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Delusional disorder refers to a condition associated with one or more nonbizarre delusions of
thinkingsuch as expressing beliefs that occur in real life such as being poisoned, being stalked,
being loved or deceived, or having an illness, provided no other symptoms of schizophrenia are
exhibited.
Delusions may seem believable at face value, and patients may appear
normal as long as an outsider does not touch upon their delusional
themes. Mood episodes are relatively brief compared with the total
duration of the delusional periods. Also, these delusions are not due to a
medical condition or substance abuse.
Themes of delusions may fall into the following types: erotomanic type
(patient believes that a person, usually of higher social standing, is in
love with the individual); grandiose type (patient believes that he has
some great but unrecognized talent or insight, a special identity,
knowledge, power, self-worth, or special relationship with someone
famous or with God); jealous type (patient believes his partner has been
unfaithful); persecutory type (patient believes he is being cheated, spied
on, drugged, followed, slandered, or somehow mistreated); somatic type
(patient believes he is experiencing physical sensations or bodily
dysfunctionssuch as foul odors or insects crawling on or under the
skinor is suffering from a general medical condition or defect); mixed
type (characteristics of more than one of the above types, but no one
theme dominates); or unspecified type (patient's delusions do not fall in described categories).
Some peculiarities of the delusional state (The patients described below have been disguised.)
In a way, everything about the delusional state is peculiar. An affected person (usually a
paranoid schizophrenic) comes to believe that an outlandish series of events, incredible to
everyone else, are taking place in which he/she is the center of attention, usually a malignant
attention.
A typical, although severe, delusion:
A 24 year old man, Andrew, with no history of mental illness became over a period of a few
weeks increasingly agitated for no obvious reason. In particular, he experienced more and more
difficulty sleeping, sometimes, by his account, not sleeping at all. He then began to notice
funny things going on. Large black cars were driving slowly by his apartment building.
Andrew reported this seemingly strange fact to members of his family. He started to think that he
was being filmed, perhaps for a television reality show. It came to him suddenly that he might be
the son of a famous person. This thought was pleasantly exciting; but, as the days went by, he
began to feel threatened by the attention being paid to him by strangers who looked up and
smirked as he walked by, or who stopped talking when he came into the room, or who ran away
from him up a flight of stairs.
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He thought he heard whispering from the adjacent carrel in his college library. The whispers
seemed to be alluding to his being homosexual, which he was not. These invisible speakers were
also laughing. He thought they might be part of a conspiracy to test him in some obscure way.
The conspiracy, he thought, might be run by the Mafia or the C.I.A.
One time, he saw a group of policemen across the street. When he accosted them and accused
them of spying on him, he was taken into custody and brought finally to a psychiatric ward in a
municipal hospital.
Although placed quickly on high doses of a neuroleptic, Andrews condition worsened. At night
he could hear his parents screaming. He told the staff that his parents were on the floor above,
and they were being tortured. The following morning, his parents came to the ward and told
Andrew emphatically that they were fine. They had not been tortured. But that night, and
subsequent nights, he continued to hear them screaming and continued to believe that they were
being tortured, even though each following day they came to visit him and were manifestly well.
Andrew seemed to improve on increasing doses of the major tranquilizer he was taking; but he
was not well enough to leave. He was transferred to a state hospital, where I came to know him.
One day, not long after admission, he called me over to the window. See those cars, he said. He
was pointing out cars on a highway which was three blocks away. We were on the sixth floor.
They are spying on me.
I pointed out that the cars were so far away, I could barely see them before they disappeared
from view. I explained that no one would set out to spy on him that way. It was impossible. But
he nodded knowingly to himself.
Three weeks later, he was well enough to be discharged. He was still somewhat paranoid; but he
was less certain of those thoughts.
I was watching a movie last night, he told me. I knew the actors were talking to me, but I
couldnt figure out how that could be since the movie was made ten years before I was born.
In time, Andrew recovered completely, although he relapsed briefly a number of years later.
