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Delusional Disorder

El Greco

Summer worshipper
El Greco
Joined
Nov 11, 2003
Messages
17,604
Something that might help with debates in P&R. From
this page (underlines mine):

Delusional Disorder

Diagostic Criteria
  • Nonbizarre delusions of at least 1 month's duration.
  • Criterion A for Schizophrenia has never been met.
  • Functioning is not markedly impaired and behavior is not obviously odd or bizarre.
  • Mood episodes, if present, have been relatively brief compared to the duration of the delusions.

Types of Delusions
  • Erotomanic
  • Grandiose
  • Jealous
  • Persecutory
  • Somatic
  • Control
  • Reference
  • Bizarre

Associated Features
  • Age of onset is typically later than for Schizophrenia.
  • No pervasive impairment, however, may be problems on the job, socially, or in their marriages.
  • Individuals with persecutory or jealous delusions may become angry, hostile, or litigious.
  • Individuals with somatic delusions often undergo unnecessary medical tests and procedures.

Differential Diagnosis
  • Cultural and religious background must be taken into account.
  • Religious persecution and racial prejudices may all produce statements that sound paranoid.

Course & Prognosis
  • Delusional Disorder is characterized by an insidious onset and chronic course.
  • Prognosis is poor, as few patients rarely give up their delusional beliefs entirely and engaging them in treatment is difficult.

Etiology & Epidemiology
  • Cause of delusional disorder is unknown.
  • Delusional disorder is relatively rare in clinic settings, representing between 1% and 4% of psychiatric admissions.
  • Disorder is most common in women, patients with lower SES, and recent immigrants. Other higher risk patients include the elderly, and people with impaired hearing, impaired vision, or other physical disabilities.

Treatment
  • Antipsychotic medication is generally ineffective against the delusional beliefs.
  • Delusional patients are unlikely to willingly participate in treatment.
  • It is pointless and futile to attempt to argue patients out of their delusional beliefs using logic or reason.
 
Thanks, El Greco. I suspect that we here can confirm the Course & Prognosis, and Treatment, fairly readily. But it's sad too, really, isn't it.
 
A delusional belief being, naturally, one diametrically opposed to our own. The strength of the delusion being directyl proportional to our strength of feeling/quality of proof. :)
 
There are many differences Don. Think about some of them:

- If a normal person gets beaten in a debate, s/he may continue to stubbornly support his initial positions out of egoism or because s/he doesn't want to admit s/he lost. S/he will not however carry the same delusional beliefs and the same rejection of logic over other threads and over several years.

- a normal person will not feel persecuted.

- a normal person will not be fixed on a particular subject. S/he will happily participate in many different discussions with various topics.
 
El Greco said:
[B
... a normal person will not feel persecuted.
[/B]
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Sometimes normal people are persecuted.

But as Dr Bruno Bettelheim (psychologist and concentration camp survivor) pointed out, even under such circumstances a normal person will react differently from a paranoid.
 
Abdul Alhazred said:
Sometimes normal people are persecuted.
Click to expand...

Tell me about it. Like I'm not currently persecuted by thousands of desperate female fans (note: this is the erotomanic/ grandiose type of dd :D).

But what I meant is that a normal person will not feel persecuted if others keep debunking any illogical arguments s/he may present in a debate :)
 
El Greco said:
There are many differences Don. Think about some of them:

- If a normal person gets beaten in a debate, s/he may continue to stubbornly support his initial positions out of egoism or because s/he doesn't want to admit s/he lost. S/he will not however carry the same delusional beliefs and the same rejection of logic over other threads and over several years.

- a normal person will not feel persecuted.

- a normal person will not be fixed on a particular subject. S/he will happily participate in many different discussions with various topics.
Click to expand...

One of the reasons why I felt sufficiently strongly to post to this thread is that, IMO, quite a lot of psychological diagnosis is subjective. A close friend who has been diagnosed with a range of psychological disorders showed me similar lists of diagnostic criteria. What struck me was that they were typically quite vague (because an objective measure is practically impossible) and that there was a tremendous degree of overlap of symptoms between disorders.

What you got diagnosed with basically came down to what that particular psychiatrist happened to feel particularly strongly about at that point in time.

Which takes us back to that set of diagnostic tools....

Cultural and religious background must be taken into account.
Click to expand...

Which is a get-out if ever I've heard one

It is pointless and futile to attempt to argue patients out of their delusional beliefs using logic or reason
Click to expand...

Yet someone whose beliefs are similar to our own is described as having stick-to-it-iveness.
 
Of course, a lot of things are subjective, like with most other mental diseases. But this subjectivity and the difficulty of an unambiguous diagnosis doesn't mean that the problem is imaginary. This is a well-described and very real disorder.

The "cultural & religious background" and the "lower SES" are not get-outs. There are some mental illnesses where the sociocultural environment plays a major role in their manifestation.

Let's say for example that for a specific disease the genes will permit a range of 7-9, where normal is < 5. The environment may affect the disease only between the upper (9) and lower (7) levels but the disease will appear anyway. In another case though, the genetic limits might be 5-7, where 5 will be considered normal (although imaginative) while 7 will be undoubtedly delusional. In such cases the sociocultural background will be of great help for the diagnosis.
 
Dear Don;
the cultural beliefs is not the out that you think it might be. In south east asia and africa it is quite a common belief that witchcraft influences soccer games. For a belief to be delusional then it must be a belief not shared by others in the culture.

In the USA belief in possesion by demons is very common, but using the oven to drive them out is not.(The most common method is to pray for the 'victim', usually after swaddling them in sheets and beating them severely.)

