{"id":845,"date":"2020-08-10T22:45:52","date_gmt":"2020-08-10T22:45:52","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=845"},"modified":"2022-07-26T20:06:28","modified_gmt":"2022-07-26T20:06:28","slug":"delusional-disorder","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/delusional-disorder\/","title":{"raw":"Delusional Disorder","rendered":"Delusional Disorder"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Explain the symptoms of, diagnosis of<span style=\"color: #0000ff;\">,<\/span> etiology of, and treatment options for delusional disorder<\/li>\r\n<\/ul>\r\n<\/div>\r\nA <strong>delusion<\/strong> is a fixed false belief based on an inaccurate interpretation of an external reality despite evidence to the contrary. The belief is not congruent with one\u2019s culture or subculture, and almost everyone else agrees it is false. An individual with delusional disorder has a difficult time discerning, or distinguishing, between external reality and their own belief. Similar to schizophrenia, delusional disorder causes a major disconnect between an individual's internal world (thoughts, feelings, and perceptions) and an individual's external world (relationships, work, and hobbies). Unlike schizophrenia, individuals with delusional disorder do not suffer from disorganized thinking\u00a0or moderate to severe hallucinations that impact the ability to function and interact with others.\r\n\r\nOne interesting aspect of delusional disorders is that overall functioning is more or less preserved as compared to other psychotic disorders such as schizophrenia.\u00a0Individuals with delusional disorder often continue to function at home and at work and relate to others in a normal manner, and their functionality is not impacted and behavior is not obviously bizarre as long as interactions do not lead to discussions of topics related to the delusion. However, the preoccupation with their delusional ideas can disrupt their overall life.\u00a0Aside from discussing the specific delusion, it would not be easy to tell that an individual has a diagnosis of delusional disorder.\u00a0Impairment can be significant in one's occupation, however,\u00a0making it difficult for those with delusional disorder to hold a steady job if they are unable to focus on other issues than the delusional thought content. Additionally, there may be social isolation\u00a0which can lead to additional psychological symptoms such as depression.\r\n<h2>Diagnosis<\/h2>\r\nThe diagnosis of a <strong>delusional disorder<\/strong> occurs when a person has one or more delusional thoughts for one month or more, that has no explanation by another physiological, substance-induced, or medical condition or any other mental health condition. An individual's cultural and religious beliefs merit consideration before coming to the diagnosis. Cultural beliefs may also impact the content of delusions. In some cultures, a specific delusion can be perceived as possible, and therefore is not considered to be an impairment on a person's life, nor abnormal. A person also cannot have met Criterion A for schizophrenia at any point (two or more of hallucinations, delusions, disorganized speech, grossly disorganized behavior, or negative symptoms of schizophrenia).\r\n\r\nThere are two main classifications of delusions: <strong>bizarre<\/strong> and <strong>non-bizarre<\/strong>. Bizarre delusions include\u00a0delusions involving a phenomenon that is impossible, not understandable, and unrelated to normal life.\u00a0An example of a bizarre delusion would be an individual believing their organs have been removed and replaced overnight while they were asleep. A bizarre delusion such as this is not only impossible, but can be demonstrated as false by\u00a0exhibiting no signs of invasion or physical marks. Even after their delusions are proven to be untrue, or impossible, individuals experiencing delusions will continue their belief with certainty and conviction.\u00a0Non-bizarre delusions involve situations that are possible, such as being manipulated or harmed, that remain fixed false beliefs even without evidence.\r\n<h2>Types of Delusions<\/h2>\r\nSome of the most frequently encountered types of delusions are\r\n<ul>\r\n \t<li><strong>delusional jealousy.<\/strong>\u00a0This delusion can be displayed by the belief that one\u2019s romantic, or sexual partner, is unfaithful, accompanied by abnormal or socially unacceptable behavior that is related to these thoughts.