Certain particular aspects of Andrews psychosis are worth underlining. They are common in the
delusions of other paranoid individuals:
Extraordinary elements of the delusional state:
1. Andrew developed an inability to distinguish what was significant in his environment.
The focus of his attention was disturbed by the ordinary background noises of his daily
life. This reflects the distinction made in gestalt psychology between the figure and the
ground. Ordinarily, we attend to what we are doing and thinking. This is the figure in
the foreground. Everything else is a blur. For example, someone should be able to
concentrate on the substance of a conversation without being distracted by other people
walking by, or by noises coming from the next room. Under stress, this ability to focus on
what is important is remarkable. Soldiers in combat, and athletes playing in a big game,
have been known to suffer a broken limb without being aware of it until the stress of the
game, or the fight, was over. Even a broken leg is subsumed under the heading of
background noise. But in the paranoid state, the background begins to bleed into the
center of focus. Andrew began to notice common thingsblack cars driving by in the
street; and they and other such things were deemed to have significance.
2. The significance experience. Andrew not only noticed the black cars driving by in the
street, he spoke of them to his family as if they too would attach significance to them. He
had lost his ability to discern accurately how other people interpret events. This behavior
telling of an ordinary event as if it is so redolent of meaning that the person listening is
expected to see it too, is called the significance experience. It is thought by some to be
specific to paranoid schizophrenia.
3. As his attention was drawn to all those innumerable events that occur in the background
of life, Andrew began to search for their meaning. There had to be a reason why the black
cars were going by one after the other. And this reason must have to do with him. As he
could no longer tell what was meaningful in the world, he could no longer separate
himself from everything that happened in the world. He was the center of things. He was
important. At first, as sometimes happens, that attention was exhilarating. He was the son
of a famous person. He was the star of a reality show. These are called grandiose
delusions.
4. But as almost always happens, the world around him became threatening. People were
communicating to him in subtle ways, whispering ugly thoughts. The particular ugly
thoughts are reflective of the affected persons real thoughts. If someone hears himself
accused of being homosexual, it is because he regards homosexuality as shameful. In this
respect there is a similarity to dreaming. The fact that someone dreams a lot at a
particular time may have to do with, perhaps, his taking certain drugs; but the details of
the dream are still a reflection of his real thoughts and feelings.
Other paranoid individuals may have the idea that other people are communicating to them
telepathicallyor even controlling them telepathically.
The boundaries of the individual begin to melt into the world at large.
1. As Andrew conceived the idea that he was at the center of a malignant conspiracy, he
imagined powerful forces arrayed against him. This is an example of a persecutory
delusion. Most delusions have this character. Since there are not very many agencies or
organizations that operate in the world powerfully and mysteriously, and out of sight, the
villains of these delusions tend usually to be either the Mafia, the C.I.A., the government
at large, or a religious villain, such as the devil.
An elderly woman who had worked all her life as a clerk, and who thought herself
the most inconspicuous person in the world, thought that her employer, AT & T, had conspired
together with blacks and the mob to make her automobile engine knock. She drove home every
night by a circuitous route so that she could not be followed. She had an inordinate respect for
me, but when I suggested that she was not, certainly by her own account, important enough to
matter to these powerful agencies, and thatit was not reasonable to think they would bother to
persecute her, she listened respectfully, but did not believe me.
It is not known why paranoid thinking takes exactly these shapes. They are, of course, the
reflection of a diseased state of mind; but they illustrate by contrast how people ordinarily come
to believe those things that they do.(c) Fredric Neuman 2013 Follow Dr. Neuman's blog at
fredricneumanmd.com/blog
A patient lies in a hospital bed in the neurological ward, his head wrapped in bandages. Hes just
suffered a major trauma to the brain. The injury has wiped out the region that controls motion in
his left arm. More than that, its destroyed the mans ability to even conceive of what moving his
arm would be like.
Hes paralyzed, in other words, but he doesnt know that. He cant know.
Would you be so kind as to raise your left hand? his doctor asks.
