Delusions: Causes, Diagnosis & Treatment

Delusions are powerful and unrealistic thoughts that do not match reality. They can be a sign of a mental illness and usually need help from a doctor or mental health professional. This article explains what delusions are, their types, symptoms and how they can be treated.

Difference Between Illusion Vs Delusion Vs Hallucination

Understanding the difference between illusion, delusion, and hallucination is crucial, especially when discussing mental health or neurological conditions:

• Illusion: A misperception or distortion of a real external stimulus. For example, mistaking a rope for a snake in dim light. The object exists but it is interpreted incorrectly.
• Delusion: A strongly held false belief that remains unchanged despite clear evidence to the contrary. For example, believing someone is spying on you when there is no proof.
• Hallucination: A perception of something that is not present at all. It can involve any of the senses, like hearing voices that no one else hears or seeing things that are not real.

Types of Delusion Disorders

There are different delusional disorders based on the major theme of experienced delusions. Types of delusional disorder include:

• Erotomanic Delusions: Belief that another person, often someone famous or of higher status, is in love with them.
• Grandiose Delusions: Belief in having exceptional abilities, wealth or fame.
• Jealous Delusions: Belief that their spouse or partner is unfaithful.
• Persecutory Delusions: Belief that they are being mistreated, spied on or conspired against.
• Somatic Delusions: Belief that they have a physical defect or medical problem.
• Mixed Delusions: Delusions with characteristics of more than one of the above types, but no one theme predominates.
• Unspecified Delusions: Delusions that do not fit neatly into the above categories.

Causes of Delusion Disorder

As with many other psychotic disorders, the exact cause of delusional disorder is unknown.

• Genetics: Family history of delusional disorder or other mental illnesses.
• Brain Chemistry: Imbalances in neurotransmitters, particularly dopamine.
• Psychological Factors: Stressful life events, trauma or a history of emotional or psychological trauma.
• Substance Use: Drug or alcohol abuse can trigger or exacerbate delusions.
• Medical Conditions: Some conditions, like neurological disorders, can lead to delusions.
• Environmental Factors: Social isolation, cultural factors and lack of social support.

Symptoms of Delusions

Delusions manifest in various ways and their symptoms can vary depending on the type. Common symptoms include:

• Persistent False Beliefs: Beliefs that remain unchanged despite evidence to the contrary.
• Inability to Be Dissuaded: Difficulty in convincing the individual that their beliefs are incorrect.
• Impaired Functioning: Difficulty in daily activities due to the preoccupation with delusional thoughts.
• Unwavering Beliefs: Holding onto beliefs that are false.
• Disturbed Behavior: Acting in ways that reflect delusional beliefs.
• Social Withdrawal: Avoiding interactions with others who may challenge or question the delusions.

Complications of Delusions

Delusions may cause people to feel anxious.

Those with delusional disorder may be depressed, typically due to life or work difficulties resulting from the delusions.

Acting on the delusions can also result in violence or legal trouble. For example, someone with an erotomanic delusion stalking or harassing the object of their delusion could be charged.

Individuals with this disorder may become estranged from others, particularly if their delusions disrupt or destroy their relationships.

When to Visit a Doctor?

Most of the time, your loved ones will not suddenly lose complete control of themselves. You will probably notice signs that lead to a psychotic episode.

Symptoms vary, but there are some common ones, including:

• Mistrustful or suspicious beliefs or ideas
• Unexpected outbursts
• Isolation from friends and family
• Noticeable mood swings
• Trouble sleeping
• Strange behavior

How is Delusional Disorder Diagnosed?

If a person experiences delusional symptoms, their doctor will take a medical history and perform a physical exam. Laboratory tests, such as X-rays or blood tests, may be ordered to rule out physical illnesses. If no physical cause is found, the doctor may refer the person to a psychiatrist or psychologist. These mental health professionals use interviews and evaluations to diagnose psychotic disorders based on the person's symptoms and observed behavior.

A diagnosis of a delusional condition is made if:

• The person has one or more delusions that last a month or more.
• The person has never been diagnosed with schizophrenia; hallucinations, if they have them, relate to the themes of their delusions.
• Apart from delusions and their effects, your life is not affected. Other behaviour is neither strange nor strange.
• Major manic or depressive episodes, if they have occurred, have been brief compared to delusions.
• There is no other mental disorder, medicine, or medical condition to blame.

Treatment Options for Delusion Disorder

Effective treatment for delusions involves a combination of approaches:

• Medicines: Antipsychotic medications can help manage the symptoms of delusions by addressing the underlying mental illness.
• Psychotherapy: Cognitive-behavioral therapy (CBT) can assist individuals in challenging and altering delusional beliefs.
• Supportive Therapy: Ongoing support and education for the individual and their family can facilitate better understanding and management of the condition.

Medication for Delusional Disorder

• First-generation antipsychotics: These drugs are used to block dopamine receptors in the brain. Dopamine is a neurotransmitter that is thought to be involved in the creation of delusions.
• Atypical antipsychotics: These drugs are used to block dopamine and serotonin receptors in the brain. This leads to a different side effect profile than first-generation antipsychotics.
• Tranquilizers: These medications are sometimes used to treat anxiety, agitation, or sleep problems common in people with delusional disorders.
• Antidepressants: These medications can be used to treat depression if someone with delirium experiences a mood problem.

Managing the environment can also help someone with delusions. For example, if someone believes that the government is spying on them through television, it may be better for that person to avoid watching television. Or, if a person thinks they are being followed when they enter the community alone, it may be better to have someone accompany them when they leave.

Prevention of Delusions

Delusions may not always be completely preventable, but some strategies can help reduce the risk or prevent recurrence:

• Early mental health intervention: Timely diagnosis and treatment of conditions like schizophrenia, bipolar disorder or severe depression.
• Consistent medication use: Sticking to prescribed medications helps maintain chemical balance and reduce psychotic episodes.
• Psychotherapy: Cognitive Behavioral Therapy (CBT) is especially helpful in challenging irrational thoughts and reinforcing reality-based thinking.
• Healthy lifestyle habits: Regular exercise, quality sleep, and balanced nutrition support overall mental stability.
• Avoid drugs and alcohol: Substance abuse can trigger or worsen delusions in vulnerable individuals.
• Stress reduction: Techniques like meditation, deep breathing, and mindfulness help lower stress, a common trigger.
• Regular psychiatric follow-ups: Ongoing care helps detect early signs and adjust treatment.