\u00a0Also known as <em>Othello syndrome<\/em>, this type is more common in males; it can sometimes correlate with suicidal or homicidal ideations, and hence safety is an important consideration in evaluation and management. It is important to note that if an individual has been in prior relationships where their significant other had been unfaithful, this belief would not merit a delusional disorder as there is a real reason for that concern, fear, and initial mistrust. In such a situation, initial skepticism or mistrust of a partner might be considered normal.<\/li>\r\n \t<li><strong>erotomanic.<\/strong>\u00a0A delusion that another person, more frequently someone of higher status, is in love with the individual.\u00a0Also known as <em>psychose passionelle<\/em>. These patients are usually socially withdrawn, dependent, sexually inhibited with a poor level of social and\/or occupational functioning. Paradoxical conduct is an important characteristic wherein all denials of affection are rationalized as affirmations. Males with this type of delusion tend to be more aggressive than their female counterparts.<\/li>\r\n \t<li><strong>grandiose.<\/strong>\u00a0A conviction that one has great talent; made a great discovery; or has power, knowledge or a relationship with someone famous or a deity. This is also known as megalomania, which is the delusion of increased self-importance. Grandiose delusions often have religious content.<\/li>\r\n \t<li><strong>persecutory.<\/strong>\u00a0The central theme is being conspired against, threatened, attacked, harassed, or obstructed in pursuit of long-term goals.\u00a0This is one of the most common types of delusions and patients can be anxious, irritable, aggressive, or even assaultive at times, often believing they need to protect themselves.\r\n\r\n[caption id=\"attachment_5076\" align=\"alignright\" width=\"182\"]<img class=\"wp-image-5076\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/11024616\/mirror-1547919_1920-212x300.jpg\" alt=\"An illustration of a person looking at their reflection in the mirror. Their body in their reflection appears to be different from their actual body. \" width=\"182\" height=\"258\" \/> <strong>Figure 1.<\/strong>\u00a0A body dysmorphic delusion may lead someone to believe that body parts are distorted, but more common types of somatic delusions have someone concerned about the way they smell.[\/caption]<\/li>\r\n \t<li><strong>somatic.<\/strong>\u00a0These delusions involve imaginary bodily functions and sensations.\u00a0Also called monosymptomatic hypochondriacal psychosis, somatic delusions can severely impair reality. The patient is unarguably convinced of the severity of symptoms, even after seeing a medical professional or doctor who lets them know they are healthy and their concern is not a reality. The most common type of somatic delusions is that the person emits a foul odor or severe bad breath. Others include beliefs of infestation, for example with parasites, or body dysmorphic delusion (that parts of the body are distorted or misshapen). These patients also tend to have high levels of anxiety and nervousness.<\/li>\r\n \t<li><strong>thought broadcasting.<\/strong>\u00a0This is the delusion that one's thoughts are projected and can be perceived by others.<\/li>\r\n \t<li><b>thought insertion.\u00a0<\/b>A delusion that an external source or entity has inserted thoughts into one's mind and one's thoughts are not their own.<\/li>\r\n \t<li><strong>mixed.<\/strong>\u00a0No single theme is prevalent, but rather a mix of two or more delusions.<\/li>\r\n<\/ul>\r\n<h3>Differential Diagnosis<\/h3>\r\nDifferential diagnosis involves ruling out other causes of delusions such as drug-induced conditions,\u00a0dementia, head injury or cancer, infections,\u00a0metabolic disorders, and\u00a0endocrine disorders.\u00a0Other psychiatric disorders must then be ruled out. In delusional disorder, mood symptoms tend to be brief or absent, and unlike\u00a0schizophrenia, delusions are usually non-bizarre, and hallucinations are minimal or absent.\u00a0Interviews are important tools to obtain information about the patient's life situation and past history to help make a diagnosis. Clinicians generally review earlier\u00a0medical records\u00a0to gather a full history. Clinicians also try to interview the patient's immediate\u00a0family, as interviews can be helpful in determining the presence of delusions. The\u00a0mental status examination (MSE) is used to assess the patient's current mental condition.\u00a0A psychological questionnaire sometimes used in the diagnosis of the delusional disorder is the Peters Delusion Inventory (PDI), which focuses on identifying and understanding delusional thinking. However, this questionnaire is more likely to be used in research than in clinical practice.