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Delusional disorder is a psychiatric diagnosis denoting a psychotic mental disorder
that is characterized by holding one or more non-bizarre delusions in the
absence of any other significant psychopathology. Non-bizarre delusions
are fixed beliefs that are certainly and definitely false, but that
could possibly be plausible, for example, someone who thinks he or
she is under police surveillance. In order for the diagnosis to be
made auditory and visual hallucinations cannot be prominent,
although olfactory or tactile hallucinations related to the content
of the delusion may be present. To
be diagnosed with delusional disorder, the delusion or 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 diagnosed
with schizophrenia. A person with delusional
disorder may be high functioning in
daily life and may not exhibit odd or bizarre behavior aside from
these delusions. The Diagnostic
and Statistical Manual of Mental Disorders (DSM) defines six
subtypes of the disorder characterized as erotomanic, grandiose,
jealous, persecutory, somatic, and mixed, i.e., having features of
more than one subtypes. Delusions also occur as
symptoms of many other mental disorders, especially the other psychotic disorders.
Indicators of a delusion
The following can indicate a delusion:
- The patient expresses an idea or belief with unusual
persistence or force. (Adrian James Honan)
- That idea appears to exert an undue influence on his or her
life, and the way of life is often altered to an inexplicable
- Despite his/her profound conviction, there is often a quality
of secretiveness or suspicion when the patient is questioned about
- The individual tends to be humorless and oversensitive,
especially about the belief. (John Parsons)
- There is a quality of centrality: no matter how
unlikely it is that these strange things are happening to him, the
patient accepts them relatively unquestioningly. (Matthew
- An attempt to contradict the belief is likely to arouse an
inappropriately strong emotional reaction, often with irritability
and hostility. (Matthew Ludgate)(Adrian James Honan)
- The belief is, at the least, unlikely, and out of keeping with
the patient's social, cultural and religious background.
- The patient is emotionally over-invested in the idea and it
overwhelms other elements of his or her psyche.
- The delusion, if acted out, often leads to behaviors which are
abnormal and/or out of character, although perhaps understandable
in the light of the delusional beliefs. (Matthew Ludgate)
- Individuals who know the patient will observe that his or her
belief and behavior are uncharacteristic and alien.
The following features are found:
- It is a primary disorder.
- It is a stable disorder characterized by the presence of
delusions to which the patient clings with extraordinary
- The illness is chronic and frequently lifelong.
- The delusions are logically constructed and internally
- The delusions do not interfere with general logical reasoning
(although within the delusional system the logic is perverted) and
there is usually no general disturbance of behavior. If disturbed
behavior does occur, it is directly related to the delusional
- The individual experiences a heightened sense of
self-reference. Events which, to others, are nonsignificant are of
enormous significance to him or her, and the atmosphere surrounding
the delusions is highly charged.
Diagnosis of a specific type of delusional disorder can
sometimes be made based on the content of the delusions. The Diagnostic
and Statistical Manual of Mental Disorders (DSM)
enumerates six types:
Type (erotomania): delusion that another person is in
love with the individual.
Type: delusion of inflated worth, power, knowledge,
identity, or special relationship to a famous person
- Jealous Type: delusion
that the individual's sexual partner is unfaithful.
- Persecutory Type:
delusion that the person (or someone to whom the person is close)
is being malevolently treated in some way.
- Somatic Type: delusions that the person has
some physical defect or general medical condition (for example, see
- Mixed Type: delusions with characteristics of
more than one of the above types but with no one theme
A diagnosis of 'unspecified type' may also be given if the
delusions fall into several or none of these categories.
- ^ a
American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders, (4th ed., text
revision). Washington, DC: American Psychiatric Association.
- ^ a
Munro, Alistair (1999). Delusional
disorder: paranoia and related illnesses. Cambridge, UK:
Cambridge University Press. ISBN
- Sims, A. (1995) Symptoms in the mind: An introduction to
descriptive psychopathology. Edinburgh: Elsevier Science Ltd.
- APA.(2000) "Diagnostic and Statistical Manual, Fourth Edition,
Text Revision". Washington DC: American Psychiatric Association.
Mental and behavioral disorders
(acute alcohol intoxication
, alcohol dependence
, alcoholic hallucinosis
, Alcohol withdrawal
, Korsakoff's syndrome
, alcohol abuse
) · opioids
, benzodiazepine dependence
, benzodiazepine withdrawal
) · cocaine
, Rebound effect
diagnosed in childhood
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