Delusional disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 26, 2016
StartDiseasesDelusional disorder

Statistically, delusional disorder affects a small percentage of the adult population. Hospital and clinical records show that it is rare to find children suffering from this mental illness. It is a difficult disease to diagnose and treat because it requires the patient to acknowledge and accept the symptoms and the causes.


Definition & Facts

Delusional disorder is defined as a mental disorder that displays expressions of false beliefs by patients. These unfounded distortions come in a variety of physical sensations, feelings, and emotions. It has also been observed that patients with delusional order can usually function in society normally, but they can also be obsessed with their delusions. For unknown reasons, studies are showing that more females than males have this disease.

Symptoms & Complaints

There are six types of delusional disorder that have been recognized in patients who have been diagnosed with this illness.

  • Erotomanic belief comes from the idea that someone of notoriety is in love with the patient. Sometimes the patient may try to stalk the famous person.
  • An unrealistic belief of power, achievement, or identity by the patient is recognized as the grandiose type of delusion.
  • Jealousy based on the perceived unfaithfulness of a spouse or partner is another type of delusional disorder.
  • Another identified type of delusion is when the patient has strong feelings of being persecuted or of a loved one being harmed by someone else. This feeling of persecution is so strong that complaints may be made to law enforcement agencies.
  • When patients are convinced that they have medical illnesses or physical defects, they are suffering from somatic delusions.
  • The sixth type of delusional disorder is called a mixed disorder because it relates to two or more of the other types of delusions.

A distinctive fact about delusional disorder is that some people who are ill with this disease may experience hallucinations that will validate their beliefs. A more outward symptom is an irritable or angry mood.


The causes of complex mental illnesses are not clear and this dilemma applies to delusional disorder. The ongoing studies are looking closely at biological, environmental factors, and psychological considerations. Since statistics show that patients with delusional disorder have family members with the illness, it is possible that genetic factors may be one of the causes.

Brain abnormalities could contribute to the abnormal thinking process that results in delusions. They may result form an abnormality of the limbic system of the brain which controls basic emotions such as fear and anger. When considering environmental causes, it is also believed that stress, alcohol, and drug abuse may play a role.

Diagnosis & Tests

Briefly stated, the American Psychiatric Association has established the following guidelines for diagnosing delusional disorder:

  • The duration of one month or longer for one or more delusions
  • Absence of active-phase symptoms of schizophrenia such as hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms
  • Functioning is not markedly impaired
  • Behavior is not odd or bizarre
  • Manic or depressive episodes have been brief relative to the duration of the delusions
  • The delusions are not attributed to the physiological effects of drugs or medications
  • The delusions are not explained by other mental disorders

There are no laboratory tests that can be given to diagnose delusional disorder but a physician may order other tests such as blood tests or scans to see if there are other physical illnesses that could be causing the disease.

Compiling a thorough medical history on the patient and conducting a physical examination would also be standard procedures to diagnose this disorder. If no physical reasons are found during the diagnosing process, the patient may be referred to a psychiatrist who is qualified to use assessment tools and interviews specifically for delusional disorder.

Treatment & Therapy

Treatment of delusional disorder is primarily administered by prescribing antipsychotic medications and conducting psychotherapy sessions with the patient. Standard antipsychotic drugs are effective in blocking dopamine receptors in the brain. Scientists believe that dopamine contributes to the development of delusions.

There is a newer generation of antipsychotic medicines that, not only block dopamine, but also hinder serotonin receptors in the brain. Antipsychotic drugs do not cure delusional disorder but they do give some relief and they improve the quality of life. Other medications that are used to treat anxiety and depression may supplement the antipsychotic medicines.

Counseling appointments with a psychologist or psychiatrist can also be part of the treatment plan but there are some difficulties if patients are reluctant to participate in the discussion about their symptoms. It is very important that there is trust between the ill person and the therapist. It is common for a delusional patient to deny that their behavior is abnormal. Until they recognize their problem, progress in treating them will be almost impossible.

In extreme cases, a patient may be hospitalized if it is possible that someone may be injured. The illusions can lead to violence or harassment of people who are the objects of the delusions. Positive response to medical treatment is shown in 50 percent of the population who suffer from this disorder, but sadly, only 8 percent of people with delusional disorder experience full remission.

Prevention & Prophylaxis

Delusional disorder cannot be prevented because there are no proven causes of this illness. There are only theories that point to why this disease occurs. If stress and alcohol abuse are actual factors of the disease, then it is only logical that these risk factors should be either avoided or controlled.