What type of delusions are there

A standard trial of an antipsychotic or, for somatic delusions, an SSRI at starting doses is commonly used to treat psychotic or mood disorders. Psychosocial interventions Any psychiatric treatment of delusional disorder should incorporate the following psychotherapeutic principles:. For patients who deny that their concerns are delusional, a supportive approach to psychotherapy, with a verbally and listening supportive strategy intended to ease distress, is helpful.

However, there have been no clinical trials of specific psychosocial interventions for delusional disorder. The following therapies have been suggested for the delusional disorder:. Supportive therapy has also been shown to be helpful.

Its goal is to facilitate treatment adherence and provide education about the illness and its treatment. Furthermore, providing social skills training has helped many persons. It can promote interpersonal competence as well as confidence and comfort when interacting with those individuals perceived as a threat.

In patients with delusional disorder who are at serious risk of harming others, involuntary treatment with antipsychotic medication may have a role. Clinical decisions regarding involuntary treatment are subject to legal regulations that vary by country and locality. Insight-oriented therapy is rarely indicated or contraindicated; yet there are reports of successful treatment.

Its goals are to develop therapeutic alliance, containment of projected feelings of hatred, impotence, and badness; measured interpretation as well as the development of a sense of creative doubt in the internal perception of the world. Specify if: The following course specifiers are only to be used after a 1-year duration of the disorder:.

Privacy Policy. Skip to main content. Schizophrenia Spectrum and Other Psychotic Disorders. Search for:. Delusional Disorders Delusional disorder may be classified according to Diagnostic and Statistical Manual based on content of the delusions into seven subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified. The Diagnostic and Statistical Manual of Mental Disorders DSM enumerates seven types: Subtypes of delusional disorder Description Erotomanic The patient believes that another person is secretly in love with her or him.

Such effort can lead to stalking in some cases, with some risk for assaultive behavior. Other names of erotomanic delusional disorder: DeClerambault syndrome, erotomania, psychose passionelle. The delusion of jealousy can lead to aggressive, possibly violent, and threatening behavior, including homicide and suicide. In some cases delusional jealousy and its disruptive impact may only improve through separation from the suspected unfaithful partner.

Other names of jealous delusional disorder: pathological or morbid jealousy, Othello syndrome, conjugal paranoia. Persecutory The patient is typically preoccupied by a delusion that he or she is being persecuted, potentially harmed, or conspired against. The individuals with persecutory delusions may resort to the courts and even to violence to right the wrongs directed at them. There are several forms: that one is ill with undiagnosed disease; that one is infested with parasites or insects delusional parasitosis ; or that parts of the body are ugly, misshapen, or emanate a foul odor.

Individuals generally go from one doctor to another, specialist to specialist, usually disappointed by the failure to detect and diagnose the medical problem that haunts them. Suicide may be a risk, thought due to frustration and lack of effective clinical intervention. Other names of somatic delusional disorder: hypochondriacal delusion, monosymptomatic hypochondriasis. Mixed More than one delusional theme predominates.

Unspecified The dominant delusional belief cannot be clearly determined or is not described by the subtypes above. Other notable differences between the DSM-IV and DSM-5 diagnostic criteria are a clearer demarcation of delusional disorder in DSM-5 from psychotic variants of obsessive compulsive disorder and body dysmorphic disorder that is made explicit with a new exclusion criterion.

If the criteria for delusional disorder are met, delusional disorder is the appropriate diagnosis. Causes The cause of delusional disorder is unknown, but genetic, biochemical, psychological, and environmental factors may play a significant role in its development. The etiology of delusional disorder is unknown, and several difficulties exist in conducting research in this area: Genetics According to the DSM-5, on an average, global function is generally better in delusional disorder than that observed in schizophrenia.

Although the diagnosis is generally stable, a proportion of individuals go on to develop schizophrenia. Delusional disorder has a significant familial relationship with both schizophrenia and schizotypal personality disorder.

There might be a genetic factor involved in the development of delusional disorder, which is suggested by the fact that delusional disorder is more common in people who have family members with delusional disorder or paranoid personality traits. It is also believed that, as with other mental disorders, a tendency to develop delusional disorder might be passed on from parents to their children. Delusion of infidelity may occur without other psychotic symptoms. Such delusions are resistant to treatment and do not change with time.

