Delusional Psychosis And Delusional Disorder
It can be challenging to understand how psychosis fits into diagnostic labels like delusional disorder or other psychotic disorders, like schizophrenia spectrum disorders. For this reason, it may be valuable to explore the topic of delusion in further detail, as well as how it relates to psychosis and specific diagnostic labels.
What is delusional disorder?
Formerly known as paranoid disorder, delusional disorder is characterized "by one or more firmly held false beliefs that persist" for a period of at least one month and cause significant functional difficulties. Delusional disorder is considered a psychotic disorder in diagnostic manuals.
People with delusional disorder may hold a strong belief based on their interpretation of external reality, disregarding evidence that refutes their interpretation. The belief must fall outside one's cultural or subcultural context to be considered a delusion.
A diagnosis of this mental health condition may be made by a mental health professional when someone exhibits "one or more non-bizarre delusional thoughts." Non-bizarre delusional thoughts are based on situations that are not real but also not impossible and must be present for one month or more, not explained by any other condition, such as a substance use disorder.
What is delusional psychosis?
Psychosis may be described as an umbrella term for a range of experiences affecting emotions, perception, and behavior. Delusional psychosis may refer to psychotic symptoms, such as paranoia, but without hallucinations and personality disorganization. Delusional thinking, however, may be related to other mental health conditions, such as bipolar disorder.
Psychosis is a cluster of symptoms and not a diagnostic label in itself. It can occur in multiple mental illnesses, including schizophrenia, schizophreniform disorder, schizoaffective disorder, bipolar I disorder, brief psychotic disorder, and other psychotic disorders.
Types of delusions
A person with delusional disorder may function in everyday life but encounter difficulties with maintaining relationships as a result of their perception of reality. Delusions can also be distressing for those who experience them. While delusional disorder does not usually involve hallucinations, delusions are considered psychotic symptoms. Delusional psychosis may refer to psychotic symptoms, such as paranoia, but without hallucinations and personality disorganization.
In some cases, people with delusional disorder may have their first encounter with a mental health worker, such as a nurse practitioner. Due to its complexity, referral to a specialist, such as a psychiatrist, can be valuable.
Common types of delusions include:
- Believing that one's partner is cheating (delusional jealousy)
- Believing one is more extraordinary than others (grandiosity)
- Believing that one has been singled out for persecution (persecutory)
- Believing that others can read one’s thoughts (thought broadcasting)
- Believing that thoughts have been inserted by something or someone else (thought insertion)
Psychotic disorders
According to the National Institute of Mental Health (NIMH), psychosis refers to a group of symptoms affecting the mind "where there has been some loss of contact with reality." An episode of psychosis results in a disruption of thoughts and perceptions, often making it challenging for the affected person to differentiate between what is and what is not real.
One of the primary features of psychosis consists of delusions and hallucinations. While delusional disorder does not usually involve hallucinations, its main feature may be delusions.
Psychotic symptoms
Anyone may experience psychosis during times of prolonged or acute stress. An episode does not always stem from a mental health disorder. When it does, symptoms of psychosis can accompany many mental health conditions, including schizophrenia, schizoaffective disorders, and bipolar disorder. It may also stem from depression. Symptoms of psychosis may include:
- Incoherent speech
- Difficulty concentrating
- Anxiety
- Agitation
- Appetite changes
- Social withdrawal
- Sleep difficulties
- Lack of motivation
- Emotional dysregulation
- Reduced regard for personal hygiene or self-care
- Unusually intense ideas
- Paranoia
- Brain fog
- “Nonsense” speech
- Inappropriate behavior concerning the situation
- Confusion
- Reduced relationship with reality
- Hallucinations
- Hearing voices
Are people with delusions aware of their condition?
There's a common misconception that those who experience altered perceptions of reality are unaware of their condition. While anosognosia (unawareness of one's condition) may be the case for some people, this symptom does not apply to many with psychosis. For example, estimates indicate that less than half of people with bipolar disorder lack awareness of their condition.
