Research repeatedly finds that typical highly-dissociated (“fragmented”) people were subjected to extreme neglect, abuse, abandonment, or other trauma as young children. Their nurturance deprivations were profound. The great majority of us don’t have anywhere close to this degree of personality splitting – and do have some.
Delusional disorder is characterized by one or more firmly held false beliefs that persist for at least 1 month.
- The false beliefs may be ordinary things that could occur (such as being deceived by a spouse) or things unlikely to occur (such as having internal organs removed without leaving a scar).
- This disorder may develop in people with a paranoid personality disorder.
- Doctors base the diagnosis mainly on the person’s history after they rule out other possible causes.
- People usually remain functional and employed.
- A good doctor-patient relationship is essential to treatment.
Delusional disorder usually first affects people in middle or late adult life. It is less common than schizophrenia. Delusional disorder is distinguished from schizophrenia by the presence of delusions without any of the other symptoms of psychosis (for example, hallucinations, disorganized speech, or disorganized behavior).
Delusions may involve situations that could conceivably occur in real life, such as being followed, poisoned, infected, or loved at a distance. Or they may involve situations that are very unlikely to occur, such as having internal organs removed without leaving a scar. The difference between a delusion and a false or mistaken belief is that people continue to believe in a delusion no matter how much clear evidence contradicts it.
Othello syndrome, sometimes referred to as delusional, pathological, morbid, or erotic jealousy, is a rare delusional disorder with high-risk implications. This article provides an overview of Othello syndrome and includes an individual example as well as a review of the literature. Pharmacological interventions and dialectical behavior therapy are discussed as options for pathological jealousy. Nursing considerations and assessment strategies of delusional jealousy are described for identification and evaluation of risk factors. Patient safety is addressed, and collaborative interventions are proposed for treatment. Staff development for the treatment team is advocated to help staff identify delusional patients and act prudently to avert possible tragic consequences associated with Othello syndrome.
Defining Delusional Disorders. According to the American Psychiatric Association (2000), as published in the DSM- IV-TR, a person who is suffering from a delusional episode would experience false fixed beliefs that can not be changed through logic and reason. Delusions may be a symptom related to other psychiatric disorders such as, psychosis, delusional disorders, organic mental disorders, and substance abuse.
The two most common forms of therapy for people suffering from shared delusional disorder are personal and family therapy.
Personal therapy is one-on-one counseling that focuses on building a relationship between the counselor and the patient and aims to create a positive environment where the patient feels that they can speak freely and truthfully. This is advantageous because the counselor can usually get more information out of the patient to get a better idea of how to help them if that patient feels safe and trusts them. Additionally if the patient trusts what the counsellor says disproving the delusion will be easier.
Family therapy is a technique in which the entire family comes into therapy together to work on their relationships and to find ways to eliminate the delusion within the family dynamic. For example, if someone’s sister is the inducer the family will have to get involved to ensure the two stay apart and to sort out how the family dynamic will work around that. The more support a patient has the more likely they are to recover, especially since SDD usually occurs because of social isolation.
Folie à deux (‘madness for two’), also known as shared psychosis or shared delusional disorder (SDD), is a psychiatric syndrome in which symptoms of a delusional belief, and sometimes hallucinations, are transmitted from one individual to another. The same syndrome shared by more than two people may be called folie à… trois (‘three’) or quatre (‘four’); and further, folie en famille (‘family madness’) or even folie à plusieurs (‘madness of several’).
Recent psychiatric classifications refer to the syndrome as shared psychotic disorder (DSM-4 – 297.3) and induced delusional disorder (ICD-10 – F24), although the research literature largely uses the original name. This disorder is not in the current DSM (DSM-5).
|Length of delusion onset|
|It took years to be certain what was occurring.||21|
|There was a build up over several months in trying to be sure what was going on.||30|
|There was a build up over a few weeks in trying to be sure what was going on.||24|
|There were a few days working out exactly what was happening to me.||6|
|I knew instantly that others were definitely trying to harm me, there was no build up at all. Things just changed in a day.||17|
|I’d been worrying a lot.||80|
|In my mind I had been going over problems again and again.||75|
|I’d been worrying about losing control.||59|
|I’d been worrying that I couldn’t control my thoughts as well as I would like.||68|
|Any of these items.||94|
|I kept having images in my mind of bad things happening.||75|
|Low self-esteem and depression|
|I felt very negative about myself.||75|
|I felt inferior to others.||66|
|My self-confidence got really low.||84|
|I just didn’t feel like my normal self.||77|
|I felt like I would make a fool of myself in front of others.||59|
|I was tormented by something, though I didn’t know what it was.||62|
|I became more passive and withdrawn.||58|
|Any of these items.||95|
|I was having problems getting or staying to sleep.||75|
|I was sleeping at all the wrong times.||37|
|I was having nightmares.||50|
|I did not feel that I needed any sleep at all.||21|
|Any of these items.||85|
|I felt strange, as if I were not real or as if I were cut-off from the world.||62|
|My surroundings felt detached or unreal, as if there was a veil between me and the outside world.||54|
|I felt automatic and mechanical as if I were a robot.||25|
