Delusional disorder is characterized by the presence of recurrent, persistent non-bizarre delusions .
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.
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297.71 Delusional Disorder
1. Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month’s duration.
Of the various subtypes of delusional disorder, the one that is most applicable to the PAS:
Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way
This diagnosis is generally applicable to the PAS indoctrinator who may initially recognize that the complaints about the behavior of the alienated parent are conscious and deliberate fabrications. However, over time, the fabrications may become delusions, actually believed by the programming parent. And the same process may ultimately be applicable to the child. Specifically, at first the child may recognize that the professions of hatred are feigned and serve to ingratiate the child to the programmer. However, over time the child may come to actually believe what were originally conscious and deliberate fabrications. When that point is reached the delusional disorder diagnosis is applicable to the child. Generally, this diagnosis is applicable to relentless programmers who are obsessed with their hatred of the victim parent, by which time the child will have probably entered the severe level of PAS. It is to be noted that when the PAS is present, most often one observes a circumscribed delusional system, confined almost exclusively to the alienated parent. This diagnosis may also be applicable to the PAS child, especially the child who is in the severe category.