Delusional disorder

Delusional disorder
Other namesDelusional insanity,[1] paranoia[citation needed]
Painting by Théodore Géricault portraying an old man with a grandiose delusion of power and military command. Grandiose delusions are common in delusional disorder.
SpecialtyPsychiatry, clinical psychology Edit this on Wikidata
SymptomsStrong false belief(s) despite superior evidence to the contrary
Usual onset18–90 years old (mean of about age 40)[2]
TypesErotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type, unspecified type
CausesGenetic and environmental[3]
Risk factorsFamily history, chronic stress, low SES, substance abuse
Differential diagnosisParanoid personality disorder, manic-depressive illness, schizophrenia, substance-induced psychosis[3]
Frequency0.02-0.1% of general population [4][5]

Delusional disorder, traditionally synonymous with paranoia, is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect.[6][7] Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content;[7] non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned.[8] Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily seem odd.[9] However, the preoccupation with delusional ideas can be disruptive to their overall lives.[9]

For the diagnosis to be made, auditory and visual hallucinations cannot be prominent, though olfactory or tactile hallucinations related to the content of the delusion may be present.[7] The delusions cannot be due to the effects of a drug, medication, or general medical condition, and delusional disorder cannot be diagnosed in an individual previously properly diagnosed with schizophrenia. A person with delusional disorder may be high functioning in daily life. Recent and comprehensive meta-analyses of scientific studies point to an association with a deterioration in aspects of IQ in psychotic patients, in particular perceptual reasoning, although, the between-group differences were small.[10][11][12]

According to German psychiatrist Emil Kraepelin, patients with delusional disorder remain coherent, sensible and reasonable.[13] [dubious – discuss] The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines six subtypes of the disorder: erotomanic (belief that someone is in love with one), grandiose (belief that one is the greatest, strongest, fastest, richest, or most intelligent person ever), jealous (belief that one is being cheated on), persecutory (delusions that one or someone one is close to is being malevolently treated in some way), somatic (belief that one has a disease or medical condition), and mixed, i.e., having features of more than one subtype.[7]

Delusions also occur as symptoms of many other mental disorders, especially the other psychotic disorders.

The DSM-IV and psychologists agree that personal beliefs should be evaluated with great respect to cultural and religious differences, as some cultures have normalized beliefs that may be considered delusional in other cultures.[14]

An earlier, now-obsolete, nosological name for delusional disorder was "paranoia". This should not be confused with the modern definition of paranoia (i.e., persecutory ideation specifically).

  1. ^ Andrew Scull, The diagnosis of delusional insanity in the United States and Great Britain, 1860-1913
  2. ^ Joseph, S. M.; Siddiqui, W. (2021). "Delusional Disorder". StatPearls. StatPearls. PMID 30969677.
  3. ^ a b "Delusional Disorder: Treatments, Causes, Types & Diagnosis".
  4. ^ Joseph, S. M.; Siddiqui, W. (2023). "Delusional Disorder". StatPearls. PMID 30969677.
  5. ^ "Diagnostic and statistical manual of mental disorders : DSM-IV". 1999.
  6. ^ Semple.David."Oxford Hand Book of Psychiatry" Oxford Press. 2005. p 230
  7. ^ a b c d American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, (5th ed., text revision). Washington, DC: American Psychiatric Association.
  8. ^ Hales E and Yudofsky JA, eds, The American Psychiatric Press Textbook of Psychiatry, Washington, DC: American Psychiatric Publishing, Inc., 2003
  9. ^ a b Winokur, George."Comprehensive Psychiatry-Delusional Disorder"American Psychiatric Association. 1977. p 513
  10. ^ Peters, Emmanuelle R.; Nunn, Julia A.; Pickering, Alan D.; Hemsley, David R. (2002). "Perceptual organization deficits in psychotic patients". Psychiatry Research. 110 (2): 125–135. doi:10.1016/S0165-1781(02)00096-3. PMID 12057825. S2CID 1529978.
  11. ^ Bora, Emre; Yucel, Murat; Pantelis, Christos (2009). "Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses: Meta-analytic study". British Journal of Psychiatry. 195 (6): 475–482. doi:10.1192/bjp.bp.108.055731. PMID 19949193.
  12. ^ Zanelli, Jolanta; Reichenberg, Abraham; Morgan, Kevin; Fearon, Paul; Kravariti, Eugenia; Dazzan, Paola; Morgan, Craig; Zanelli, Caroline; Demjaha, Arsime; Jones, Peter B.; Doody, Gillian A.; Kapur, Shitij; Murray, Robin M. (2010). "Specific and Generalized Neuropsychological Deficits: A Comparison of Patients with Various First-Episode Psychosis Presentations". American Journal of Psychiatry. 167 (1): 78–85. doi:10.1176/appi.ajp.2009.09010118. PMID 19952077.
  13. ^ Winokur, G (1977). "Delusional Disorder (Paranoia)". Comprehensive Psychiatry. 18 (6): 511–521. doi:10.1016/s0010-440x(97)90001-8. PMID 923223.
  14. ^ Bourgeois, James A. "Delusional Disorder". Medscape. WebMD. Retrieved 2018-11-16.