\r\n<h2>Etiology<\/h2>\r\n[caption id=\"attachment_5079\" align=\"alignright\" width=\"300\"]<img class=\"wp-image-5079 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/11025452\/Knipsel-300x212.png\" alt=\"The basal ganglia is located near the center of the brain and consists of the nucleus accumbens, caudate head, caudate body, caudate tail, thalamus, putamen, and globus pallidus. \" width=\"300\" height=\"212\" \/> <strong>Figure 2.<\/strong> The basal ganglia is located deep within the brain under the cerebral cortex.[\/caption]\r\n\r\nDelusions can be caused in several ways, including from both substance use and medical conditions including traumatic brain injury and other forms of damage to brain tissue including strokes and dementia. Neurological conditions involving the limbic system and basal ganglia in those with intact cortical functioning can also cause delusions (Joseph &amp; Siddiqui, 2020). The main functions of the limbic system involve processing emotion, memory, motivation, and learning. The basal ganglia is a structure that plays a role in emotional and cognitive functioning, but is mainly responsible for motor control and movement.\r\n\r\nHypersensitive persons and ego defense mechanisms like reaction formation, projection, and denial are some psychodynamic theories for delusional disorder. Social isolation, envy, distrust, suspicion, and low self-esteem are some of the factors, which when becoming intolerable, lead to a person seeking an explanation and thus form a delusion as a solution.\u00a0Immigrants with language barriers, deaf and visually impaired persons, as well as the elderly, are special populations who are more vulnerable to delusions due to a greater sense of vulnerability.\r\n<h2>Epidemiology<\/h2>\r\nThe lifetime risk of delusional disorder in the general population has been estimated to range from 0.05%-0.1%, based on data from various sources, including case registries, case series, and population-based samples.\u00a0According to the DSM-5, the lifetime prevalence of delusional disorder is about 0.02%. The prevalence of delusional disorder is much rarer than other conditions like schizophrenia, bipolar disorder, and other mood disorders, possibly due to under-reporting, as those with delusional disorder may not seek mental health attention unless forced by family or friends. The mean age of onset is about 40 years, but the range is from 18 years to 90 years. The persecutory and jealous types of delusion are more common in males, while the erotomanic variety is more common in females\u00a0<span style=\"font-size: 1rem; text-align: initial;\">(Joseph &amp; Siddiqui, 2020)<\/span>.\r\n<h2>Treatment<\/h2>\r\nThe treatment of delusional disorder is difficult considering the lack of insight. A good doctor-patient relationship is a key to treatment success. Treatment includes psychotherapy by establishing trust and building a therapeutic alliance.\r\n\r\nA patient's history of medication compliance is the best guide to select appropriate antipsychotic medication. An antipsychotic should be started for a trial period of six weeks after which there is an evaluation of the effectiveness of the medication. Start a low dose and gradually increase the dosage as needed. Another drug from another class can be tried after six weeks if no benefit is noted from the initial treatment.\r\n\r\nSome delusional disorders may respond well to antipsychotic medications; often the best approach is a combined treatment that includes antipsychotics and psychotherapy.\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways:\u00a0Delusional Disorder<\/h3>\r\n<iframe title=\"46. Delusional Disorder\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291235755585985728\/embed\" width=\"1088\" height=\"463\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script>\r\n\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nThis video explains delusional disorder and types of delusions.\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=YbSEybahiVA\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/DelusionalDisorderMentalHealthNCLEXRN_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"Delusional disorder | Mental health | NCLEX-RN | Khan Academy\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/61c25245-e093-4af0-ad66-19049eb67792\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>bizarre delusions: <\/strong>delusions that\u00a0involve phenomenon that are impossible, not understandable, and unrelated to normal life\r\n\r\n<strong>delusion:<\/strong>\u00a0a fixed false belief based on an inaccurate interpretation of an external reality despite evidence to the contrary\r\n\r\n<strong>delusional jealousy:<\/strong>\u00a0the belief that one\u2019s romantic, or sexual partner, is unfaithful, accompanied by abnormal or socially unacceptable behavior that's related to these thoughts\r\n\r\n<strong>erotomanic delusions: <\/strong>a delusion that another person, more frequently someone of higher status, is in love with the individual\r\n\r\n<strong>grandiose delusions: <\/strong>a\u00a0conviction of great talent, discovery, inflated self-worth, power, knowledge or relationship with someone famous or deity\r\n\r\n<strong>non-bizarre delusions:<\/strong> involve situations that are possible, such as being manipulated or harmed, but remain fixed false beliefs even after proven false.