Delusional Disorder Introduction - OmniMedicalSearch.com

Conditions & Diseases: Psychological & Mental Health

Delusional Disorder

Delusional Disorder Introduction and Overview

Delusional disorder, previously known as paranoid disorder or paranoia, is a mental illness listed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a psychotic disorder. The term psychotic is associated with the presence of certain symptoms such as delusions and hallucinations resulting in an impairment that interferes "..with the capacity to meet ordinary demands of life", a "loss of ego boundaries", and a "gross impairment in reality testing." (1)

Although the disorder was part of the official nomenclature starting with 1950 (from ICD-8 to ICD-10 and from DSM-I to DSM-IV), the concept and diagnosis

"fell into relative disuse" between the early part of the twentieth century until 1987 when the original terminology (paranoia) was changed to delusional disorder.

Despite the disorder's official recognition, for many mental health professionals delusional disorder still represents a "shadowy concept" and most might not see or recognise it in their clinical work.

Delusional disorder is characterized by the presence of one or more non-bizarre delusions that persist for at least 1 month (as long as the symptom presentation does not meet the Schizophrenia diagnosis criteria). Delusions are defined as false, erroneous beliefs "...based on incorrect inferences about external reality" that persist despite evidence to the contrary and cannot be accounted for by the person's cultural and religious background or level of intelligence.

The non-bizarre delusions include situations that can "conceivably occur in real life" such as being followed, poisoned, infected, conspired against, loved at a distance, and deceived. The nature of the delusion (nonbizarre vs bizarre) is considered to be "...especially important in distinguishing between Delusional Disorder and Schizophrenia." Distinguishing between bizarre and non-bizarre delusions can be problematic and open to different interpretations - especially when considering cultural differences. Those delusions considered to be bizarre (delusions that are considered to be especially characteristic for schizophrenia) are "clearly implausible, not understandable, and not derived from the ordinary life experiences."(1). An example of a bizarre delusion is the belief that a stranger removed the person's internal organs and replaced them with another person's organs without leaving any wounds or scars.

Some of the other symptoms that can be associated with delusional disorder include auditory or visual hallucinations (but when present they are not prominent), tactile or olfactory hallucinations related to the delusional theme (such as sensations of being infested with insects in individuals displaying infestation delusions), and in some cases, even brief mood episodes. In individuals with delusional disorder, the psychological functioning can vary. Unlike most psychotic disorders, most individuals with delusional disorder are able to socialize and function normally without displaying odd or bizarre behaviors and appear very normal during periods of active illness when their delusions are not discussed or acted on. The signs of the problem can manifest as unusual choices in their day-to-day life due to the delusional beliefs. However in more severe cases individuals can become so preoccupied with their delusions that they isolate themselves from society and are unable to work. "In general, social and marital functioning are more likely to be impaired than intellectual and occupational functioning." (1)

Due to the fact that the condition is not common in clinical settings, most studies suggest that delusional disorder "...accounts for 1-2 percent of admissions to inpatient mental health facilities." It is estimated that the prevalence among general population of delusional disorder is around 0.03 percent, lower than the schizophrenia prevalence (1 percent) or mood disorders (3 percent). "Because of its usually late age at onset, the lifetime morbidity risk may be between 0.03 percent and 0.1 percent." (1)

Unfortunately most of the studies concerned with understanding delusional disorder are conducted on a small number of participants and uncontrolled mostly because such patients escape clinical detection hiding their symptoms and resisting treatment, while looking for help in non-psychiatric settings. Most of the available reports about the disorder rely mostly on clinical descriptions which make the data difficult or impossible to replicate. Most mental health specialists agree that the disorder is hard to detect until the person is not discussing the area of their lives affected by delusions. (3)

Article by Alina Morrow,
MS Psychology
OmniMedicalSearch.com