What is Delusions (Delusions)?
In his ‘Critique of Pure Reason,’ Kant proposes an idea about the existence of a thing as it truly is (the noumenon) and the way it appears to us (the phenomenon). He explains that the observer’s personal interpretation prevents an exact reflection of the object as it truly is. Insights suggest we can never fully grasp the reality of an object because our perception always blends our current experiences with our previously acquired knowledge and intuition. In simpler terms, our experiences are a blend of what we see around us (noumenon) and how our minds organize these sensations (phenomenon), making each person’s reality unique.
Kant’s idea suggests that people who have similar backgrounds will have similar perceptions of reality. However, when a person has irregular sensory processing, the individual’s perception of the world dramatically changes. This different perception of reality is what we consider a “delusion”.
Jaspers, a respected figure in psychology, was one of the first to describe and categorize delusions. In his book ‘General Psychopathology,’ he defined delusion as an unswerving misinterpretation of reality. For Jaspers, these misconceptions are puzzlingly complex, held with unshakeable certainty, and unchangeable. He further explained that these false beliefs range in how far they deviate from normal thought patterns, from slight distortions to severe delusions. Even a century later, this theory remains influential in understanding the nature of delusions.
According to the Diagnostic and Statistical Manual (DSM) of Psychiatric Disorders, delusions are defined as strong and unwavering beliefs that lack substantial evidence and are not swayed by rational argument or proof. They do not align with the person’s regional, cultural, or educational background.
What Causes Delusions (Delusions)?
There’s no single consensus on what causes psychological delusions, but some theories suggest it could be due to psychological, neurobiological, cognitive, or emotional factors.
Freud, a famous psychologist, believed delusions were a result of unresolved conflict between different parts of a person’s mind: the id, ego, and superego. He believed that repressed desires, particularly homosexual ones, could turn into delusions as the mind tries to manage these unwanted feelings.
Anthropologist Roberts thought that there were three stages to the development of delusions: the pre-psychotic phase, where a person at risk of mental illness encounters a stressor; the acute phase, where the person begins to have unusual feelings and thoughts that may turn into delusions; and the elaboration phase, where these initial delusions become more developed and detailed.
Some neurobiologists believe that delusions could be caused by high levels of dopamine in the brain. Too much dopamine could make a person more likely to see personal significance in unrelated events. This theory is supported by the fact that medicines which lower dopamine levels can reduce delusions.
The perceptual-cognitive theory suggests that certain mental processes, such as putting more attention on unusual aspects of a situation, could lead to delusions. This imbalance could cause a person to make decisions based on skewed information. This theory also suggests that some people might be more likely to “jump to conclusions”, which could also contribute to the development of delusions.
Some experts believe that past trauma, especially violence, can increase the risk of delusions. Past trauma can affect brain development and cause changes in brain chemicals that might lead to delusions.
Finally, an integrated theory combines several of the above theories. It suggests that delusions are caused by several factors, including a biological difference that changes perception, cognitive factors that shape these perceptions based on personal history, and psychological factors that maintain these delusions over time.
Risk Factors and Frequency for Delusions (Delusions)
Delusions can develop independently or as a result of other underlying conditions. When they develop on their own, as in delusional disorder, it’s possible for experts to calculate how common they are. However, when they are a side effect of another condition, it’s much harder to figure out how common they are. That being said, delusional disorder is estimated to affect around 0.02% of people in the United States, according to the DSM-V.
The ratio of women to men who experience this condition is between 1.18 to 3 to 1. Man are more likely to develop paranoid delusions, while women are more likely to develop delusions of someone being in love with them (erotomania).
There are several factors that can make a person more likely to experience delusions. They include:
- Being married
- Being employed
- Having recently immigrated
- Financial stress
- Choosing not to have sex (celibacy)
- Having lost a spouse (widowhood)
Signs and Symptoms of Delusions (Delusions)
Delusions can occur as a result of certain mental or medical conditions. However, despite having various underlying causes, they typically revolve around fairly common themes. Here are some of the most common types of delusions:
- Erotomanic: The individual believes someone, usually of higher status, is in love with them.
- Delusional jealousy: The individual wrongly believes that their partner is being unfaithful.
- Grandiose: This delusion is characterized by an inflated sense of self-worth, power, or talent, or a belief of being connected with someone famous.
- Persecutory: The person feels as if they’re being conspired against, harassed, or hindered.
- Religious delusions: The individual believes they are a god or chosen to perform divine acts.
- Bizarre: This refers to delusional beliefs about events or phenomena that are impossible or unrelated to regular life.
- Somatic: These delusions involve bodily functions and sensations.
- Control: The individual believes some external force is controlling their feelings and thoughts.
- Thought broadcasting: The person believes their thoughts are being projected outwards and perceived by others.
- Thought insertion or withdrawal: The person believes their thoughts are being put into or removed from their mind by an external source.
- Delusional Misidentification Disorder: The person may believe they are dead, non-existent, or that different people are the same person in disguise.
- Delusions of infestation: The person firmly believes that there is a parasitic infestation of their skin, even if there’s no medical evidence to support such a claim.
- Delusions of misidentification: The individual believes familiar people or places have been swapped with identical copies.
Researchers have noticed patterns among delusions and specific illnesses. For instance, grandiose delusions are commonly seen in those with bipolar disorder, while guilt delusions are generally associated with psychotic depression. Persecutory delusions tend to appear more in individuals with schizophrenia and other delusional disorders, rather than mood disorders.