\r\n\r\n<strong>persecutory delusions:<\/strong>\u00a0central theme is being conspired against, attacked, harassed, obstructed in pursuit of long-term goals\r\n\r\n<strong>somatic delusions:<\/strong>\u00a0delusions involving imaginary bodily functions and sensations\r\n\r\n<strong>thought broadcasting:\u00a0<\/strong>the delusion that one's thoughts are projected and perceived by others\r\n\r\n<b>thought insertion: <\/b>a\u00a0delusion that an external source or entity has inserted thoughts into one's mind and one's thoughts are not their own\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Explain the symptoms of, diagnosis of<span style=\"color: #0000ff;\">,<\/span> etiology of, and treatment options for delusional disorder<\/li>\n<\/ul>\n<\/div>\n<p>A <strong>delusion<\/strong> is a fixed false belief based on an inaccurate interpretation of an external reality despite evidence to the contrary. The belief is not congruent with one\u2019s culture or subculture, and almost everyone else agrees it is false. An individual with delusional disorder has a difficult time discerning, or distinguishing, between external reality and their own belief. Similar to schizophrenia, delusional disorder causes a major disconnect between an individual&#8217;s internal world (thoughts, feelings, and perceptions) and an individual&#8217;s external world (relationships, work, and hobbies). Unlike schizophrenia, individuals with delusional disorder do not suffer from disorganized thinking\u00a0or moderate to severe hallucinations that impact the ability to function and interact with others.<\/p>\n<p>One interesting aspect of delusional disorders is that overall functioning is more or less preserved as compared to other psychotic disorders such as schizophrenia.\u00a0Individuals with delusional disorder often continue to function at home and at work and relate to others in a normal manner, and their functionality is not impacted and behavior is not obviously bizarre as long as interactions do not lead to discussions of topics related to the delusion. However, the preoccupation with their delusional ideas can disrupt their overall life.\u00a0Aside from discussing the specific delusion, it would not be easy to tell that an individual has a diagnosis of delusional disorder.\u00a0Impairment can be significant in one&#8217;s occupation, however,\u00a0making it difficult for those with delusional disorder to hold a steady job if they are unable to focus on other issues than the delusional thought content. Additionally, there may be social isolation\u00a0which can lead to additional psychological symptoms such as depression.<\/p>\n<h2>Diagnosis<\/h2>\n<p>The diagnosis of a <strong>delusional disorder<\/strong> occurs when a person has one or more delusional thoughts for one month or more, that has no explanation by another physiological, substance-induced, or medical condition or any other mental health condition. An individual&#8217;s cultural and religious beliefs merit consideration before coming to the diagnosis. Cultural beliefs may also impact the content of delusions. In some cultures, a specific delusion can be perceived as possible, and therefore is not considered to be an impairment on a person&#8217;s life, nor abnormal. A person also cannot have met Criterion A for schizophrenia at any point (two or more of hallucinations, delusions, disorganized speech, grossly disorganized behavior, or negative symptoms of schizophrenia).<\/p>\n<p>There are two main classifications of delusions: <strong>bizarre<\/strong> and <strong>non-bizarre<\/strong>. Bizarre delusions include\u00a0delusions involving a phenomenon that is impossible, not understandable, and unrelated to normal life.\u00a0An example of a bizarre delusion would be an individual believing their organs have been removed and replaced overnight while they were asleep. A bizarre delusion such as this is not only impossible, but can be demonstrated as false by\u00a0exhibiting no signs of invasion or physical marks. Even after their delusions are proven to be untrue, or impossible, individuals experiencing delusions will continue their belief with certainty and conviction.