, somatic and erotic delusions are thought to have a better
prognosis than do patients with grandiose and jealous delusions.
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TREATMENT
 Hospitalization
 Often needed because patients may need a complete medical and neurological evaluation to
determine whether a nonpsychiatric medical condition is causing the delusional symptoms.
 Patients may need an assessment of their ability to control violent impulses, such as to commit
suicide and homicide.
 Patient's behavior about the delusions may have significantly affected their ability to function
within their family or occupational settings so they may require professional intervention to
stabilize social or occupational relationships.
 Pharmacotherapy
 In an emergency, severely agitated patients should be given an antipsychotic drug intramuscularly.
 Most clinicians think that antipsychotic drugs are the treatment of choice for delusional disorder.
 If the patient receives no benefit from antipsychotic medication the drug should be discontinued.
In patients who do respond to antipsychotic drugs data indicate that maintenance doses can be
low.

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TREATMENT
Psychotherapy
 The essential element is to establish a relationship in which patients begin to
trust a therapist.
 Individual therapy seems to be more effective than group therapy.
 Insight-oriented supportive, cognitive and behavioral therapies are often
effective.
 The family may benefit from the therapist’s support and may thus be supportive
of the patient.
 A good therapeutic outcome depends on a psychiatrist's ability to respond to the
patient's mistrust of others and the resulting interpersonal conflicts, frustrations
and failures.
 The mark of successful treatment may be a satisfactory social adjustment rather
than an abatement of the patient's delusions.
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