What Are Delusions?

Delusions are fixed, false beliefs that conflict with reality. If a person is in a delusional state, they can’t let go of their untrue convictions despite contrary evidence.

Delusions are often reinforced by misinterpreting events. Many also involve some level of paranoia. For example, someone who is delusional might contend that the government is controlling our every move via radio waves, even with no evidence to support this belief.

Delusions are common symptoms of some psychotic disorders. They may occur along with hallucinations, which involve perceiving something that isn’t really there, like hearing voices or feeling bugs crawling on your skin.

Signs of Delusional Thinking

How can you tell if you or someone you love is experiencing delusional thoughts? Delusions are characterized by an unshakable belief in things that are not true, and in many cases, people continue to believe in them despite evidence to the contrary.

It's also important to recognize that not all delusions are the same. Some delusions might involve non-bizarre beliefs that could theoretically occur in real life, such as believing that your spouse is cheating on you. Other delusions are bizarre, fantastical, or impossible, like thinking that you are responsible for the fate of the world. 

The nature of the delusional symptoms may play a central role in the diagnosis. Delusional disorder, for example, is characterized by non-bizarre delusions that often involve the misinterpretation of an experience or perception. Conversely, in schizophrenia, delusions may be bizarre and not rooted in reality.

Types of Delusions

Several different types of delusions can characterize the diagnosis of a delusional disorder. The disorder is diagnosed as delusional disorder and includes a specifier with XYZ type. For example, if you have grandiose delusions, your diagnosis would be "delusional disorder, grandiose type."

Erotomanic Delusions

In this type of delusion, individuals believe that a person—usually with a higher social standing—is in love with them. An example of erotomanic delusional thinking would be someone who believes that an actress loves them and that they are communicating with them via secret hand gestures during their TV show.

Grandiose Delusions

In grandiose delusions, individuals believe that they have extraordinary talent, fame, wealth, or power despite a lack of evidence. An example of this type of delusional thinking would be someone who believes God gave them the power to save the universe and completes certain tasks every day that will help the planet continue.

Persecutory Delusions

Individuals with persecutory delusions believe that they are being spied on, drugged, followed, slandered, cheated on, or somehow mistreated. A delusional thought of this type might involve someone believing that their boss is drugging the employees by adding a substance to the water cooler that makes people work harder. 

Jealous Delusions

Individuals with jealous delusions might believe that their partners are unfaithful. For instance, someone with this type of delusion might believe their partner is meeting their lover every time they use the restroom in public settings—they also think that they are sending their lover secret messages through other people (like the cashier in a grocery store).

Somatic Delusions

Individuals with somatic delusions believe that they are experiencing physical sensations or bodily dysfunctions under the skin or that they're suffering from a general medical condition or defect. For instance, someone who believes there are parasites living inside their body could be suffering from somatic delusions.

Mixed or Unspecified Delusions

When delusional beliefs don't fall into a single category, and no single theme dominates, the delusions are considered "mixed." Mental health professionals may refer to the disorder as "unspecified" when delusions don't fall into a specific category or the delusion type can't be clearly determined.

Causes of Delusions

Researchers aren’t exactly sure what causes delusional behavior and states. It appears that various genetic, biological, psychological, and environmental factors may be at play.

• Genetic causes: Psychotic disorders seem to run in families, so researchers suspect that 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.
• Biological causes: Abnormalities in the brain may contribute to delusional thoughts and behaviors. An imbalance of neurotransmitters (chemical messengers in the brain) might increase the likelihood that an individual will develop delusions.
• Psychological causes: Trauma and stress can even trigger delusions. Individuals who tend to be isolated appear more vulnerable to developing a delusional disorder as well.
• Environmental causes: Sometimes, people share delusions. This experience is most common in individuals who reside together and have little contact with the outside world.