\u00a0Non-bizarre delusions involve situations that are possible, such as being manipulated or harmed, that remain fixed false beliefs even without evidence.<\/p>\n<h2>Types of Delusions<\/h2>\n<p>Some of the most frequently encountered types of delusions are<\/p>\n<ul>\n<li><strong>delusional jealousy.<\/strong>\u00a0This delusion can be displayed by the belief that one\u2019s romantic, or sexual partner, is unfaithful, accompanied by abnormal or socially unacceptable behavior that is related to these thoughts.\u00a0Also known as <em>Othello syndrome<\/em>, this type is more common in males; it can sometimes correlate with suicidal or homicidal ideations, and hence safety is an important consideration in evaluation and management. It is important to note that if an individual has been in prior relationships where their significant other had been unfaithful, this belief would not merit a delusional disorder as there is a real reason for that concern, fear, and initial mistrust. In such a situation, initial skepticism or mistrust of a partner might be considered normal.<\/li>\n<li><strong>erotomanic.<\/strong>\u00a0A delusion that another person, more frequently someone of higher status, is in love with the individual.\u00a0Also known as <em>psychose passionelle<\/em>. These patients are usually socially withdrawn, dependent, sexually inhibited with a poor level of social and\/or occupational functioning. Paradoxical conduct is an important characteristic wherein all denials of affection are rationalized as affirmations. Males with this type of delusion tend to be more aggressive than their female counterparts.<\/li>\n<li><strong>grandiose.<\/strong>\u00a0A conviction that one has great talent; made a great discovery; or has power, knowledge or a relationship with someone famous or a deity. This is also known as megalomania, which is the delusion of increased self-importance. Grandiose delusions often have religious content.<\/li>\n<li><strong>persecutory.<\/strong>\u00a0The central theme is being conspired against, threatened, attacked, harassed, or obstructed in pursuit of long-term goals.\u00a0This is one of the most common types of delusions and patients can be anxious, irritable, aggressive, or even assaultive at times, often believing they need to protect themselves.\n<div id=\"attachment_5076\" style=\"width: 192px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5076\" class=\"wp-image-5076\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/11024616\/mirror-1547919_1920-212x300.jpg\" alt=\"An illustration of a person looking at their reflection in the mirror. Their body in their reflection appears to be different from their actual body.\" width=\"182\" height=\"258\" \/><\/p>\n<p id=\"caption-attachment-5076\" class=\"wp-caption-text\"><strong>Figure 1.<\/strong>\u00a0A body dysmorphic delusion may lead someone to believe that body parts are distorted, but more common types of somatic delusions have someone concerned about the way they smell.<\/p>\n<\/div>\n<\/li>\n<li><strong>somatic.<\/strong>\u00a0These delusions involve imaginary bodily functions and sensations.\u00a0Also called monosymptomatic hypochondriacal psychosis, somatic delusions can severely impair reality. The patient is unarguably convinced of the severity of symptoms, even after seeing a medical professional or doctor who lets them know they are healthy and their concern is not a reality. The most common type of somatic delusions is that the person emits a foul odor or severe bad breath. Others include beliefs of infestation, for example with parasites, or body dysmorphic delusion (that parts of the body are distorted or misshapen). These patients also tend to have high levels of anxiety and nervousness.<\/li>\n<li><strong>thought broadcasting.<\/strong>\u00a0This is the delusion that one&#8217;s thoughts are projected and can be perceived by others.<\/li>\n<li><b>thought insertion.\u00a0<\/b>A delusion that an external source or entity has inserted thoughts into one&#8217;s mind and one&#8217;s thoughts are not their own.<\/li>\n<li><strong>mixed.<\/strong>\u00a0No single theme is prevalent, but rather a mix of two or more delusions.<\/li>\n<\/ul>\n<h3>Differential Diagnosis<\/h3>\n<p>Differential diagnosis involves ruling out other causes of delusions such as drug-induced conditions,\u00a0dementia, head injury or cancer, infections,\u00a0metabolic disorders, and\u00a0endocrine disorders.\u00a0Other psychiatric disorders must then be ruled out. In delusional disorder, mood symptoms tend to be brief or absent, and unlike\u00a0schizophrenia, delusions are usually non-bizarre, and hallucinations are minimal or absent.