Delusions of jealousy are common with alcohol abuse, they may also occur in some organic states, and are often associated with impotence, e. Husbands or wives may show sexual jealousy, as may sexual cohabitees and homosexual pairs. Morbid jealousy makes a major contribution to the frequency of wife battering and is one of the commonest motivations for homicide. The respect the fixed and permanent delusions attending erotomania sometimes prompt those laboring under it to destroy themselves or others, for though in general tranquil and peaceful, the patient sometimes becomes irritable, passionate and jealous.

These have sometimes been classified as paranoia, rather than paranoid schizophrenia; these delusional symptoms sometimes occur in the context of manic-depressive psychosis. A variation of erotomania was described by and retains the name of de Clerambault Typically, a woman believes a man, who is older and of higher social status than she, is in love with her. In this the patient may believe himself to be a famous celebrity or to have supernatural powers.

Expansive or grandiose delusional beliefs may extend to objects, so leading to delusion of invention. Grandiose and expansive delusions may also be part of fantastic hallucinosis, in which all forms of hallucinations occur. The form of the delusion is dictated by the nature of the illness. So religious delusions are not caused by excessive religious belief, nor by the wrongdoing which the patient attributes as cause, but they simply accentuate that when a person becomes mentally ill his delusions reflect, in their content, his predominant interests and concerns.

Although common, they formed a higher proportion in the nineteenth century than in the twentieth century and are still prevalent in developing countries. Initially the patient may be self-reproachful and self-critical which may ultimately lead to delusions of guilt and unworthiness, when the patients believe that they are bad or evil persons and have ruined their family.

They may claim to have committed an unpardonable sin and insist that they will rot in hell for this. These are common in depressive illness, and may lead to suicide or homicide.

These are the reverse of grandiose delusions where oneself, objects or situations are expansive and enriched; there is also a perverse grandiosity about the nihilistic delusions themselves.

Feelings of guilt and hypochondriacal ideas are developed to their most extreme, depressive form in nihilistic delusions. Delusions impair respect for and competence of the sufferer and promote compensatory delusional interpretation.

None of these factors are absolute but any or all may act synergistically to initiate and maintain delusion. Conrad proposed five stages of which are involved in the formation of delusions:. Freud proposed that delusion formation involving denial, contradiction and projection of repressed homosexual impulses that break out from unconscious. Later in de Clerambault, put forth the view that chronic delusions resulted from abnormal neurological events infections, intoxications, lesions.

Maher offered a cognitive account of delusions which emphasized disturbances of perception. He proposed that a delusional individual suffers from primary perceptual abnormalities, seeks an explanation which is then developed through normal cognitive mechanism, the explanation i.

Also, delusion is maintained in the same way as any other strong belief. These are further reinforced by anxiety reduction due to developing explanation for disturbing or puzzling experiences.

He postulated that delusions in schizophrenia arise from faulty logical reasoning. The defect apparently consists of the assumption of the identity of two subjects on the ground of identical predicates e. Learning theorists have tried to explain delusions in terms of avoidance response, arising specially from fear of interpersonal encounter. Luhmann defines that information, message and understanding connects the social systems with the psychic ones.

If the psychic system fails to recognize the message of information correctly or is unable to negotiate between understanding and misunderstanding message, it detaches itself from the social system to which it is normally closely connected. This detachment releases the possibility of unhindered autistic fulfillment of desires and uncontrolled fear may appear as delusions.

Acute delusions are the result of an increased activity of the euromodulators dopamine and norepinephrine. This not only leads to a state of anxiety, increased arousal and suspicion, but also to an increased signal to noise ratio in the activation of neural networks involved in higher order cognitive functions, leading to formation of acute delusions. Alteration in the neuromodulatory state not only causes the occurrence of unusual experiences but also modify neruroplasicity which influences the mechanism of long term changes.

So chronic delusions may be maintained by a permanently increased neuromodulatory state, or by an extremely decreased noradrenergic neuromodulatory state Black wood et al. It refers to the capacity of attributing mental states such as intentions, knowledge, beliefs, thinking and willing to oneself as well as to others.

Amongst other things this capacity allows us to predict the behavior of others. Frith postulated that paranoid syndromes exhibit a specific ToM deficit, e. Since deluded patients in symptomatic remission performed as well as normal controls at ToM tasks, ToM deficits seem to be a state rather than a trait variable.

Delusions driven by underlying affect mood congruent may differ neurocognitively from those which have no such connection mood incongruent. Thus, specific delusion-related autobiographical memory contents may be resistant to normal forgetting processes, and so can escalate into continuous biased recall of mood congruent memories and beliefs. Regarding threat and aversive response, identification of emotionally weighted stimuli relevant to delusions of persecution has been seen.