It can be possible to foster more awareness of one's mental state and build resiliency and resources for managing psychotic episodes. This process may involve the support of mental health professionals and one’s personal support system, such as family members and partners.
Psychosis in various mental disorders
Below are a few ways psychosis may impact different people in different situations. Delusions may occur in any psychotic episode, but each person is different.
Post-natal psychosis
A psychotic episode may affect anyone in situations of acute or prolonged stress. According to findings, it's estimated postnatal psychosis affects one to two women in 1000 in the first few weeks after giving birth. When affected, a person may experience a sudden onset of symptoms, including auditory, visual, and olfactory hallucinations, delusions, and drastic mood swings.
Those who have developed postnatal psychosis tend to have had a mental health condition in the past. Researchers also note a need for further investigation to assist in the prevention of psychosis and early detection efforts.
Depression with psychotic features
Some people with major depressive disorder (MDD) may also experience psychotic features. When very depressed, psychosis may manifest as delusions and hallucinations, which may be tied to the person's mood at the time. For instance, a person may hear voices that are critical or that tell them they are not worthy. Delusions may manifest as a false belief of having developed a medical condition, such as a rare disease. The risk of suicide may also be significantly higher when psychotic features are present with depression.
Treatment for psychotic features in connection with depression often involves antipsychotic medication, antidepressants, and psychotherapy. Electroconvulsive therapy may also be recommended in certain situations. Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.
Psychotic features and bipolar disorder
Episodes of depression, hypomania, and mania characterize bipolar disorder. Over 50% of all people with bipolar disorder may experience psychotic symptoms at some point in their lives. Psychosis manifests in connection with episodes of mania in bipolar I disorder, but this circumstance may vary. The mood (depression versus mania) can also affect the content of the delusions and hallucinations.
Delusions tend to be more common than hallucinations in bipolar disorder-related psychosis, which might negatively impact the course of the condition. However, psychotic features are associated with the severity of the mental illness and the rate and duration of hospitalizations. Common symptoms may manifest as "grandiose, persecutory, and referential delusions, auditory verbal hallucinations or hearing voices, and visual hallucinations." Due to the similarity of certain symptoms, bipolar disorder can sometimes be misdiagnosed as schizophrenia.
How to treat delusional disorder and psychosis
Methods to treat psychosis depend on its cause. There are many ways to address and treat psychosis, including antipsychotic medication, psychotherapy, self-help groups, rehabilitation programs, and other therapeutic approaches. Seeking and receiving treatment can be valuable, as it may reduce the risk of hospital admissions, alleviate symptoms, and improve one's quality of life and social functioning.
Support options
If you or someone you know are experiencing symptoms of psychosis, seek a mental health specialist for physical and psychiatric evaluation. Outside of a crisis, it might be helpful to talk to a therapist to have a safe space to express thoughts and manage symptoms that affect your well-being. A therapist can also help you develop a safety plan.
You might also try an online platform if you face barriers to attending in-person therapy. Online therapy through platforms like BetterHelp can be convenient for those who would rather speak to a therapist by phone, video, or in-app messaging. In addition, online platforms allow clients to message their therapist at any time, receiving a response as soon as the provider is available.
One study suggests that "online interventions are both feasible and acceptable to individuals with psychotic disorders and may be effective in assisting with clinical and social outcomes." The same study noted that online therapy is associated with the reduction of psychotic symptoms.
Takeaway
Psychosis may manifest as hallucinations, delusions, confused thinking, as well as behavioral signs such as social withdrawal and less attention to self-care. While delusional disorder does not involve hallucinations, delusions can cause significant distress. Anyone may experience psychosis during times of prolonged or acute stress. Psychosis can also accompany many mental health conditions, including schizophrenia, depression, and bipolar disorder.
There's a common misconception that those affected by psychosis are not aware of their symptoms, but this is not always the case. If you or someone you know are experiencing symptoms of psychosis, seek mental health or medical support immediately. Attending to a crisis early on can be vital in reducing symptom severity. You might also consider contacting a therapist online or in your area for long-term care and personalized advice.
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