delusional disorder
Delusional disorder is one of several types of psychotic disorders, all of which involve highly impaired reality testing. The central feature of delusional disorder is one or more nonbizarre delusions lasting at least a month. These delusions involve situations that could plausibly happen in life. Aside from the direct impact of delirium, people with this disorder appear normal to others and can function adequately in everyday life. If the person has a mood episode (such as depression) while having delusions, it must be relatively brief to justify a diagnosis of delusional disorder. The delusions must not be directly caused by substance use or a general medical condition to meet the criteria for this diagnosis.
There are seven types of delusional disorders. In the erotomanic type, the person mistakenly believes that someone is in love with him or her. The love object is often someone famous and/or of higher status than the individual. Celebrities are plagued with letters, phone calls and even harassed by people with erotic delusions.
People with delusions of grandeur believe they have special talents, powers, or identities (such as having found a cure for cancer or that they are Albert Einstein). Delusions of grandeur sometimes have religious content, such as the conviction that one is Jesus Christ or a special messenger of God.
Jealous delusions involve unfounded suspicions that a spouse or lover is unfaithful. The so-called evidence of infidelity is interpreted through grossly flawed logic. A person with this type of disorder may hire a private detective to spy on her spouse.
The persecutory type is the most prevalent type of delusional disorder. In this type, the person is convinced that others are conspiring against him or her to deceive, poison, slander or harm that person. In retaliation for these fantasized attacks or insults, these individuals often become litigious and repeatedly file lawsuits against the imaginary criminals.
A somatic type of delusion involves the distortion of a person’s bodily functions or sensations. Such a person may be convinced that he has contracted AIDS in a swimming pool, despite the negative results of medical tests and the extreme implausibility of his belief.
When there is more than one type of delusion, a mixed type of delusional disorder is diagnosed. An unspecified type of this disorder is diagnosed when the nature of the delusional belief cannot be determined.
When considering a diagnosis of delusional disorder, it is important to consider the person’s religious and cultural background. Some religions and cultures have beliefs that are sanctioned throughout the community but would be considered delusional outside of it. An example of this would be the virgin birth of Jesus and his bodily resurrection after his death. These are core beliefs for many within the Christian faith. However, these beliefs may seem misleading to someone who has no knowledge of Christian doctrines.
The cause of this disorder is unknown, and its treatment is notoriously difficult due to the deep-seated nature of delusions. A treatment plan must first and foremost involve gaining the person’s trust and establishing a therapeutic alliance. The therapist must respond with empathy to the person without accepting the illusion. This is best accomplished by reflecting concern about feelings of frustration, fear, inadequacy, or loneliness that the person experiences as a result of the delusion.
Concern for the safety of the patient and others must be taken into account early in treatment, as several types of delusional disorders involve a propensity for violence. In the erotomania and jealousy subtypes, there is a danger that the patient will murder the love object in extreme circumstances. The persecutory type also involves the potential use of violence in retaliation for fantasized mistreatment by others. It may be necessary for a victim of such a person to obtain a restraining order for protection. Psychiatric hospitalization may also be necessary if the person is in clear danger of harming someone.