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How to Spot the Signs of a Delusional Disorder in Someone You Know

If you know someone who has trouble perceiving reality in a certain part of their life and who focuses on false ideas, they might have a delusional disorder. These disorders are a type of psychotic disorder where someone believes something that isn’t true and resists alternative explanations, even with overwhelming, clear and logical facts that prove otherwise. 

Tyler G. Jones, MD, a psychiatrist and chief medical officer at Banner Behavioral Health Hospital, explained that these disorders are relatively rare, affect men and women equally and typically strike during adulthood.

There are different types of delusional disorders

There are delusional disorders that are “non-bizarre,” meaning they could occur in real life, and “bizarre,” meaning they could not. Some examples of delusional disorders include:

  • Erotomanic delusios: a false belief that another person, usually someone of higher social or economic status, is in love with the person.
  • Grandiose delusions are a belief that a person has great talent, discovery, self-worth or knowledge. 
  • Delusional jealousy is the consistent belief that one’s partner is unfaithful. 
  • Delusions based on bodily perceptions, functions, sensations or the overwhelming feeling the person is sick or has some physical defect with no evidence of genuine symptoms. 
  • Delusional beliefs centered on being harmed, poisoned, followed, conspired against, spied on, harassed or obstructed.

Watch for these signs and symptoms of delusional disorders

The main symptom is the presence of delusion. This type of delusion can influence a person’s behavior. People with delusional disorders don’t see their beliefs as irrational or inaccurate even when others point this out. So, they don’t have a good sense of the problems created by their belief.

Depending on the type of delusion, they may be angry or violent. This behavior is more likely with people who feel persecuted or jealous. “Although their belief is not real, they behave in ways that would be understandable if their belief were true,” Dr. Jones said. 

A person suffering from a delusional disorder may be socially isolated, distrustful or suspicious or have low self-esteem. They may feel exploited or be preoccupied with loyalty or trustworthiness. “Delusions are often based on misinterpretations of real events, and the person may overvalue particular ideas or read threatening or malicious intent into harmless or typical remarks or events,” Dr. Jones said.

Causes of delusional disorders

Most of the time, we don’t know exactly what causes delusional disorders. Genetics may play a role since people who have family members with delusional disorders or schizophrenia have a higher risk of developing it. Living with a person who has a delusional disorder can cause a delusional disorder.

Substance use or misuse can play a role, and social isolation, low self-esteem or a high degree of envy could predispose someone to misinterpret ideas which can lead to delusional thinking.

Groups that are at increased risk because of isolation include people with significant hearing loss or a visual impairment, immigrants who may be isolated due to language barriers and seniors.

How delusional disorders are diagnosed

Psychiatrists and psychologists usually diagnose these disorders. There’s no test for them, but bloodwork and imaging exams such as CT scans and MRI can rule out other possible causes. To assess for these disorders, a physician will ask questions about the person’s ideas and when they began, perform a full mental status exam and, with the person’s consent, interview family members for more details and information.

How to deal with someone who has a delusional disorder

The most important thing you can do for someone who may have a delusional disorder is to provide support and encourage them to seek a psychiatric evaluation. A positive, encouraging and supportive approach is more effective since they do not believe their thoughts are unusual. “They may also already feel persecuted or criticized, and a positive approach is less likely to cause more stress,” Dr. Jones said.

Friends and family members often experience their own stress, isolation, depression, frustration and grief in dealing with or living with someone with a delusional disorder. If that’s the case for you, it’s crucial to take care of your own mental health and seek help through your primary care provider, a therapist or a psychiatrist.

If you think you might be the object of someone’s delusional disorder, you may need to call the police. For example, if you have a neighbor who accuses you of things that aren’t true, such as spying, playing loud music, causing the wires to hum in their house or stealing, it is important to report these incidents to the police and possibly request protective services. “Although most people with serious mental illness are not violent, a smaller portion of people have committed crimes as a result of their delusions,” Dr. Jones said.

How to treat delusional disorders

People won’t understand that their ideas are delusional without proper treatment. Doctors generally recommend a combination of antipsychotic medications and cognitive behavioral therapy (CBT) for psychosis. CBT is a structured, goal-oriented therapy focused on unlearning negative thoughts and behaviors.

Untreated delusional disorders can lead to depression, harm to others and legal issues if the person stalks, harasses or harms the person involved in the delusion. For example, a person who believes a neighbor is spying on them may harass the neighbor to get them to stop the imagined offending behavior. “When a person’s delusions are not validated (because they are untrue), they may feel they have no other recourse but to harm the target of their belief,” Dr. Jones said.

If you’re a family member of someone who has a delusional disorder, you might want to seek counseling. “Family members should also consider treatment to gain education, support and guidance for themselves and the person with delusional disorder,” Dr. Jones said.

The bottom line

Delusional disorders are a rare type of psychiatric disorder where people believe something to be true despite clear and logical facts that show otherwise. People with these disorders need treatment, usually a combination of medication and therapy.

Need help diagnosing or treating a delusional disorder?

Call the Banner Behavioral Health Appointment Line at (800) 254-4357.

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