Delusional disorder: Recognizing the signs and finding support

Delusions are persisting false beliefs that aren’t grounded in reality. For example, a delusion could be believing that the government is tracking you or that you have a close relationship with a famous celebrity. Delusions are associated with several mental health conditions, including delusional disorder. 

People with delusional disorder experience false beliefs that persist for at least one month. But unlike other psychotic disorders, delusional disorder doesn’t involve hallucinations (seeing or hearing things that aren’t there) or other forms of psychosis. 

Delusional disorder is relatively rare and is believed to affect approximately .05% to 1% of the general population. However, researchers hypothesize that these low rates could be due to underreporting, as people with delusional disorders may be unlikely to seek support unless prompted by family or friends.

Different types of delusional disorder

Delusional disorder can involve symptoms that fall into predictable patterns. Experts have recognized a few different types of false beliefs that a person with delusional disorder may experience. 

Symptoms include:

• Eromantic type: Thinking someone is in love with you (like a celebrity or someone you have no connection with)
• Grandiose type: Thinking you have special or magical capabilities
• Jealous type: Thinking that your spouse or romantic partner has been unfaithful (without any concrete evidence)
• Persecutory: Thinking you’re being followed, surveilled, poisoned, or otherwise harmed either by people or institutions
• Somatic type: Thinking something is happening inside your body or that you’re seriously ill without any medical cause
• Mixed type: Having a combination of false beliefs that don’t focus on a central theme
• Unspecified type: Having false beliefs that don’t fall into any of the recognized categories 

In addition to these subtypes, providers may distinguish between bizarre and nonbizarre delusions. Bizarre delusions are objectively false beliefs for which there’s no real evidence — for example, believing you can control the weather. Nonbizarre delusions are things that could technically be true, even though they’re false — like believing that your spouse is having an affair or that your weight loss is due to parasites despite no evidence found on your medical tests.

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Delusional disorder symptoms

To be diagnosed with delusional disorder, a person must have:

• Persistent delusions: Experiencing delusions (false beliefs for which there’s no verifiable evidence) that persist for at least one month
• No hallucinations, unless directly related to a delusion: Unlike schizophrenia and related disorders, there’s no presence of hallucinations (seeing or hearing things that aren’t there) unless they’re directly related to a delusion. For example, if a person has a somatic delusion that they have a serious skin infection, they may hallucinate that their skin itches
• A lack of other psychotic features: For example, no odd or disorganized speech or behavior

If a person is experiencing persisting false beliefs, it could be due to several other concerns besides delusional disorder. So their provider may also assess them for following conditions to ensure they receive an accurate diagnosis:

• Schizophrenia
• Obsessive-compulsive disorder (OCD)
• Substance use disorder (SUD)
• Epilepsy
• Elder abuse in early dementia
• Alzheimer’s disease 
• Bipolar disorder (with psychosis)

What causes delusional disorder?

The exact cause of delusional disorder is unknown. But researchers have uncovered some risk factors for delusions that may contribute to the onset of the condition, including:

• Substance use
• A neurological condition
• An auditory or visual impairment
• Social isolation
• A hypersensitive personality that’s prone to suspiciousness, distrust, and envy
• Low self-esteem
• Being an immigrant with a language barrier
• Being an older adult

Treating delusional disorder

Delusional disorder is considered a lifelong condition that typically requires ongoing monitoring and care. However, with the right support, people with delusional disorder can improve their overall quality of life, including their ability to function in both social and work environments.  

It’s also worth noting that delusional disorder is frequently accompanied by other mental health concerns. Treating co-occurring conditions simultaneously can help promote the best outcomes. 

Treatment for delusional disorder typically includes a combination of therapy and medication. 

• Therapy: Cognitive behavioral therapy (CBT) is a first-choice treatment for delusional disorder. CBT can be modified to help identify and interrupt false beliefs with the support of a trusted therapist. Therapy can also help people with delusional disorder address worry, navigate interpersonal concerns, and manage uncomfortable emotions. 
• Medications: Several antipsychotic medications can be used to treat delusional disorder. Symptoms of co-occurring conditions like depression can also be improved with medication. However, there are various pros and cons for these medications. So talk to your provider if you’re curious about whether medication is right for you.

A note for loved ones: If someone you care about is living with delusional disorder, it’s important to be aware that people with this condition often experience a lack of insight. They may not see their beliefs as false or see a reason to ask for help. So they may need someone else, like a friend or loved one, to encourage them to seek treatment. In addition, in severe cases, the presence of delusions can elicit unsafe behaviors in some people. So hospitalization may be required before a person can effectively access other forms of care.

Find care with Rula

People with delusional disorder experience persistent false beliefs. For example, they may believe that someone is spying on them, that they have special powers, or that someone they don’t know is in love with them. But unlike other psychotic disorders, delusional disorder doesn’t cause hallucinations (unless directly related to the delusion) or other psychotic symptoms. 

While this condition can be difficult to identify, it can be managed with the right support. With therapy and medication, people with delusional disorder can learn to challenge false beliefs and reduce the impact of delusions in their daily lives. 

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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