What is a shared psychotic disorder?

Shared psychotic disorder — sometimes referred to as folie à deux or shared delusional disorder — is a mental health condition that causes two people to share a specific delusion, or false belief. It tends to affect people in close relationships (like family members or romantic partners) but can sometimes affect larger groups. We aren’t sure how common the condition is among the general population. But it’s believed to affect approximately 2% to 3% of people who are admitted to psychiatric hospitals.

A note on terminology: For the purposes of accessibility, we’ll be using the term “shared psychotic disorder” throughout this article. However, shared psychotic disorder is no longer recognized as a distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). While a person can’t be diagnosed with this condition today, the experience of shared psychosis, while rare, is very real. Currently, it’s categorized under other specified schizophrenia spectrum and other psychotic disorders in the DSM.  

Can two people share the same delusion?

Delusions are objectively false beliefs. As a symptom of psychosis, they represent a break from reality that can lead to serious consequences. For example, a person could believe that they’re receiving messages through the radio, that the government is tracking them, or that they have special powers or abilities. When this happens, it could be a sign of a psychotic disorder like schizophrenia or another medical or mental health condition. 

In the case of shared psychotic disorder, two (or more) people share the same delusion. While shared delusions can show up in many ways, the experience tends to present in a few specific subtypes: 

• Folie imposée (imposed psychosis): The people sharing a delusion are in a close intimate relationship. Prior to the shared delusions, one person (sometimes called the “primary”) experiences psychosis, but the other (sometimes called the “secondary”) does not. Once they’re separated, the secondary no longer has delusions.
• Folie simultanée (simultaneous psychosis): Both people in this presentation experience psychosis at the same time. This is likely due to having similar risk factors, like genetics, as this presentation is often seen in siblings.
• Folie communiquée (communicated psychosis): In this presentation, shared delusions occur after a period of resistance from the secondary. Unlike with imposed psychosis, the secondary continues to experience delusions after being separated from the primary.
• Folie induite (induced psychosis): This presentation affects two people who have preexisting psychosis. It causes one person to experience new delusions due to the influence of the other person.

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What are shared psychosis symptoms like?

Research shows that the two most common delusions among people experiencing shared psychosis are:

• Persecutory delusions: Believing someone is out to harm them
• Delusions of grandeur: Believing they’re special or superior to others

Left untreated, these delusions can cause significant impairments and lead to fixed, false beliefs like:

• “Government agents have installed listening devices throughout our home.”
• “The 5G network is sending secret messages only we can detect.”
• “Our neighbors are spies, and they’re watching our every move.”
• “Only we can communicate with supernatural entities, like ghosts or angels.” (not related to religious or cultural beliefs)
• “We can take safety risks (like running in traffic) without being harmed because we have special powers.”

The health outcomes for shared psychotic disorder are difficult to predict, as they can vary due to co-occurring conditions and other factors. However, research suggests that consistently engaging with treatment can improve outcomes.

Potential causes and risk factors

We don’t yet know exactly what causes shared psychotic disorder. But it appears to me more common among people who:

• Have a close, long-standing relationship
• Are either siblings or in a romantic partnership
• Experience social isolation and communication difficulties
• Have a preexisting personality disorder or another untreated mental health condition
• Secondaries experience neurological challenges that affect their judgment and intelligence 
• Experience a stressful life event that affects their relationship
• Are assigned female at birth 

Treating shared psychotic disorder

People experiencing shared psychotic disorder deserve personalized treatment that reflects their unique needs. In the past, it was believed that separating the primary and secondary was critical for recovery. However, recent data suggests that this isn’t always necessary and, in some instances, can make symptoms worse. 

Whether you receive care together or individually, your shared psychotic disorder treatment plan may include:

• Therapy: Cognitive behavioral therapy (CBT) can help people identify and challenge false beliefs, learn new coping skills, and better understand how their thoughts affect their actions.
• Medication: Medications to address psychosis are frequently used to treat conditions like shared psychotic disorder. Other forms of medication can be helpful if co-occurring conditions (like depression or anxiety) are present.

Find care with Rula

Shared psychotic disorder is a rare mental health condition that causes two people (often siblings or romantic partners) to experience the same delusional beliefs. While this condition can take many forms, it often occurs when one person experiences psychosis and transfers their experience onto someone else. With the right support, people affected by this condition can increase their stability and live more balanced 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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