What is a Delusion?

People described as “delusional” see or believe things that are not there. Remember the immortal line from the film The Sixth Sense: “I see dead people…”? If you were not a believer in ghosts, you would assume the boy was delusional. Of course it turned out he was not deluded in any way—there really were dead people all around him! So what is a delusion in the psychological sense and is it connected to an actual psychiatric condition?

The definition of a delusion is a false belief or impression that continues to be maintained despite reality contradicting it. People suffering from delusions are living in an alternate reality. They might think they are a celebrity, even though they work at the meat packing factory doing twelve hour shifts.

But delusions are much more than a bit of harmless daydreaming. Delusions can be a symptom of an underlying disorder. For example, they are a common symptom of schizophrenia, bipolar disorder, schizoaffective disorder, manic depression with psychosis, delusional disorder, and psychotic episodes caused by substance abuse. Delusions are also seen in the later stages of dementia.

What are the different types of delusions?

• Grandiose type delusions are when a person believes they are some kind of higher being or entity, or that they have special powers or knowledge. A person suffering from grandiose delusions might think they are famous or the son of God.

• Erotomanic type delusional people believe that other people are madly in love with them, even when the evidence is clearly to the contrary.

• Persecutory type delusions revolve around feeling persecuted or badly treated.

• Jealous type delusions are exactly what they sound like: the person becomes convinced that their loved one is cheating on them.

• Somatic type delusional people believe that they are suffering from a serious medical problem or disease.

• Mixed type delusions fall into more than one category.

What is delusional disorder?

Some delusions are bizarre, but what differentiates delusional disorder is that the patient suffers from delusions that are not all that different from the person’s real life. For example, the patient might be convinced they are having a relationship with someone they are close to, but they are in fact married to someone else, or they could become convinced that their partner is being unfaithful. Their story is always very plausible and to the outsider they are telling the truth, but upon closer examination, the holes soon begin to appear.

What is the treatment for delusional disorder?

The main treatment for delusional disorder is psychotherapy, but the therapist has to be very careful not to challenge the delusional beliefs of the patient as this will shatter their trust. Instead the goal of psychotherapy is to work on other problem areas of the patient’s life and try to help them improve their self confidence and sense of security. Over time the patient is encouraged to relinquish their delusional beliefs, but it can be a long and challenging process.

Can medications be helpful in treating the symptoms of delusional disorder?

Medications are not usually very effective in treating the symptoms of delusions, although anti-psychotic drugs can sometimes have limited success.