It assumes that the probability-based decision-making process in delusional individuals requires less information than that of healthy individuals, causing them to jump to conclusions, which is neither a function of impulsive decision-making nor a consequence of memory deficit. Kemp et al. The findings in reasoning abilities in delusional patients are only subtle and one might question the strength of their causality in delusional thinking.

Bentall and others proposed that negative events that could potentially threaten the self-esteem are attributed to others externalized causal attribution so as to avoid a discrepancy between the ideal self and the self that is as it is experienced. An extreme form of a self-serving attributional style should explain the formation of delusional beliefs, at least in cases where the delusional network is based on ideas of persecution, without any co-occurring perceptual or experiential anomaly.

During the course of illness, the preferential encoding and recall of delusion-sensitive material can be assumed to continually reinforce and propagate the delusional belief. The emergence of symptoms assumed to depend upon an interaction between vulnerability and stress. Therefore the formation of delusion begins with a precipitator such as life event, stressful situations, drug use leading to arousal and sleep disturbance.

This often occurs against the backdrop of long-term anxiety and depression. The arousal will initiate inner outer confusion causing anomalous experiences as voices, actions as unintended or perceptual anomalies which will turn on a drive for a search for meaning, leading to selection of explanation in the form of delusional belief [ Figure 1 ].

Roberts G. The earlier works like Hartley suggested that vibration caused by brain lesion may match with vibrations associated with real perception. Ey believed delusion to be a sign of cerebral dysfunctions and Morselli listed the metabolic states for delusional pathogenesis. Jackson suggested pathogenesis of delusions due to combination of loss of functions of damaged part of brain.

Cummings found that a wide variety of conditions can induce psychosis, particularly those that affect the limbic system, temporal lobe, caudate nucleus. He also noted that dopaminergic excess or reduced cholinergic activity also predispose to psychosis. He suggested that the common locus is limbic dysfunctions leading to inappropriate perception and paranoid delusion formation. Septo-hippocampal dysfunction model: The dysfunction leads to erroneous identification of neutral stimuli as important and judge expected as actual.

Storage of erroneous information leads to delusion formation. Semantic memory dysfunction model: Delusions form due to inappropriate lying down of semantic memory and their recollections. The study indicated that severity of delusions was associated with hypometabolism in additional prefrontal and anterior cingulate regions. Delusion of alien control has been linked with hyperactivation of the right inferior parietal lobule and cingulate gyrus, brain region important for visuospatial functions.

Organic delusional disorders are more likely to be noted in extrapyramidal disorders involving the basal ganglia and thalamus and in limbic system disease. Alexander et al.

Any lesions, dysfunctions or derangements that affect any part of this loop can be expected to alter beliefs and emotional behavior [ Figure 2 ]. Prediction error theories of delusion formation suggest that under the influence of inappropriate prediction error signal, possibly as a consequence of dopamine dysregulation, events that are insignificant and merely coincident seem to demand attention, feel important and relate to each other in meaningful ways.

Delusions ultimately arise as a means of explaining these odd experiences Kapur, ; Maher, The insight relief gained by arriving at an explanatory scheme leads to strong consolidation of the scheme in memory.

In support of this view, aberrant prediction error signals during learning in patients with first-episode psychosis have been confirmed experimentally. Furthermore, the magnitude of aberrant prediction error signal correlated with delusion severity across a group of patients with first-episode psychosis. However, there are important characteristics of delusions that still demand explanation: Notably their persistence. Normal associations can extinguish if they prove erroneous, normal beliefs can be challenged and modified.

But delusions are noteworthy for the fact that they remain even in the absence of support and in the face of strong contradictory evidence. We believe that this striking clinical phenomenon can be explained within the same framework by considering key findings from the animal learning literature, a literature that has been formerly invoked to explain chronic relapse to drug abuse; extinction and reconsolidation.

If delusion formation may be explained in terms of associative learning then perhaps extinction may represent the process through which delusions are resolved. Extinction involves a decline in responding to a stimulus that has previously been a consistent predictor of a salient outcome. Prediction error is also central to extinction. It has been suggested that negative prediction error a reduction in baseline firing rate of prediction error coding neurons leads the organism to categorize the extinction situation as different from the original, reinforced, situation and it now learns not to expect the salient event in that situation.

This learning focuses on contextual cues, allowing the animal to distinguish the newly non-reinforced context from the old, reinforced one.

