Folie a deux

Behaviour of children who have been alienated (brainwashed) are often:

  1. they express the same hostility as does the custodial parent, hence the “folie a deux” analogy;
  2. they identify with and imitate the alienator;
  3. they do not wish to visit or spend time with the absent and alienated parent;
  4. the child’s views of rejecting the absent parent is virtually identical with the programming of the custodial parent;
  5. the children suffer from the same delusions and the irrational beliefs as the alienator in regard to the non resident parent (this occurs because the children have totally identified with the custodial parent);
  6. the children feel themselves to be powerful due to their alliance with the controlling and powerful alienator;
  7. they are not frightened (albeit they claim to be) by the absent parent or the court;
  8. the children have no valid reasons for rejecting the alienated parent, but will often manufacture these reasons, or exaggerate events for the purpose of rejecting alienated parents;
  9. they can see nothing positive or good about the absent parent and even the absent parent’s family, indeed they claim not to be able to remember anything of a positive nature in the form of memories about the absent parent;
  10. they have difficulties in being able to distinguish between what they are told about the absent parent and their own recollections of that parent;
  11. they appear not to feel any sense of guilt about the way they treat the absent parent if and when there is contact;
  12. they appear to be ‘normal’, yet appear also no longer to have a mind of their own being totally obsessed with the custodial parent and his/her implacable hostility towards the absent parent and frequently his/her extended family.

Delusional Disorder

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.

Preventing a Tragedy When Treating Patients with Delusional Disorders

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.

Therapy for Delusional Disorder


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.à_deux

Folie à deux

Folie à deux (‘madness for two’), also known as shared psychosis[2] or shared delusional disorder (SDD), is a psychiatric syndrome in which symptoms of a delusional belief, and sometimes hallucinations,[3][4] are transmitted from one individual to another.[5] 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’).

The disorder was first conceptualized in 19th-century French psychiatry by Charles Lasègue and Jean-Pierre Falret and is also known as Lasègue-Falret syndrome.[3][6]

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).à_deux

Persecutory delusions: a cognitive perspective

A spectrum of severity of paranoia (unfounded thoughts that others are deliberately intending to cause harm) exists within the general population. This is unsurprising: deciding whether to trust or mistrust is a vital aspect of human cognition, but accurate judgment of others’ intentions is challenging. The severest form of paranoia is persecutory delusions, when the ideas are held with strong conviction. This paper presents a distillation of a cognitive approach that is being translated into treatment for this major psychiatric problem. Persecutory delusions are viewed as threat beliefs, developed in the context of genetic and environmental risk, and maintained by several psychological processes including excessive worry, low self-confidence, intolerance of anxious affect and other internal anomalous experiences, reasoning biases, and the use of safety-seeking strategies. The clinical implication is that safety has to be relearned, by entering feared situations after reduction of the influence of the maintenance factors. An exciting area of development will be a clinical intervention science of how best to enhance learning of safety to counteract paranoia.

Continue reading “Persecutory delusions: a cognitive perspective”

The weeks before 100 persecutory delusions: the presence of many potential contributory causal factors

Table 1

Endorsement of checklist items

Item n
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
Missing data 2
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
Poor sleep
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
Mood dysregulation
My mood was very up and down. 66
It was hard to control my emotions. 67
Any of these items. 80
Manic symptoms
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
Aberrant salience
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
Substance use
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

Dealing With Persecutory Delusions

Individuals with mental illness may experience persecutory delusions. These delusions are most commonly associated with schizophrenia, but they also may appear in manic episodes of bipolar disorder or with severe depression with psychosis.

They may also signal a delusional disorder—an illness that is characterized by at least one month of delusions but no other psychotic symptoms. It’s also common for individuals with dementia to develop delusions. It’s estimated that 27% of individuals with dementia experience persecutory delusions at one time or another.

Delusional disorders are far less common than other mental illnesses that may involve psychosis. It’s estimated that only 0.2% of the population experiences delusional disorder.

Individuals with persecutory delusions believe that harm is going to occur and that other people intend for them to be harmed. Individuals experiencing persecutory delusions may say things such as:

  • “My neighbors break into my house at night and steal my clothes out of my closet.”
  • “The police are following me because they want to torture me.”
  • “An evil spirit is trying to kill me.”
  • “The government is poisoning me through the drinking water.”
  • “The people up the street are spying on me and are going to steal my stuff.”

Individuals reporting persecutory delusions may talk in vague terms by saying things like, “They’re out to get to me,” without being able to articulate who “they” are.

Sometimes, individuals with persecutory delusions report their concerns to the authorities. When nothing happens, they often grow suspicious that the authorities are somehow involved.

They also grow frustrated when no one will help them. They may be confused about why friends and family members don’t seem to share their concerns; or they may become angry that no one will take action.

Continue reading “Dealing With Persecutory Delusions”


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”

Transforming the Three Poisons: Greed, Hatred, and 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”