Certainly, the patient. But the hand remains where it is. Its gotten tangled up in the sheets,
the man explains.
The doctor points out that his arm is lying free and unencumbered on top of the sheets.
Well, yes, the man says. But I just dont feel like lifting it right now.
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The inability to recognize ones own disability is a disorder called anosognosia, and it offers an
unusually clear window into that peculiarly infuriating and astonishing aspect of human
psychology: our seemingly boundless capacity for delusion. Faced with stark and unambiguous
information that a part of their body is paralyzed, anosognosia sufferers can effortlessly produce
a stream of arguments as to why this is simply not the case. Theyre not lying; they themselves
actually believe in the validity of their claims.
The disorder sounds bizarre, but we all do something similar on a daily basis. Though wed like
to think that we mold our beliefs to fit with the reality that surrounds, but theres a natural human
impulse to do the reverse: to mold our reality so that it fits with our beliefs,no matter how flimsy
their justification may be.
Psychologists define delusion as a manifestly absurd belief held in the face of overwhelming
evidence to the contrary, specifically as a symptom of a disorder like schizophrenia or bipolar
disorder. But were all delusional to some degree. In fact, a certain amount of delusion may be
essential for our mental health.
As we go about our lives, we form all sorts of beliefs and opinions about the world, which
psychologists divide into two types. The first kind, instrumental beliefs, are ideas that can
directly help us accomplish our goals. I believe that a chain saw can cut down a tree; I believe
that the price of a first-class postage stamp is 44 cents. These kinds of beliefs tend to be directly
testable: if I rely on them and they fail, Ill have to revise my understanding.
The other kind of belief, the philosophical kind, are not so easily tested. These are ideas that
we hold these beliefs not because they are demonstrably true, but because of the emotional
benefits of holding them. When I say that I live in the greatest country on earth, or that true love
lasts forever, I cant really offer any evidence supporting these ideas, and thats okay. Theyre
worth believing because they fulfill my emotional needs.
We get into trouble when we confuse the two types, and start holding instrumental beliefs for
emotional reasons.
What kind of emotion tends to lead us astray? Well, one of the most powerful is the need to feel
in control. Countless psychological experiments have shown that for both humans and animals,
helplessness in the face of danger is intensely stressful. Believing that we have power over our
destiny helps relieve that negative experience, even when that belief is unfounded. Hence the
enormous appeal of magical thinkingthe belief that ones thoughts and private gestures by
themselves can influence the surrounding world. If youve ever put on a lucky shirt because you
thought it would help your favorite sports team win, leaned sideways to keep a bowling ball out
of the gutter, or felt like you were more likely to win the lottery because you used numbers that
had special significance to you, then youve succumbed to the delusion of magical thinking.
This kind of delusion isnt particularly damaging, in itself. No ones going to mind too much if
you wear a ratty old shirt to a Super Bowl party. Nor are you going to be harmed by the hundreds
of our other daily delusions we swaddle ourselves in: how adorable our children are, how
fascinating our appendectomy was, how chartworthy our morning-shower impersonation of
Carly Rae Jepsen is. But when you start relying on emotionally-motivated beliefs to make
decisions with real consequences, youre treading in dangerous territory.
As I write this, the world has just managed to survive the end of the world, as supposedly
predicted by ancient Mayans. Experts of every stripe spent the preceding year reassuring the
public that no Apocalypse was afoot, just as theyd spent 2011 quelling anxieties over Harold
Campings predicted Rapture. And yet for a certain segment of the population, the prospect of
forecasted doom seemed somehow too appealing to let go of. One fellow I know had to sell his
small business and move lock, stock and barrel to rural Idaho because his wife had a dream about
the Apocalypse. She said if he didnt come with her, it would mean divorce. I like Idaho, but
having to move there in the dead of winter strikes me as a steep price for confusing two modes of
belief.