Extinction does not involve unlearning of the original association, but rather the formation of a new association between the absence of reinforcement and the extinction situation. Extinction experiences the absence of expected reinforcement invoke an inhibitory learning process which eventually overrides the original cue response in midbrain dopamine neurons. Individuals with psychosis do not learn well from these absent but expected events, nor do they consolidate the learning that does occur.

But there is more to delusion maintenance than persistence in the absence of supportive evidence: delusions persist even when there is evidence that directly contradicts them. When confronted with counterfactual evidence, deluded individuals do not simply disregard the information.

Rather, they may make further erroneous extrapolations and even incorporate the contradictory information into their belief. So, while delusions are fixed, they are also elastic and may incorporate new information without shifting their fundamental perspective.

Once a simple delusional belief is adopted with conviction, the subsequent course is very variable. Some patients have fleeting or brief delusional states, spontaneously remitting and returning to normal. Others elaborate and develop their belief into a comprehensive system which may remain unaltered even with regular medication.

The multidimensionality of delusional experience also has implications for the conceptualization of the temporal course of psychotic decompensation and resolution. Individual dimensions of delusional experience often change independently of one another during the course of a psychotic episode, so that recovery can be determined by changes in one of the several dimensions Garety and Freeman, Encapsulation: Patients vary very much in the degree to which they can maintain their original personality and adapt to a normal life.

It is frequently seen in residual states. In some cases one sees a longitudinal splitting as it were in the current of life, both the reality adapted and the delusional life go on alongside each other. On certain occasions e. Meeting certain people, return to familiar locations, meeting the doctor who had treated the patient the delusional complex comes to the surface and florid symptoms reappear.

Jorgensen found three types of recovery, one with full and the other two with partial recovery of delusional beliefs. In patients with partial recovery, decrease in pressure precede, decrease in other dimensions. For two-thirds there was no change in the degree or insight during recovery. Delusions are a key clinical manifestation of psychosis and have particular significance for the diagnosis of schizophrenia.

Although common in several psychiatric conditions, they also occur in a diverse range of other disorders including brain injury, intoxication and somatic illness. Delusions are significant precisely because they make sense for the believer and are held to be evidentially true, often making them resistant to change.

Although an important element of psychiatric diagnosis, delusions have yet to be adequately defined. The last decade has witnessed a particular intensification of research on delusions, with cognitive neuroscience-based approaches providing increasingly useful and testable frameworks from which to construct a better understanding of how cognitive and neural systems are involved.

There is now considerable evidence for reasoning, attention, metacognition and attribution biases in delusional patients. Recently, these findings have been incorporated into a number of cognitive models that aim to explain delusion formation, maintenance and content.

Although delusions are commonly conceptualized as beliefs, not all models make reference to models of normal belief formation. It has been argued that aberrant prediction error signals may be important not only for delusion formation but also for delusion maintenance since they drive the retrieval and reconsolidation-based strengthening of delusional beliefs, even in situations when extinction learning ought to dominate. Given the proposed function of reconsolidation, in driving automaticity of behavior it is argued that in an aberrant prediction error system, delusional beliefs rapidly become inflexible habits.

Taking this translational approach will enhance our understanding of psychotic symptoms and may move us closer to the consilience between the biology and phenomenology of delusions. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Journal List Ind Psychiatry J v. Ind Psychiatry J. Chandra Kiran and Suprakash Chaudhury. Author information Copyright and License information Disclaimer.

Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.

Abstract Delusion has always been a central topic for psychiatric research with regard to etiology, pathogenesis, diagnosis, treatment, and forensic relevance.

Keywords: Delusions, Etiology, Psychopathology, Phenomenology. Open in a separate window. Jaspers regarded a delusion as a perverted view of reality, incorrigibly held, having three components: They are held with unusual conviction They are not amenable to logic The absurdity or erroneousness of their content is manifest to other people.

Table 3 Phenomenological classification of delusions. Table 4 Classification of delusions according to cause Cutting Primary and secondary delusions The term primary implies that delusion is not occurring in response to another psychopathological form such as mood disorder. Delusional mood It is usually a strange, uncanny mood in which the environment appears to be changed in a threatening way but the significance of the change cannot be understood by the patient who is tense, anxious and bewildered.

Delusional perception In this an abnormal significance, usually in the sense of self-reference, despite the absence of any emotional or logical reason, is attributed to normal perception. Delusional memory This is the symptom when the patient recalls as remembered an event or idea that is clearly delusional in nature, that is, delusion is retrojected in time.