The themes of some delusions even reflect the political climate of the time. It was noted that during World War II, American patients often had delusions involving Germans, and during the Cold War, delusions revolved around communists.
Testing for Delusions (Delusions)
Assessing someone’s mental state can be a tough task, even for an experienced clinician. Before starting a mental health evaluation, doctors should always check if the person’s delusions could be a symptom of a physical illness. There are no specific tests that can detect delusions, but there are several key factors to consider during the examination.
Family history and genetics play a part: If a person’s family has a history of mental disorders, this increases their risk of having symptoms, such as delusions.
The environment matters too: Evidence suggests that the environment you live in can affect how and when delusions may appear.
Early traumatic events can also influence: Research repeatedly shows the connection between exposure to trauma at a young age and development of severe delusions later. Experts also think that the type of trauma can affect the severity of the delusions and how they manifest.
Strength of the beliefs: Another key point is that these beliefs are resistant to logic, proof, or debate. Trying to challenge these delusions might lead to resistance from the person, early end of treatment, and possible estrangement.
Culture impact: Cultural background is yet another factor. Delusions are found in many different cultures, with paranoid delusions being the most common, followed by the religious and grandiose kind. However, recent studies suggest that delusions can partially reflect a person’s background and experiences with social and political events.
Treatment Options for Delusions (Delusions)
People who experience delusional thinking usually don’t voluntarily seek out medical help. This is because they view their delusional thoughts as normal (what doctors call ‘ego-syntonic’), which leads them to blame others for the distress they’re feeling. Usually, these individuals only seek medical help when loved ones notice a decline in their social and work situations.
When a person experiencing delusions seeks treatment, it’s crucial for the healthcare provider to build a trustful relationship with them. Trying to directly challenge or confront the person’s delusional beliefs typically does not work and can upset the person. Instead, doctors will put their personal judgments aside and study how these delusional beliefs are affecting the patient’s daily life. They will also take a closer look at the person’s personal history and cultural background to better understand their situation.
An interesting approach to treating delusions was suggested by Bebbington and Freeman in 2017. They proposed a way of understanding and treating delusions that bring together mind and body. According to them, effective treatment needs to address physical and mental aspects, and improvements need to happen in both areas for the person to get better.
The physical aspect involves using antipsychotic medicine to reduce the release of a chemical in the brain known as dopamine. Lowering dopamine levels lessens the significance and personal interpretation the person may attach to things around them. With less importance and personal weight given to these things, the person can reconsider the importance of various stimuli in their environment and better distribute their attention. This results in a more accurate understanding of their situation.
On the mental side, the person would reevaluate their first-hand experiences with psychosis. The mental and physical aspects are partly independent of each other, meaning that changes need to occur in both for the delusional symptoms to go away.
What else can Delusions (Delusions) be?
Delusions, or false beliefs that are strongly held despite evidence to the contrary, often occur in conjunction with certain mental health conditions, such as psychotic disorders and manic depressive illness. They can also occur due to isolation. Studies show that up to 20% of individuals with severe mood disorders may experience delusions. These delusions often revolve around themes of persecution or ridicule. These kinds of delusions usually have an emotional component and may be slightly more structured than the delusions experienced by individuals with schizophrenia.
It’s also common for delusions to happen in various forms of dementia, including Alzheimer’s disease, vascular dementia, frontotemporal dementia, and Lewy body dementia. Often, individuals with these conditions have delusions of theft. It’s believed that between 25% to 40% of individuals diagnosed with Alzheimer’s disease will have delusions at some point during their illness.
Research has shown that about half of patients with Lewy body dementia experience delusions. These individuals might incorrectly identify individuals or things, a phenomenon known as Capgras or Fregoli syndrome. Finally, delusions can also be seen in people with Charles Bonnet syndrome, which is related to vision loss.
What to expect with Delusions (Delusions)
The outcome can change based on other existing health conditions. It appears that people with primary delusions seem to function better overall compared to those with primary psychotic disorders, but not as well as those with primary affective disorders. It’s believed that delusions that occur as the result of an existing medical disease should stop once that medical condition is resolved.
Possible Complications When Diagnosed with Delusions (Delusions)
When dealing with delusions, various complications have been noticed. These issues are often due to other existing health conditions or circumstances. Notable complications include acts of violence, stalking and, even murder. These problems seem to be especially prevalent in certain specific cases of delusions.
Common Complications:
- Acts of violence, stalking, and homicide seen in Othello syndrome, which involves delusions of infidelity in a partner.
- Refusing to care for or showing aggression towards loved ones as seen in Capgras syndrome, a condition where the sufferer believes that someone close to them has been replaced by an imposter.
- Placing oneself in dangerous situations as observed in Fregoli syndrome, a disorder where the person believes that different individuals are, in fact, a single person who changes appearance or is in disguise.
- Dramatic reactions to delusions about their bodies, with some patients trying to amputate their limbs or remove their own eyes.
- Injuries resulting from grandiose delusions, as those suffering from them might believe they are invincible and behave recklessly.
- Suicide, caused by paranoid delusions where the person feels excessively suspicious or persecuted.
Preventing Delusions (Delusions)
By increasing the education and understanding of psychological health for patients, their families, and the general public, we can raise awareness about signs of delusion. This can lead to quicker recognition of this symptom and, in turn, result in better and more suitable treatment and care.