\u00a0Interviews are important tools to obtain information about the patient&#8217;s life situation and past history to help make a diagnosis. Clinicians generally review earlier\u00a0medical records\u00a0to gather a full history. Clinicians also try to interview the patient&#8217;s immediate\u00a0family, as interviews can be helpful in determining the presence of delusions. The\u00a0mental status examination (MSE) is used to assess the patient&#8217;s current mental condition.\u00a0A psychological questionnaire sometimes used in the diagnosis of the delusional disorder is the Peters Delusion Inventory (PDI), which focuses on identifying and understanding delusional thinking. However, this questionnaire is more likely to be used in research than in clinical practice.<\/p>\n<h2>Etiology<\/h2>\n<div id=\"attachment_5079\" style=\"width: 310px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5079\" class=\"wp-image-5079 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/11025452\/Knipsel-300x212.png\" alt=\"The basal ganglia is located near the center of the brain and consists of the nucleus accumbens, caudate head, caudate body, caudate tail, thalamus, putamen, and globus pallidus.\" width=\"300\" height=\"212\" \/><\/p>\n<p id=\"caption-attachment-5079\" class=\"wp-caption-text\"><strong>Figure 2.<\/strong> The basal ganglia is located deep within the brain under the cerebral cortex.<\/p>\n<\/div>\n<p>Delusions can be caused in several ways, including from both substance use and medical conditions including traumatic brain injury and other forms of damage to brain tissue including strokes and dementia. Neurological conditions involving the limbic system and basal ganglia in those with intact cortical functioning can also cause delusions (Joseph &amp; Siddiqui, 2020). The main functions of the limbic system involve processing emotion, memory, motivation, and learning. The basal ganglia is a structure that plays a role in emotional and cognitive functioning, but is mainly responsible for motor control and movement.<\/p>\n<p>Hypersensitive persons and ego defense mechanisms like reaction formation, projection, and denial are some psychodynamic theories for delusional disorder. Social isolation, envy, distrust, suspicion, and low self-esteem are some of the factors, which when becoming intolerable, lead to a person seeking an explanation and thus form a delusion as a solution.\u00a0Immigrants with language barriers, deaf and visually impaired persons, as well as the elderly, are special populations who are more vulnerable to delusions due to a greater sense of vulnerability.<\/p>\n<h2>Epidemiology<\/h2>\n<p>The lifetime risk of delusional disorder in the general population has been estimated to range from 0.05%-0.1%, based on data from various sources, including case registries, case series, and population-based samples.\u00a0According to the DSM-5, the lifetime prevalence of delusional disorder is about 0.02%. The prevalence of delusional disorder is much rarer than other conditions like schizophrenia, bipolar disorder, and other mood disorders, possibly due to under-reporting, as those with delusional disorder may not seek mental health attention unless forced by family or friends. The mean age of onset is about 40 years, but the range is from 18 years to 90 years. The persecutory and jealous types of delusion are more common in males, while the erotomanic variety is more common in females\u00a0<span style=\"font-size: 1rem; text-align: initial;\">(Joseph &amp; Siddiqui, 2020)<\/span>.<\/p>\n<h2>Treatment<\/h2>\n<p>The treatment of delusional disorder is difficult considering the lack of insight. A good doctor-patient relationship is a key to treatment success. Treatment includes psychotherapy by establishing trust and building a therapeutic alliance.<\/p>\n<p>A patient&#8217;s history of medication compliance is the best guide to select appropriate antipsychotic medication. An antipsychotic should be started for a trial period of six weeks after which there is an evaluation of the effectiveness of the medication. Start a low dose and gradually increase the dosage as needed. Another drug from another class can be tried after six weeks if no benefit is noted from the initial treatment.<\/p>\n<p>Some delusional disorders may respond well to antipsychotic medications; often the best approach is a combined treatment that includes antipsychotics and psychotherapy.<\/p>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways:\u00a0Delusional Disorder<\/h3>\n<p><iframe loading=\"lazy\" title=\"46. Delusional Disorder\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291235755585985728\/embed\" width=\"1088\" height=\"463\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script><\/p>\n<\/div>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>This video explains delusional disorder and types of delusions.