Delusional awareness Delusional awareness is an experience which is not sensory in nature, in which ideas or events take on an extreme vividness as if they had additional reality. Delusion of persecution It is the most frequent content of delusion. Delusion of infidelity Described by Ey may be manifested as delusion, overvalued idea, depressive affect or anxiety state.

Grandiose delusions In this the patient may believe himself to be a famous celebrity or to have supernatural powers. Delusions of guilt and unworthiness Initially the patient may be self-reproachful and self-critical which may ultimately lead to delusions of guilt and unworthiness, when the patients believe that they are bad or evil persons and have ruined their family.

Factors concerned in the germination of delusions: Disorder of brain functioning Background influences of temperament and personality Maintenance of self-esteem The role of affect As a response to perceptual disturbance As a response to depersonalization Associated with cognitive overload. Factors concerned in the maintenance of delusions: The inertia of changing ideas and the need for consistency Poverty of interpersonal communication Aggressive behavior resulting from persecutory delusions provokes hostility Delusions impair respect for and competence of the sufferer and promote compensatory delusional interpretation.

Learning theory Learning theorists have tried to explain delusions in terms of avoidance response, arising specially from fear of interpersonal encounter. The role of emotions Delusions driven by underlying affect mood congruent may differ neurocognitively from those which have no such connection mood incongruent.

Probabilistic reasoning bias It assumes that the probability-based decision-making process in delusional individuals requires less information than that of healthy individuals, causing them to jump to conclusions, which is neither a function of impulsive decision-making nor a consequence of memory deficit. Theory of attributional bias Bentall and others proposed that negative events that could potentially threaten the self-esteem are attributed to others externalized causal attribution so as to avoid a discrepancy between the ideal self and the self that is as it is experienced.

Multifactorial model The emergence of symptoms assumed to depend upon an interaction between vulnerability and stress. Figure 1. Neurobiological theories The earlier works like Hartley suggested that vibration caused by brain lesion may match with vibrations associated with real perception.

Figure 2. Others respond well to standard treatment. Adler A. Delusional jealous thinking is marked by the constant suspicion that the loved one is guilty of infidelity.

This may be accompanied by constantly harassing the loved one with questions and accusations about how they spent the day, where they went, and who they spoke with. The delusion can be fed by very circumstantial evidence—such as their partner not answering the phone when they call—and they will still hold to the delusion even in the face of evidence to the contrary.

When someone experiences persecutory delusions, they believe a person or group wants to hurt them. They firmly believe this is true, despite a lack of proof.

Whether people with this condition think co-workers are sabotaging their work or they believe the government is trying to kill them, persecutory delusions vary in severity.

Some individuals with persecutory delusions believe they have to go to great lengths to stay safe—and consequently, they may struggle to function normally. It is not uncommon for people with this type of delusion to make repeated complaints to legal authorities. Individuals with somatic delusions have a false belief related to one or more bodily organs, such as that organs are functioning improperly or are diseased, injured, or otherwise altered.

It is not uncommon to worry about catching a contagious disease or developing a rare illness. But somatic-type delusions are much more convincing, consistent, and compelling than these fleeting and temporary fears. Most people who experience them find it impossible to acknowledge they are not real and tend to resist any facts that contradict or undermine their delusional belief, even if these facts can be conclusively and scientifically proven.

Not all delusions are the same. Some might involve non-bizarre beliefs that could theoretically occur in real life. Others may be bizarre, fantastical, or impossible such as having your thoughts broadcast on television or being abducted by aliens. In addition to these categories, delusions can often manifest according to a consistent theme. Although delusions can have any theme, certain themes are more common. These include:. It appears a variety of genetic, biological, psychological, and environmental factors are involved.

Psychotic disorders seem to run in families, so researchers suspect there is a genetic component to delusions. Children born to a parent with schizophrenia, for example, may be at a higher risk of developing delusions.

Evidence suggests that delusions can be triggered by a significant life event, stressful situations, drug and alcohol use, and sleep disturbance. Taking steps to reduce stress or remove yourself from stressful situations may reduce instances of delusions. It's important to speak to a medical professional if you begin experiencing delusions as these can be the symptom of an underlying condition that will require treatment.

In fact, some people are able to live healthy, productive lives with few symptoms. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Kiran C, Chaudhury S. Understanding delusions. Ind Psychiatry J. Joseph SM, Siddiqui W. Delusional disorder. Updated November 20,