Delusional Disorder

A person with delusional disorder will have the presence of non-bizarre delusions for at least 1 month. Bizarre delusions, often distinguish delusional disorder from schizophrenia. Bizarre delusions are clearly implausible and are not “derived” from ordinary life experiences. Daily functioning is usually not impaired (aside from the impact of the delusions) and the person’s behavior is not odd or bizarre in an obvious way. There is no display of pervasive disturbances of mood or thought found in other psychotic conditions. There are either no hallucinations or hallucinations are not prominent. Personality is usually preserved and there is no disorganized behavior or grossly confused thought processes as in schizophrenia. Delusions are often of persecution, but may also include infidelity, grandiosity, somatic change, or erotomania. Delusions are usually specific to a certain person, a given place, time or activity. The delusions are usually well organized with elaborate reasons for what they are doing. The delusions are generally grandiose.

These patients generally do not seek out treatment on their own, but are usually identified by a family member. Diagnosis is difficult because these individuals are so mistrustful. The therapist has to be careful not to become “the enemy”.

When dealing with a delusional disorder the theoretical approach is usually supportive. It is most important to gain the trust of the individual through a neutral and accepting attitude. These patients are extremely sensitive to criticism making rapport building very difficult.

The goals associated with delusional disorder are to conduct an assessment and address any safety issues as well as establishing a working alliance. When doing the assessment you must be cautious. The patient may be testing you to determine whether you should be received as dangerous. You will assess the client for dangerousness to self or others and take any necessary action to ensure safety. Intervention is a very gradual process. Engage the patient in their world; Get inside to really understand things from the patient’s perspective. With empathic and sensitive involvement, you may be able to slowly allow the patient to see things from your perspective.

Antipsychotic medication may be helpful to take the “power” out of the delusion. Anti-depressants may also have some positive effect.Medication compliance is very important and should be monitored as well.

Two unusual conditions have been observed in patients with delusional disorder: Capgras syndrome, in which a patient believes that a person close to him has been replaced by a double and Fregoli Syndrome, the patient identifies various people encountered as “psychologically identical” to a familiar person. In this syndrome, the patient acknowledges that there is no physical similarity to the other person but continues to insist that they are identical.