Delusions — Part 2 of 3

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Many individuals get confused with the terms, illusions, delusions and hallucinations. I’ve discussed the topic of illusions here. Part 1 is an overview of delusions. Today, I will discuss the types of delusions. Part 3 will give a review of medical conditions associated with delusion.

delusionA delusion is commonly defined as a fixed false belief and is used in everyday language to describe a belief that is either false, fanciful or derived from deception. Delusions typically occur in the context of neurological or mental illness, although they are not tied to any particular disease and have been found to occur in the context of many pathological states (both physical and mental).

Types of Delusions

  • Erotomanic type
    • The central theme of delusions is that another person, usually of higher status such as someone important or famous, is in love with the patient. The object of delusion is generally perceived to belong to a higher social class, being married, or otherwise unattainable. Patients with this type of delusion are generally female.
    • Delusional love is usually intense in nature. Signs of denial of love by the object of the delusion are frequently falsely interpreted as affirmation of love Patients may attempt to contact the object of the delusion by making phone calls, sending letters and gifts, making visits, and even stalking. Some cases lead to assaultive behaviors as a result of attempts to pursue the object of delusional love or attempting to “rescue” her/him from some imagined danger
  • Grandiose type
    • Patients believe that they possess some great and unrecognized talent, have made some important discovery, have a special relationship with a prominent person, or have special religious insight, inflated worth, power, knowledge and identity. Many patients with paranoid type show some degree of grandiosity in their delusions. The person might believe he or she has a great talent or has made an important discovery.
  • Jealous type
    • The main theme of the delusions is that her or his spouse or lover is unfaithful. Some degree of infidelity may occur; however, patients with delusional jealousy support their accusation with delusional interpretation of “evidence” (eg, disarrayed clothing, spots on the sheets).
    • Patients may attempt to confront their spouses and intervene in imagined infidelity. Jealousy may evoke anger and empower the jealous individual with a sense of righteousness to justify their acts of aggression. This disorder can sometimes lead to acts of violence, including suicide and homicide.
    • Persecutory type People with this type of delusional disorder believe that they (or someone close to them) are being mistreated, persecuted and harmed or that someone is spying on them or planning to harm them. It is not uncommon for people with this type of delusional disorder to make repeated complaints to legal authorities. The delusions are systematized, coherent, and defended with clear logic. No deterioration in social functioning and personality is observed. Patients often experience some degree of emotional distress such as irritability, anger, and resentment. In extreme situations, they may resort to violence against those who they believe are hurting them.
  • Somatic type The core belief of this type of disorder is delusions around bodily functions, physical defect or general medical condition. The most common are the belief that one is infested with insects or parasites, the belief of emitting a foul odor, the belief that parts of the body are not functioning, and the belief that their body or parts of the body are misshapen or ugly.
    • Patients are totally convinced in physical nature of this disorder, which is contrary to patients with hypochondriasis who may admit that their fear of having a medical illness is groundless.
    • Patients are usually first seen by dermatologists, cosmetic surgeons, urologists, gastroenterologists, and other medical specialists.
  • Mixed type Patients exhibit more than one of the delusions simultaneously, and no one delusional theme predominates.
  • Unspecified type
    • Delusional themes fall outside the specific categories or cannot be clearly determined.
    • Misidentification syndromes such as Capgras syndrome (characterized by a belief that a familiar person has been replaced by an identical impostor) or Fregoli syndrome (a belief that a familiar person is disguised as someone else) fall into this category. Misidentification syndromes are rare and frequently are associated with other psychiatric conditions (eg, schizophrenia) or organic illnesses (eg, dementia, epilepsy).
    • Another unusual syndrome is Cotard syndrome, in which patients believe that they have lost all their possessions, status, and strength as well as their entire being, including their organs.

People with delusional disorder often can continue to socialize and function normally, apart from the subject of their delusion, and generally do not behave in an obviously odd or bizarre manner. This is unlike people with other psychotic disorders, who also might have delusions as a symptom of their disorder. In some cases, however, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted.

Because of poor insight into their pathological experiences, patients with delusional disorder may rarely seek psychiatric help and often may present to internists, surgeons, dermatologists, policemen, and lawyers rather than psychiatrists.

The mean age of onset is 40 years and ranges from 18-90 years.

Men are more likely than woman to develop paranoid delusions; women are more likely than men to develop delusions of erotomania.


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One Response

  1. […] hallucinations. I’ve discussed the topic of illusions here. Part 1 is an overview of delusions. Part 2 covers the types of delusions. Today, I will discuss the medical conditions associated with development of […]

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