I wish I could wrap up this essay by giving you the secret key for avoiding delusion, but its not
easy. The whole problem with delusion is that we dont want to escape from its clutches. Even I
dont. I mean, look at us: suspended on a tiny dot in the middle of the vastness of empty space,
doomed to suffer and die, and never know the reason why. If we woke up every morning and
stared reality in the face, wed slit our wrists. Maybe literally. Psychologists have long known
that depressed people are less delusional than the rest of us; theyre much more perceptive of
their own flaws, a phenomenon called depressive realism. (Imagine knowing exactly how
flawed your Call Me Maybe is.) So I say: Raise a cheer and throw up your arms, assuming
youre able. Enjoy your delusions while you can. Lets just hope that they dont wreak too much
havoc along the way.
A whole range of mental health problems are acquired and maintained through the development
of delusional beliefs about the self and the world and Im not just confining that statement to
the obvious conditions that display delusional thinking, such as psychosis. Even the most
common mental health problems, such as anxiety and depression, are underpinned by quite
ingrained, strongly held delusional beliefs about the self or the world, and this led me to thinking
about the role of delusional beliefs in maintaining chronic or pathological worrying.
As Ive said before, pathological, uncontrollable worrying is extremely common, can be found
in almost all the anxiety disorders, is the cardinal diagnostic feature of Generalized Anxiety
Disorder, and is paralleled in depression and other conditions by perseverative ruminative
thought. Chronic worrying is all about the individuals need to worry, the perseverative nature
of worrisome thought, and the regular lack of closure or resolution to that worrying the worrier
spends hours worrying, with the usual outcome being that the topic of the worry now seems
much worse than better!
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So what delusional beliefs does the chronic worrier hold? There are a lot! When I came to list
these, I surprised even myself with the length of the list. And they are all delusional by that, I
mean they are thoughts and beliefs that do not reflect reality. Heres my list of 10 delusional
beliefs held by chronic worriers.
1.
Im a born worrier. No worriers are not born, they are made. Anxiety has a modest,
nonspecific genetic component to it, but there is no evidence that worrying is inherited. True,
your mother or your father may have been a worrier, but in all probability you simply learnt the
habit from them. The Im a born worrier plea often spoken by worriers is more of a: I have to
worry, so dont even try to change me! plea.
2.
If I worry about something its likely to happen. No most of the things that
worriers worry about are highly unlikely to ever happen. But it is true that the more you worry
about something, the more you think its likely to happen.
3.
Just because something I worried about in the past didnt happen, doesnt mean it
wont happen in the future. No I suspect that around 90% of what chronic worriers worry
about is never likely to happen. If something you worried about in the past didnt happen, theres
probably a reason for that, and that reason may well be around in the future. Alternatively,
worriers catastrophise their worries to highly improbable ends (e.g. if a partner is 15 minutes
late, the worrier will catastrophise that into the partner having an accident, being injured, being
taken to hospital, etc.). The end points of catastrophized worries are highly improbable and as
unlikely to happen in the future as they were in the past.
4.
Worrying will prevent bad things happening. No worrying alone never prevented
anything from happening, only actions stop things happening. Unfortunately, chronic worriers
have very poor problem-solving confidence so are usually unlikely to reach a solution to a
problem that they believe is worth acting on (see No. 6).
5.
If Im anxious about something, it must mean its a threat or a problem, so I
should worry about it. No this is called the fallacy of ex consequentia reasoning. People can
feel anxious for lots of reasons, such as being tired, in pain, or simply in a negative mood, and
these feelings dont mean that what youre thinking about at the moment is a threat or problem.
6.
Im useless at thinking up solutions to problems, so I must keep worrying. No
chronic worriers are as good as anyone at thinking up useful solutions to social problems, they
just lack confidence in the solutions they generate.
7.
I must think through all the possible things that might happen otherwise I wont
be prepared. No worriers are excellent at continually asking themselves What if?
questions that fuel their worrying. But the more potential outcomes that you generate, the less
likely they are to ever happen.
8.
