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Delusional disorder: Causes, symptoms, treatment, and more

A delusion is someone’s unshakable belief in something untrue. It’s not a part of the person’s culture or subculture—and almost everyone else knows the belief is false. Delusions can also be linked to a mental health condition, known as delusional disorder. 

While delusional disorder is a single condition, people with delusional disorder tend to fall within one or more of seven distinct subtypes of the disorder, all of which can lead to social and occupational problems, and interpersonal conflict, too—especially as others begin to see these individuals’ beliefs as irrational.

Delusional disorder symptoms are difficult to cope with alone, but are highly treatable with help from a mental health professional. Successful long-term outcomes for clients with delusional disorder are best achieved with a blended treatment approach that offers psychiatric care and therapeutic support for clients, and educational opportunities and problem-solving skills for their loved ones, who may not understand the condition.

What Is an Example of Delusional Disorder?

Most of us know what delusions are—but having delusional disorder and believing in something that has been disproven, like “flat earth” theory, is quite different. And even though delusional disorder is a single mental health condition, there are seven unique subtypes; all with their own defining features:

  • Erotomanic type: Someone with this form of delusional disorder may believe another person, with whom they’ve never had previous contact, is in love with them. The person in question is typically someone of important or famous status. 
    • Example: Someone believes that a world-famous pop star is communicating with them via their song lyrics, and so they begin stalking them, convinced that the celebrity is in love with them.  
  • Grandiose type: Individuals with the grandiose type of delusional disorder believe they have a great talent (which is unrecognized) or made a great, important discovery that remains disregarded by others. 
    • Example: An individual is convinced that they deserve credit for the atomic bomb, or that they can communicate via telepathy. 
  • Jealous type: This involves delusions about one’s lover, spouse, or partner being unfaithful, even though no evidence exists to suggest their beliefs are true.
    • Example: Someone continuously believes that their spouse is sleeping with a coworker, despite the accusation being untrue and no evidence existing to support their belief. 
  • Persecutory type: This subtype of delusional disorder involves the belief that the individual is being conspired against, spied on, drugged, harassed, or followed, or otherwise being obstructed in the pursuit of their personal goals.
    • Example: An individual believes that their recent job applications are being rejected as part of a conspiracy organized by their former coworkers to prevent them from progressing professionally. 
  • Somatic type: Individuals with the somatic type of delusional disorder have delusions involving bodily functions/and or sensations, feeling things that aren’t there. 
    • Example: Someone constantly believes they’re sick with a fever, despite having a normal body temperature and no symptoms of illness.
  • Mixed type: There is not one delusional theme that persists over others—someone experiences different types of delusions.
    • Example: An individual may consistently fight with the belief that they’re going to be kidnapped, yet also believe that their partner is unfaithful. 
  • Unspecified type: The dominant delusional belief cannot be clearly determined or does not fall into the descriptions of the specific types.
    • Example: Someone believes that the color blue doesn’t exist, and is part of an elaborate hoax or illusion. 

Even though delusional disorder may sound similar to schizophrenia, it’s much less common. It’s also less visible, as far as clinical symptoms go. Other than their delusional belief(s), people with this disorder don’t usually display the unorganized speech patterns, random thoughts, or visual and auditory hallucinations often experienced by individuals with schizophrenia.

What’s the Most Common Form of Delusional Disorder?

Persecutory delusional disorder is the most common subtype. As listed above, those who suffer from this form of the disorder believe that others are conspiring against them in one or more ways. They may make frequent calls or complaints to law enforcement about imaginary threats, causing irritation and potentially leading to a psychiatric evaluation.

Even though persecutory beliefs are one of the more common delusional disorder symptoms, this doesn’t mean that the condition is actually common. Delusional disorder is thought to affect between only .005 to .01% of individuals.

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Who Is at Risk of Developing Delusional Disorder DSM-5 297.1 (F22)?

Like all other mental health conditions, someone’s cultural and religious background must be considered during their assessment. Delusional disorder is not associated with having religious, spiritual, or any specific cultural beliefs—and being of a particular faith or cultural group doesn’t appear to elevate someone’s risk of developing delusional disorder. 

Furthermore, neither gender is more prone to developing the disorder than the other, although the jealous subtype is more common in males, and the erotomaniac subtype is more common in females. It is thought that alcohol use disorder and substance use disorder might contribute to someone developing the condition. 

Currently, there’s only a handful of other risk factors for the development of delusional disorder, including: 

  • The presence of schizophrenia and schizotypal personality disorder in someone’s immediate family member
  • A childhood marked by long stretches of social isolation
  • Immigrating to a new country or locale with significant language barriers
  • Hearing impairment
  • Visual impairment
  • Being of elderly status

Below is a more comprehensive list of the DSM-5’s criteria for delusional disorder—the details clinicians will assess before making a diagnosis. 

Diagnostic Criteria for Delusional Disorder DSM-5 297.1 (F22)

While the essential feature of this disorder is simply the existence of one or more delusions that occur for at least 1 month, the following DSM-5 specifications are all used to make a correct diagnosis of delusional disorder:

  • The individual has one or more delusions that persist for at least a month or more.
  • The individual hasn’t ever been diagnosed with schizophrenia and doesn’t show schizophrenic symptoms.  
  • Aside from the delusions’ direct effects, the individual’s functioning is not obviously impaired, and their behavior is not noticeably strange.
  • Any manic or major depressive episodes have been brief, compared to the length of the delusional period.