|I became preoccupied with my own world||65|
|Any of these items.||82|
|My mood was very up and down.||66|
|It was hard to control my emotions.||67|
|Any of these items.||80|
|I was highly excitable.||25|
|I had difficulties concentrating.||77|
|My thoughts were jumping around too much.||76|
|I had so many thoughts that I couldn’t keep track.||59|
|Any of these items.||87|
|I was analysing everything in great detail.||72|
|I became interested in people, events, places, or ideas that normally would not make an impression on me.||33|
|My senses were sharpened. I became fascinated by the little insignificant things around me.||54|
|Sights and sounds possessed a keenness that I had never experienced before.||34|
|My senses seemed alive. Things seemed clear cut, I noticed things I had never noticed before.||46|
|Certain trivial things suddenly seemed especially important or significant to me.||70|
|Any of these items.||92|
|I heard noises or sounds when there was nothing about to explain them.||63|
|I saw shapes, lights or colours even though there was nothing really there.||33|
|I began to hear voices that were hard to explain.||56|
|Sounds were distorted in strange or unusual ways.||30|
|Any of these items.||78|
|I was smoking cannabis (or taking other drugs).||18|
|I was drinking quite a lot of alcohol.||23|
|Any of these items.||32|
|I was being bullied.||44|
|Someone close to me died.||18|
|I had left home.||17|
|My relationship had ended with my boyfriend/girlfriend.||19|
|There were lots of arguments occurring.||31|
|I left school or university or my job.||23|
|There were lots of stresses in my life.||69|
|Any of these items.||83|
|Absence of changes|
|There was nothing unusual at all in the period before.||7|
|I was feeling perfectly fine.||9|
|Any of these items.||13|
Delusion is our wrong understanding or wrong views of reality. Delusion is our misperception of the way the world works; our inability to understand the nature of things exactly as they are, free of perceptual distortions. Influenced by delusion, we are not in harmony with ourselves, others, or with life; we are not living in accordance with Dharma. Affected by the poison of delusion, which arises from ignorance of our true nature, we do not understand the interdependent and impermanent nature of life. Thus, we are constantly looking outside of ourselves for happiness, satisfaction, and solutions to our problems. This outward searching creates even more frustration, anger, and delusion. Because of our delusion, we also do not understand the virtuous, life-affirming actions that create happiness, nor do we understand the nonvirtuous, negative, and unwholesome actions that create suffering. Again, our delusion binds us to a vicious cycle where there does not appear to be any way out. Continue reading “Delusion”
In Buddhist teachings, greed, hatred, and delusion are known, for good reason, as the three poisons, the three unwholesome roots, and the three fires. These metaphors suggest how dangerous afflictive thoughts and emotions can be if they are not understood and transformed. Greed refers to our selfishness, misplaced desire, attachment, and grasping for happiness and satisfaction outside of ourselves. Hatred refers to our anger, our aversion and repulsion toward unpleasant people, circumstances, and even toward our own uncomfortable feelings. Delusion refers to our dullness, bewilderment, and misperception; our wrong views of reality. The poisons of greed, hatred, and delusion are a byproduct of ignorance—ignorance of our true nature, the awakened heart of wisdom and compassion. Arising out of our ignorance, these poisonous states of mind then motivate nonvirtuous and unskillful thoughts, speech, and actions, which cause all manner of suffering and unhappiness for ourselves and others.
Greed, hatred, and delusion are deeply embedded in the conditioning of our personalities. Our behavior is habitually influenced and tainted by these three poisons, these unwholesome roots buried deep into our mind. Burning within us as lust, craving, anger, resentment, and misunderstanding, these poisons lay to waste hearts, lives, hopes, and civilizations, driving us blind and thirsty through the seemingly endless round of birth and death (samsara). The Buddha describes these defilements as bonds, fetters, hindrances, and knots; the actual root cause of unwholesome karma and the entire spectrum of human suffering. Continue reading “Transforming the Three Poisons: Greed, Hatred, and Delusion”
An important aspect of delusional disorder is the identification of the form of delusion from which a person suffers. The most common form of delusional disorder is the persecutory or paranoid subtype, in which the patients are certain that others are striving to harm them.
In the erotomanic form of delusional disorder, the primary delusional belief is that some important person is secretly in love with the sufferer. The erotomanic type is more common in women than men. Erotomanic delusions may prompt stalking the love object and even violence against the beloved or those viewed as potential romantic rivals.
The grandiose subtype of delusional disorder involves the conviction of one’s importance and uniqueness, and takes a variety of forms: believing that one has a distinguished role, has some remarkable connections with important persons, or enjoys some extraordinary powers or abilities.
In the somatic subtype, there is excessive concern and irrational ideas about bodily functioning, which may include worries regarding infestation with parasites or insects, imagined physical deformity, or a conviction that one is emitting a foul stench when there is no problematic odor.
The form of disorder most associated with violent behavior, usually between romantic partners, is the jealous subtype of delusional disorder. Patients are firmly convinced of the infidelity of a spouse or partner, despite contrary evidence and based on minimal data (like a messy bedspread or more cigarettes than usual in an ashtray, for instance). Delusional jealousy sufferers may gather scraps of conjectured “evidence,” and may try to constrict their partners’ activities or confine them to home. Delusional disorder cases involving aggression and injury toward others have been most associated with this subtype.