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Delusional Disorder


Carol Tamminga

, MD, UT Southwestern Medical Dallas

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Delusional disorder usually first affects people in middle or late adult life. It is less common than schizophrenia Schizophrenia Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually, hearing voices), firmly held false beliefs (delusions), abnormal thinking... read more . Delusional disorder is distinguished from schizophrenia by the presence of delusions without any of the other symptoms of psychosis (for example, hallucinations, disorganized speech, or disorganized behavior).

Delusions may involve situations that could conceivably occur in real life, such as being followed, poisoned, infected, or loved at a distance. Or they may involve situations that are very unlikely to occur, such as having internal organs removed without leaving a scar. The difference between a delusion and a false or mistaken belief is that people continue to believe in a delusion no matter how much clear evidence contradicts it.

Types of delusional disorder

There are several subtypes of delusional disorder:

  • Erotomanic: People believe that another person is in love with them. They often try to contact the object of the delusion through telephone calls, letters, or digital messages. Some attempt surveillance, and stalking is common. Behavior related to the delusion may be against the law.



  • Persecutory: People believe that they are being plotted against, spied on, maligned, or harassed. People may repeatedly file lawsuits or reports to the police or other government agencies. Rarely, people resort to violence in retaliation for imagined persecution.


Symptoms of Delusional Disorder

A delusional disorder may develop from a preexisting paranoid personality disorder Paranoid Personality Disorder Paranoid personality disorder is characterized by a pervasive pattern of unwarranted distrust and suspicion of others that involves interpreting their motives as hostile or harmful. Because... read more . Beginning in early adulthood, people with a paranoid personality disorder have a pervasive distrust and suspiciousness of others and their motives.

Early symptoms of delusional disorder 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

  • Responding readily to perceived slights

Behavior is not obviously bizarre or odd. People with delusional disorder tend to function relatively well, except when their delusions cause problems. For example, they may have marital problems if they are incorrectly convinced their spouse is being unfaithful.

Diagnosis of Delusional Disorder

  • A doctor's evaluation

After ruling out other specific conditions that can cause delusions (such as a substance use disorder Substance Use Disorders Substance use disorders generally involve behavior patterns in which people continue to use a substance despite having problems caused by its use. The substances involved tend to be members... read more ), a doctor bases the diagnosis largely on the person’s history and symptoms. The doctor also must assess how dangerous the person might be, particularly how likely the person is to act on the delusions.

Prognosis of Delusional Disorder


Most people are able to remain employed, as long as their work does not involve people or events related to their delusions.

Treatment of Delusional Disorder

  • Establishment of a good doctor-patient relationship

  • Sometimes antipsychotic drugs

Treatment can be difficult because some people firmly believe their delusion and refuse to seek help. A good doctor-patient relationship helps. Once a relationship is established, doctors can encourage people who are resistant to being treated to participate in treatment.



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Test your knowledge

Substance Use Disorders
Substance use disorders involve behavior patterns in which people continue to use a drug despite problems caused by its use. Many classes of drugs tend to cause these disorders. Which of the following is NOT a class of drugs that causes substance use disorders?
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