Section 7. Mental Health Disorders

Chapter 107. Schizophrenia and Delusional Disorder

Topics: Introduction | Schizophrenia | Delusional Disorder

Delusional Disorder

Delusional disorder is characterized by one or more false beliefs that persist for at least 1 month.

Delusional disorder generally first affects people in middle or late adult life. Delusions tend to be nonbizarre and involve situations that could conceivably occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by a spouse or lover. Several subtypes of delusional disorder are recognized.

In the erotomanic subtype, the central theme of the delusion is that another person is in love with the individual. Efforts to contact the object of the delusion through telephone calls, letters, or even surveillance and stalking may be common. Behavior related to the delusion may come in conflict with the law.

In the grandiose subtype, the person is convinced that he has some great talent or has made some important discovery.

In the jealous subtype, the person is convinced that a spouse or lover is unfaithful. This belief is based on incorrect inferences supported by dubious "evidence." Under such circumstances, physical assault may be a significant danger.

In the persecutory subtype, the person believes that he is being plotted against, spied on, maligned, or harassed. The person may repeatedly attempt to obtain justice by appealing to courts and other government agencies. Rarely, violence may be resorted to in retaliation for imagined persecution.

In the somatic subtype, the person is preoccupied with a bodily function or attribute, such as an imagined physical deformity or odor. The delusion can also take the form of an imagined general medical condition, such as a parasitic infection.

Symptoms and Diagnosis

A delusional disorder may arise from a preexisting paranoid personality disorder (see Section 7, Chapter 105). Beginning in early adulthood, people with a paranoid personality disorder demonstrate a pervasive distrust and suspiciousness of others and their motives. Early symptoms may include feeling exploited, being preoccupied with the loyalty or trustworthiness of friends, reading threatening meanings into benign remarks or events, bearing grudges for a long time, and responding readily to perceived slights.

After ruling out other specific conditions that are associated with delusions, a doctor bases the diagnosis of delusional disorder largely on the person's history. It is particularly important for the doctor to assess the degree of dangerousness, particularly the extent to which the person is willing to act on his delusions.

Prognosis and Treatment

Delusional disorder does not generally lead to severe impairment. However, the person may become progressively involved with the delusion. Most people are able to remain employed.

A good doctor-patient relationship helps in the treatment of delusional disorder. Hospitalization may be needed if the doctor believes the person is dangerous. Antipsychotic drugs are not generally used but are sometimes effective in suppressing symptoms. A long-term treatment goal is to shift the person's focus away from the delusion to a more constructive and gratifying area, although this goal is frequently difficult to achieve.