Conditions With Delusional Symptoms

Delusions may be symptoms of a mental health issue or brain disorder. The following are a few conditions that are associated with delusional thoughts or behaviors:

• Brief psychotic disorder: When triggered by a stressful event, people can experience brief episodes of hallucinations, delusions, or disorganized speech. In brief psychotic disorder, symptoms persist for one month or less.
• Delusional disorder: People with delusional disorder experience "non-bizarre" types of delusions and can usually act normally, with no markedly impaired functioning. An estimated 0.2% of the population meets the criteria, so this disorder is considered a relatively rare mental illness.
• Dementia: Although estimates vary, roughly one-third of individuals with dementia may experience delusions. Often, these delusions involve paranoia, such as thinking family members or caretakers are stealing from them.
• Mood disorders: Sometimes, individuals with mood disorders like depression or bipolar disorder experience delusional thinking.
• Parkinson's disease: The prevalence varies widely, but many patients with advanced Parkinson's disease experience hallucinations and delusions.
• Postpartum psychosis: Hormonal shifts after giving birth may trigger postpartum psychosis in some women, and one symptom of this condition is delusions. Some research indicates that postpartum psychosis might be linked to bipolar disorder.
• Schizoaffective disorder: This disorder involves symptoms of schizophrenia—including delusional thinking and hallucinations—as well as mood issues like depression and mania.
• Schizophrenia: Schizophrenia involves "positive symptoms," such as hallucinations or delusions. It also involves "negative symptoms," including flat affect, reduced feelings of pleasure in everyday life, difficulty beginning and sustaining activities, and reduced speaking.
• Schizophreniform disorder: This disorder involves symptoms similar to schizophrenia, but, in this case, the symptoms are experienced for less than six months.
• Substance/medication-induced psychotic disorder: Drug or alcohol intoxication or withdrawal may cause some individuals to experience delusions. Delusional symptoms are usually brief and tend to resolve once the drug is cleared, although psychosis triggered by amphetamines, cocaine, and PCP can persist for weeks.

Diagnosis of Delusions

If a person is experiencing delusional symptoms, their healthcare provider will begin by taking a medical history and performing a physical exam. Lab tests may also be ordered to rule out any physical illnesses that might be causing the delusions.

If no medical condition is instigating the symptoms, the healthcare provider may refer the individual to a psychiatrist for further evaluation. Mental health professionals can use a variety of psychological assessments to learn more about the person's symptoms. A diagnosis may then be made based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). 

Treatment for Delusions

It's essential for anyone experiencing delusional thinking to seek professional help. This can be incredibly challenging, however, since people experiencing delusions often don't think of their beliefs as a problem.

Treatment for delusions often includes a combination of medication and therapy.

Medication

Medications that may be used to help treat delusional thought processes and their resulting behaviors may include:

• Typical antipsychotics: These first-generation medications are used to block dopamine receptors in the brain. Dopamine is a neurotransmitter believed to be involved in the development of delusions.
• Atypical antipsychotics: These medicines block dopamine and also serotonin receptors in the brain. This leads to a different side effect profile than first-generation antipsychotics.
• Tranquilizers: Sometimes, tranquilizers are used to address the anxiety, agitation, or sleep issues that are common in people with delusional disorders.
• Antidepressants: These prescription medications may be used if the person with delusional beliefs is also experiencing a mood issue, such as depression.

Therapy

Therapy for delusions may include cognitive behavioral therapy (CBT). CBT helps an individual with delusional beliefs learn to recognize and change unhelpful thoughts and behaviors.

Family therapy is often part of the treatment for delusions as well. Through this type of therapy, family members can learn how to support their loved one who is experiencing delusional thoughts or behavior patterns.

Coping With Delusions

Managing the environment can help someone with delusions. For example, if a person believes that the government is spying on them through the TV, it may be best to avoid watching television. Or if a person believes they are being followed when they go out in the community alone, it may be best to have someone go with them.

Final Thoughts

Most disorders that involve delusions are treatable. This enables people with these delusional beliefs to live healthy, productive lives with relatively few symptoms.

Others with delusions do struggle to work, maintain healthy relationships, or participate in activities associated with daily living. If you or a loved one are experiencing issues as a result of delusional thinking, a healthcare professional can provide the help and support you need.