Sounds like you has a friend who was shopping for a diagnosis, fortunately they did away with the more popular ones!
 
I was going to say I had erotomanic delusions (sounded cool), until I looked them up. Nevermind...
 
Yahweh said:

[size=0.5]They're looking at you.[/size]
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If I wasn't so tired I'd try to make some sense outta all this, but I'll just giggle at all the sillyisms instead. ***giggles***
 
Dancing David said:
Dear Don;
the cultural beliefs is not the out that you think it might be. In south east asia and africa it is quite a common belief that witchcraft influences soccer games. For a belief to be delusional then it must be a belief not shared by others in the culture.

In the USA belief in possesion by demons is very common, but using the oven to drive them out is not.(The most common method is to pray for the 'victim', usually after swaddling them in sheets and beating them severely.)

Sounds like you has a friend who was shopping for a diagnosis, fortunately they did away with the more popular ones!
Click to expand...

*That* was my point, delusion is in the eye of the beholder

My friend was hardly shopping for a diagnosis, each time he got "sectioned" (detained under the mental health act) they just diagnosed him differently and pumped him full of a different set of psychotropic drugs.

I woudl argue that the reason main reason he was differently diagnosed each time had to do with the subjective nature of the diagnosis criteria and the scope that leaves for the psychiatrist to diagnose one of thir "pet" conditions.

Of course none of this helped particularly in treating his condition :(
 
Dear Don,
I greatly regret my flippant response to your post, that was cynical mental health humor and I apologise. My experience in the mental health field caused me to develop a very scwed outlook on people in the mental health system and I apologise.
Being through involuntary commital is a very damaging process to the individual. It is sometimes nessecary but always deals a major whack to the person involved. I regret making a flippant remark at the expense of a human that I have never met.
Sincerely
David G.

The Don said:


*That* was my point, delusion is in the eye of the beholder

It is to the extent that I am very certain that one of my former clients was not Elvis! Now that is based upon the commonly held belief that Elvis is dead. My client alos was able to convince other people he had served in Viet'Nam although it was a commonly held belief in his family that he never left the states.

And belief me I understand the point, evn before working with delusional people I was aware of the plastic nature of reality. After twelve years in mental health I became very aware of it.
In my current area of work we have to be very consious of it as well. In domestic violence the abuser will set up a series of events and structures to change the beliefs of the victim. And unfortunately in mental health the victim of domestic violence often gets medicated on the beliefs of the abuser.


My friend was hardly shopping for a diagnosis, each time he got "sectioned" (detained under the mental health act) they just diagnosed him differently and pumped him full of a different set of psychotropic drugs.

I woudl argue that the reason main reason he was differently diagnosed each time had to do with the subjective nature of the diagnosis criteria and the scope that leaves for the psychiatrist to diagnose one of thir "pet" conditions.

Now that I can agree with, doctors do tend to get into ruts and treat the patients in a very consistent fashion!

It sound like your friend needs to start keeping a journal so they can give a semi-accurate history of events in being diagnosed.

If they abuse alcohol or street drugs that will just make the diagnosis almost impossible. Seizure disorders also od a lot of weird things to people that can be almost impossible to diagnos.

Even the best doctor I used to work with was accurate about 60% in the initial diagnosis. And that was dependant on accurate information from the people seeking treatment. Often diagnosis is more of an 'administer drugs and see which work' phenomena. this of course make people seeking treatment very unhappy.

You add to that the effects of alcohol and street drugs and the fact that people seeking treatment really don't like to tell doctors exactly what is going on, well it makes the doctors job very challenging. A very depressed person and some one with schizophrenia will present in an emergency in almost the same fashion. Some depressed people also become very delusional and have auditory hallucinations.

Then you get into the area of 'preferential' diagnosis on the part of those recieving treatment. I worked with individuals who really did not want to have any diagnosis that even looked like 'schizophrenia', in particular individuals who would have rather had a diagnosis of developemental disability(retardation of developemment) than psychosis. I have known people who were full blown psychotic (and no mood disorder) but would not recieve treatment unless the doctor assuered them that they were being treated for bipolar disorder. Then there are the people who won't even aknowledge that they have a mental illness but focus on the somatic side of thier illness, IE the take the 'sleeping' medicine or 'something for my appetite' when it is for depression.

I really feel for your friend, in the USA it can be very hard to hospitalize people against thier will, which is the way I feel that it should be. If they don't present a 'clear and present danger' then they shouldn't be forced into treatment. In some jurisdictions this is done just because someone is a nuisance to the family or to preserve thier future inheritance.

Again I think that if your friend is going to get good medical treatment they are going to need to be able to give the doctor an accurate picture of what is going on in their life. And if they have organic brain damage, even that is going to be of little help.

Of course none of this helped particularly in treating his condition :( [/B]
Click to expand...
 
Don, some delusions may be in the eye of the beholder, but my ex-wife's two-month-long claim that she was the second coming of Christ was very likely a real delusion, regardless of what sort of diagnoses were given.

~~ Paul
 
Dancing David said:
I line all my hats too, it prevents them from reading my mind.
Click to expand...
Some people may need lead lined underwear to stop other's from reading their minds.
 
Paul C. Anagnostopoulos said:
Don, some delusions may be in the eye of the beholder, but my ex-wife's two-month-long claim that she was the second coming of Christ was very likely a real delusion, regardless of what sort of diagnoses were given.

~~ Paul
Click to expand...


What the heck did she do that for? How did she stop?

***dying of curiosity***
 
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