Delusions

Claiming to be the Queen of England, Elvis Presley or the Incredible Hulk while you’re clearly an average Joe might sound like a perfect story for an entertaining movie, but for people who truly believe they are a famous or fictional person, delusions are to blame. Some think such a delusion is what lead James Holmes to shoot and kill 12 people at a Colorado movie theatre during the showing of “The Dark Knight Rises.” Shortly after his arrest, Holmes told police that he was Batman’s enemy, the “Joker.” Still, people toss around the words delusions and delusional quite often. “She’s totally delusional.” “He has delusions of grandeur.” Here, we delve into the ins and outs.

Definition of Delusions

Delusions are a persistent, false psychotic belief regarding the self or persons or objects outside the self that is maintained despite indisputable evidence to the contrary.[1] Delusions indicate an abnormality in the affected person’s content of thought.[2]

Types of Delusions

Delusions are grouped into the following categories.[2,3,4,5,6]

Non-bizarre delusions: These delusions are firmly held beliefs about things that are actually possible in the real world, but are not true. Being loved by someone who isn’t in love with you is an example of an erotomanic delusion. For instance, talk show host David Letterman had to obtain a court injunction to keep a woman who falsely claimed to be his wife out of his house. Technically, it was possible for the woman to have been married to Letterman, (they were both human beings living on the planet Earth at the same time) but she clearly wasn’t. Other delusions that fall into this category might include being paranoid that the FBI is conspiring against you (delusion of persecution) or that your husband is cheating on you based on erroneous inferences drawn from innocent events imagined to be evidence (delusions of jealousy). Other non-bizarre delusions include the following:

  • Delusion of grandeur: Delusional conviction of one’s own importance, power, or knowledge or that one is, or has a special relationship with, a deity or a famous person.
  • Somatic delusion: The fixed, false belief that one’s bodily functioning, sensation, or appearance is grossly abnormal or diseased in some way. For example, the false belief that one’s body is completely infested with parasites.
  • Religious delusion: Any delusion with a religious or spiritual content. These may be combined with other delusions, such as grandiose delusions, delusions of control or delusions of guilt or sin, which is a false feeling of remorse or guilt of delusional intensity. For example, a person may believe that he or she is responsible for a disaster such as flood or earthquake, yet there can be no possible connection.
  • Delusion of mind being read: The false belief that other people can know one’s thoughts.

Bizarre delusions: These delusions are present in more severe types of psychotic illnesses, such as schizophrenia, and are not derived from ordinary life experiences. The thought that aliens inserted a chip into one’s brain or that aliens have control over one’s bodily movement would be a bizarre delusion referred to as a delusion of control. Other delusions of control include the following:

  • Delusion of negation, nihilistic delusion: A depressive delusion that the self or part of the self, part of the body, other persons or the whole world has ceased to exist.
  • Delusion of thought broadcasting: The belief that a person’s own thoughts are heard aloud.
  • Delusion of thought insertion: The belief that a person’s thoughts are being inserted into his or her mind from some outside force, person or group of people, and these thoughts are not recognized as the person’s own thoughts.
  • Delusion of thought withdrawal: The delusion that someone or something is removing thoughts from one’s mind.

Delusions can also be categorized into the following groups, with which some bizarre and non-bizarre delusions also fall into.

Mood-congruent delusions: Any delusion in which content is consistent with either a depressive or manic state. For instance, a depressed person believing that the world is ending or a person in a manic state believing that he or she has special talents or abilities or is a famous person.

Mood-incongruent delusions: Any delusion in which content is not consistent with either a depressed or manic state or is mood-neutral. For example, a depressed person who believes that an outside force, person or group of people is inserting thoughts into his or her mind.

Signs & Symptoms of Delusions

Delusions can present themselves in many forms, but paranoid delusions are most common and might include the following symptoms:[7]

  • The belief that someone or something is going to harm the person in some way
  • Extreme suspicion, fear, isolation, insomnia due to fear of being harmed while asleep, avoidance of food and/or medication for fear of poisoning, and sometimes violent actions
  • Extreme difficulty trusting others, frequently misinterprets others’ words and actions, and experiences ordinary things in his or her environment as a threat

Causes of Delusions

Delusions are a symptom of either a medical, neurological or mental disorder. Delusions may be present in any of the following mental disorders:[2]

  • Psychotic disorders or disorders in which the affected person has a diminished or distorted sense of reality and cannot distinguish the real from the unreal, including, schizophrenia, schizoaffective disorder, delusional disorder, schizophreniform disorder, shared psychotic disorder, brief psychotic disorder and substance-induced psychotic disorder
  • Bipolar disorder
  • Major depressive disorder with psychotic features
  • Delirium

Treatments for Delusions

Antipsychotics and psychotherapy may be used to treat delusions along with specific treatment for the medical, neurological or mental disorder causing the delusions.

References

  1. Merriam-Webster. Delusions. Retrieved February 10, 2013, from http://www.merriam-webster.com/dictionary/delusion.
  2. Encyclopedia of Mental Disorders. Delusions. Retrieved February 10, 2013, from http://www.minddisorders.com/Br-Del/Delusions.html.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric; 2000.
  4. Medscape. Delusions. Retrieved February 10, 2013, from http://emedicine.medscape.com/article/292991-overview#a1.
  5. The Free Dictionary. Delusion. Retrieved February 14, 2013, from http://medical-dictionary.thefreedictionary.com/Grandiose+delusion.
  6. PsychCentral.Somatic Delusion. Retrieved February 14, 2013, from http://psychcentral.com/encyclopedia/2008/somatic-delusion/.
  7. Canadian Mental Health Association. Hallucinations and Delusions: How to Respond. [PDF] Retrieved February 10, 2013, from http://www.cmha.bc.ca/files/6-hallucinations_delusions.pdf.

By C. J. Newton, MA, Counseling.info Editor

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