Alongside schizophrenic symptoms, providers will also determine if the disturbances cannot be attributed to the physiological effects of a substance, another medical condition, or another mental disorder.

How Can You Tell If Someone Is Delusional?

As you’re probably aware, only clinicians can properly diagnose someone with delusional disorder—or any other condition, for that matter. But many conditions, like delusional disorder, have the potential to create friction between the sufferer and their coworkers, friends, relatives, and romantic partners. 

Besides the information listed above, some of the key indications that you or someone you know is suffering from delusional disorder might involve: 

  • Constant complaints of feeling taken advantage of without having any proof or logical rationale
  • Becoming obsessed with the loyalty of loved ones
  • Making a habit of assuming the worst of others’ intentions, comments, or motives
  • Holding grudges past a reasonable amount of time
  • A tendency to overreact to perceived slights
  • Beliefs that defy logic
  • Taking credit for the work or achievements of others

Experiencing these symptoms doesn’t prove that you or another person has delusional disorder. But if these mental health “red flags” persist for longer than a month, or are causing significant turmoil in daily life, talking with a mental health professional should be the next step. 

Is There Treatment for Delusional Disorder?

Individuals that are coping with delusional disorder have more than one treatment option available—and the best results are usually achieved with a blended approach. 

Therapy 

This is typically the most effective treatment for individuals suffering from delusional disorder, as the condition can be resistant to solely medication. The therapist will avoid directly challenging the delusional beliefs and instead concentrate on realistic problems and goals the person has. 

Cognitive behavioral therapy (CBT) is a short-term, goal-oriented type of therapy that individuals with delusional disorder may benefit from. CBT treatment can help them to understand how their thoughts influence their actions—and they’ll learn how to replace negative, unhealthy thoughts with more beneficial thinking patterns and habits.

Family therapy and relationship counseling may also help people with delusional disorder and their loved ones to communicate more effectively, and will assist relatives or partners in knowing how to better cope with the condition. These relationship-based therapeutic methods may focus on better educating the couple or family about delusional disorder, improving communication skills, and offering new ways to cope and resolve conflicts.

Psychiatry

Antipsychotic medication is the most common prescription type used to treat delusional disorder. Antipsychotic medications work in a few different ways, most commonly by blocking dopamine receptors, and/or serotonin receptors in the brain. 

It’s believed that excess dopamine and serotonin play a crucial role in the development of irrational thoughts caused by delusional disorder. Some of the most common generic names for dopamine-blocking antipsychotic medications include chlorpromazine, trifluoperazine, and thioridazine. 

More contemporary antipsychotics are also effective in treating the symptoms of delusional disorder, and work to prevent dopamine and serotonin from binding to receptors in your brain. Common names for these dual-blocking medications are clozapine, ziprasidone, and olanzapine.

It’s also possible that a psychiatric provider will prescribe anxiolytics or antidepressants with or without antipsychotic medications, to offset the upsetting nature of delusional disorder symptoms. 

What’s the Long-Term Outlook for People with Delusional Disorder?

Delusional disorder symptoms can take control over someone’s thoughts and actions. But with the right treatment, and the patience and willingness needed to help their provider understand what they’re experiencing, individuals with delusional disorder can lead fulfilling lives. 

This condition can be better managed with therapeutic and psychiatric interventions that help reduce delusional disorder symptoms and improve a client’s ability to function on a daily basis. 

Table of contents

What Is an Example of Delusional Disorder?

What’s the Most Common Form of Delusional Disorder?

Who Is at Risk of Developing Delusional Disorder DSM-5 297.1 (F22)?

Diagnostic Criteria for Delusional Disorder DSM-5 297.1 (F22)

How Can You Tell If Someone Is Delusional?

Is There Treatment for Delusional Disorder?

What’s the Long-Term Outlook for People with Delusional Disorder?

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  • Clinical reviewer
  • Writer
  • Update history
Laura Harris, LCMHC in Durham, NC

Laura Harris, LCMHC

Laura Harris is a Licensed Clinical Mental Health Counselor (LCMHC). She specializes in anger, anxiety, depression, stress management, coping strategies development, and problem-solving skills.

Jason Crosby

Jason Crosby

Jason Crosby is a Senior Copywriter at Thriveworks. He received his BA in English Writing from Montana State University with a minor in English Literature. Previously, Jason was a freelance writer for publications based in Seattle, WA, and Austin, TX.

We update our content on a regular basis to ensure it reflects the most up-to-date, relevant, and valuable information. When we make a significant change, we summarize the updates and list the date on which they occurred. Read our editorial policy to learn more.

  • Originally published on 08/02/2017

    Author: Taylor Bennett

  • Updated on 01/09/2023

    Author: Jason Crosby

    Reviewer: Laura Harris, LCMHC

    Changes: Rewrote entire blog to utilize keywords, added several new H2s to support new content, and sought clinical review from L. Harris.

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