If I worry about others, it will show I care about them. No theres nothing worse
than knowing that someone else is continually worrying about you. If you do care about
someone, then let them know that in more direct ways.
9.
If I let other people know what they do makes me worry, they will change their
behaviour. No theyll just get angry with you. Family and friends can easily see through this
form of emotional blackmail, and its one of the major reasons why individuals with conditions
like Generalized Anxiety Disorder regularly have problems with close relationships.
10.
It is better to spend a lot of time thinking about a problem than making a snap
decision. No most people make decisions on a daily basis by the way they feel, on the advice
of others, or a gut instinct you dont need to spend a long time thinking through every aspect
of an issue before making a decision. This is the difference between what is known as using
heuristics and using systematic processing
These are all delusional beliefs that have to be deconstructed in therapy with the chronic worrier
but like everyone who holds well-rehearsed delusional beliefs, that is not a simple process.
Creative individuals have fresh perceptions and may make important discoveries that only they
know about. A delusion is a belief that is sustained despite what almost everyone else believes
and not ordinarily accepted by other members of the person's culture or subculture. Many
Americans are not in agreement with the beliefs and ordinary accepted behaviors of our political
leaders at this time, as we await their decision about the national debt.
Delusional disorder is a psychiatric diagnosis denoting a psychotic mental disorder that is
characterized by holding one or more non-bizarre delusions. Is it delusional to believe that our
healthcare system is promoting health? Is it delusional to think that our country will ever be out
of debt? Is it delusional to think that we the people are a priority in the USA?
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The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines six subtypes of the
disorder; one type is grandiose (the believes that he/she is the greatest, strongest, fastest, most
intelligent person ever), the persecutory type (a person believes that someone is following
him/her to do some harm in some way), somatic type (a person believes that he/she has a disease
or medical condition), and mixed, i.e., having features of more than one subtypes.
Is it delusional to distrust the FDA and pharmaceutical companies when we listen to the
commercial on TV which describes the fatal side effects of the medication that they are
advertising? Or are the FDA and pharmaceutical companies delusional?
I see clients daily who have developed illnesses as a result of the medications that they are so
freely prescribed and told to have trust in. They believe their doctors when they are told "take
this." Is it delusional to question or distrust your physician at times or is it clear thinking?
Are we living in a delusional society that is becoming the norm, which makes this type of
thinking non delusional? Delusions are false judgments held with extraordinary conviction and
subjective certainty, resistant to contrary experience and counter-argument, whose content is
impossible-or at least not verifiable.
If wealthy hedge fund managers, corporate Americans etc would give up their tax breaks our
budget may move toward balance. Is that delusional thinking or creative insightful thinking?
According to President Obama in his recent speech he stated "We are on the verge of a deep
crisis." Has Washington been delusional while our country continues to be in trillions of dollars
of debt?
A person with delusional disorder may be high functioning in daily life and may not exhibit odd
or bizarre behavior aside from these delusions. Look at many of the politicians who are leading
double lives, committing heinous crimes and when caught, they have beliefs to support their
behaviors. Grandiose ideas are part of delusional thinking. These people believe that they are the
greatest, strongest, or most intelligent ever.
The DSM-IV, and psychologists, generally agree that personal beliefs should be evaluated with
great respect to complexity of cultural and religious differences since some cultures have widely
accepted beliefs that may be considered delusional in other cultures. Our culture is changing and
with it the belief that everyone is created equal. I believe our country has a chance if we start to
think creatively and with insight.
Specifically, to be a "delusion," a belief must be sustained despite what almost everyone else
believes, and not be one ordinarily accepted by other members of the person's culture or
subculture. As I mentioned before, many Americans are not in agreement with the beliefs and
ordinary accepted behaviors of our political leaders at this time, as we await their decision about
the national debt.
On the other hand, creativity is like a muscle. It has to be used, especially at this time. Meditation
is a wonderful source and vehicle for creativity. At this time of crisis I believe the people who
run our government would be more insightful, creative and less delusional if they meditated
together. It couldn't hurt!