<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Delusional disorder | Mental health | NCLEX-RN | Khan Academy\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/YbSEybahiVA?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/DelusionalDisorderMentalHealthNCLEXRN_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;Delusional disorder | Mental health | NCLEX-RN | Khan Academy&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_61c25245-e093-4af0-ad66-19049eb67792\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/61c25245-e093-4af0-ad66-19049eb67792?iframe_resize_id=assessment_practice_id_61c25245-e093-4af0-ad66-19049eb67792\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>bizarre delusions: <\/strong>delusions that\u00a0involve phenomenon that are impossible, not understandable, and unrelated to normal life<\/p>\n<p><strong>delusion:<\/strong>\u00a0a fixed false belief based on an inaccurate interpretation of an external reality despite evidence to the contrary<\/p>\n<p><strong>delusional jealousy:<\/strong>\u00a0the belief that one\u2019s romantic, or sexual partner, is unfaithful, accompanied by abnormal or socially unacceptable behavior that&#8217;s related to these thoughts<\/p>\n<p><strong>erotomanic delusions: <\/strong>a delusion that another person, more frequently someone of higher status, is in love with the individual<\/p>\n<p><strong>grandiose delusions: <\/strong>a\u00a0conviction of great talent, discovery, inflated self-worth, power, knowledge or relationship with someone famous or deity<\/p>\n<p><strong>non-bizarre delusions:<\/strong> involve situations that are possible, such as being manipulated or harmed, but remain fixed false beliefs even after proven false.<\/p>\n<p><strong>persecutory delusions:<\/strong>\u00a0central theme is being conspired against, attacked, harassed, obstructed in pursuit of long-term goals<\/p>\n<p><strong>somatic delusions:<\/strong>\u00a0delusions involving imaginary bodily functions and sensations<\/p>\n<p><strong>thought broadcasting:\u00a0<\/strong>the delusion that one&#8217;s thoughts are projected and perceived by others<\/p>\n<p><b>thought insertion: <\/b>a\u00a0delusion that an external source or entity has inserted thoughts into one&#8217;s mind and one&#8217;s thoughts are not their own<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-845\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Wallis Back for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Delusional Disorder . <strong>Authored by<\/strong>: Shawn M. Joseph; Waquar Siddiqui.. <strong>Provided by<\/strong>: StatPearls. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK539855\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK539855\/<\/a>. <strong>Project<\/strong>: NIMH. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Delusional disorder. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Delusional_disorder\">https:\/\/en.wikipedia.org\/wiki\/Delusional_disorder<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Body dysmorphia illustration. <strong>Authored by<\/strong>: Stephanie Ghesquier. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/pixabay.com\/illustrations\/mirror-ice-image-depression-1547919\/\">https:\/\/pixabay.com\/illustrations\/mirror-ice-image-depression-1547919\/<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Pixabay License<\/li><li>Basal ganglia diagram. <strong>Authored by<\/strong>: Lim S-J, Fiez JA and Holt LL. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.braininjury-explanation.com\/consequences\/impact-by-brain-area\/basal-ganglia\">https:\/\/www.braininjury-explanation.com\/consequences\/impact-by-brain-area\/basal-ganglia<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>Delusional disorder. <strong>Provided by<\/strong>: Khan Academy. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=YbSEybahiVA&#038;feature=emb_logo\">https:\/\/www.youtube.com\/watch?v=YbSEybahiVA&#038;feature=emb_logo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>Delusional disorder. <strong>Provided by<\/strong>: Khan Academy. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?time_continue=208&#038;v=YbSEybahiVA&#038;feature=emb_logo\">https:\/\/www.youtube.com\/watch?time_continue=208&#038;v=YbSEybahiVA&#038;feature=emb_logo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section>","protected":false},"author":29,"menu_order":4,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Delusional Disorder \",\"author\":\"Shawn M. 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