6.83: Delusional Disorder (297.1)

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DSM-IV-TR criteria

A. Non-bizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, deceived by spouse or lover, or having a disease) of at least 1 month’s duration.
Symptoms include:
- Nonbizarre delusions for at least one month.
- Absence of obviously odd or bizarre behavior.
- Schizoaffective Disorder and Mood Disorder with Psychotic Features have been ruled out.
- Absence of evidence that an organic factor initiated and maintained this psychotic disturbance.
- Absence of prominent hallucinations of a voice for at least one week. Absence of visual hallucinations for at least one week.
- Has never met the criteria for the active phase of Schizophrenia.

Subtypes

B. Criterion A for Schizophrenia has never been met.
- *Note: Tactile and olfactory hallucinations may be present in Delusional Disorder if they are related to the delusional theme.
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.
D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.
E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Specify type (the following types are assigned based on the predominant delusional theme):
- 1. Erotomanic Type: delusions that another person, usually of higher status, is in love with the individual.
- 2. Grandiose Type: delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.
- 3. Jealous Type: delusions that the individual’s sexual partner is unfaithful.
- 4. Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.
- 5. Somatic Type: delusions that the person has some physical defect or general medical condition.
- 6. Mixed Type: delusions characteristic of more than one of the above types but no one theme predominates.
- 7. Unspecified Type

Associated features

People with Delusional Disorder often appear to be very “normal” and function in many areas of their life without any difficulty. Others such as family members, coworkers, or doctors are more likely to see a problem than the person themselves.

The person with Delusional Disorder may develop a particular mood in reaction to their delusion, such as gloomy, irritated, extreme anger, or violence. One may go for unnecessary medical tests on a regular basis.

According to Kendler and Manschreck, associated factors include being married, being employed, recent immigration, low socioeconomic status, celibacy among men, and widowhood among women (Kendler, 1982; Manschreck, 2000).

Child vs. adult presentation

The onset of this disorder ranges from adolescents to adulthood but appears more frequently later in life.

The age of onset ranges from 18 to 90 and the mean onset is around 40.

Gender and cultural differences in presentation

There is no specific culture that presents with Delusional Disorder more than any other culture.

Overall, there are no obvious gender differences with Delusional Disorder.

The ratio for males to females with the disorder is about 1:1; however, some delusion types such as Jealous Type can be seen more commonly in men than in women.

Typically, there is an excess of women with the disorder.

Epidemiology

An uncommon disorder, the prevalence of delusional disorder in the United States is estimated in the DSM-IV-TR to be around 0.03%.

The age of onset can range anywhere from 18-90 years, with an average of about 40 years.

Etiology

Many factors seem to play a part in the etiology of this disorder, but a clear etiology is unknown. Because it is generally difficult to diagnose this disorder and those with this disorder to not often seek treatment, the etiology has not been extensively studied.

However, there are several theories as to what causes this disorder including genetic/biological factors, cognitive processing errors, or defensive delusions.

In studies that have been conducted, it has been shown that those persons with relatives with delusional disorder have higher rates of the disorder, suggesting that a genetic factor might play a part.

Additionally, persons with this disorder may have distorted views of people and life, which can lead to delusional interpretations of daily events.

Empirically supported treatments

Treatment for Delusional Disorder often involves both biological therapy, such as medications, as well as psychotherapy.

Medicinal treatments may involve anti-psychotics and antidepressants such as SSRI and Clomipramine. Agitation, a state of frantic activity experienced with anger or fearfulness can occur from some of these medications. When this situation occurs, haloperidol can be given.

Psychotherapy treatments involve supportive therapy and cognitive therapy.

Treatment should be explored and implemented on a case by case basis, as each client is unique and needs an individualized treatment. Combining the medications with cognitive therapy is generally the best solution.