What is Shared Psychotic Disorder?
Shared psychotic disorder, also known as ‘folie à deux’, is an unusual condition where a false belief or delusion is shared between two or more closely connected people. Generally, one person (the inducer) who already has a mental health issue with delusions, influences another person or more (the secondary, who didn’t have them originally) to also believe in the same delusion. While this usually happens between two people, in rare circumstances, it can influence a larger group like an entire family, which is referred to as ‘folie à famille’.
This condition has been known since 1860, first reported by Jules Baillarger, and it’s been labelled different things across Europe over the time. In France, for instance, it was once called ‘folie communiquee’ meaning communicated psychosis. In German psychiatry, it was given the name ‘Induziertes Irresein’. Later in 1877, the term ‘folie à deux’ was coined, which translates to ‘madness shared by two’.
In the early 1940s, a psychiatrist named Gralnick studied over 100 cases of shared psychosis and divided the condition into four types, based on how the delusion spreads and how it affects the people involved.
‘Folie imposee’ describes a situation where delusions spread from one individual with psychosis to another person without psychosis within a close relationship. These delusions stop when the two individuals are separated. ‘Folie simultanee’ describes a situation where both people have long-standing social interactions, leading them to develop the same delusions simultaneously. ‘Folie communiquée’ is similar to folie imposee, but in this case, the second person continues to believe in the delusion even after being separated from the inducer. Finally, ‘Folie induite’ describes a scenario where an individual with psychosis takes on new delusions under the influence of another psychotic individual.
This disorder has seen various classifications in the medical field. Initially, it was listed in the Diagnostic and Statistical Manual of Mental Disorders as shared paranoid disorder, but in the next edition, it was renamed to shared psychotic disorder. However, in the latest edition, it was removed as a standalone disease and now falls under the category of other specified schizophrenia spectrum and other psychotic disorders. It’s also listed in the International Classification of Diseases as induced delusional disorder.
What Causes Shared Psychotic Disorder?
We don’t have a clear understanding of what exactly causes shared psychotic disorder, but there are a few risk factors that can increase the chances of it happening:
* Length of Relationship: Studies have found that longer relationships are often linked to this disorder. The connection and bond shared with the person responsible for the delusion can be a key factor in developing this condition.
* Type of Relationship: This disorder is most commonly reported in family members. Being in a married or common-law partnership represents the most frequent type of relationship, followed by relationships between siblings.
* Social Isolation: It is often reported in those who don’t have much interaction with society. If a person is isolated and experiencing fear or confusion, they could be more likely to accept the delusional beliefs of someone else. This is especially true if those beliefs align with their own anxieties or worries. Accepting these ideas can sometimes seem like the only way to maintain a close relationship.
* Personality Disorder: Those with shared psychotic disorder often have traits of a personality disorder. They might be described as neurotic, introverted, and emotionally immature. It’s also been noted that some have a history of dependent, schizoid, or schizotypal personality disorders.
* Unmanaged Mental Disorders: If one person in a relationship has an untreated mental illness, such as delusional disorder, schizophrenia, or affective disorder, this can pose a risk to the other person.
* Cognitive Impairment: It’s been reported that those who are influenced (termed ‘secondaries’) lack good judgment and intelligence.
* Other Mental Disorders: Those who have been diagnosed with a mental disorder, like schizophrenia, bipolar disorder, depression, dementia, or an intellectual disability, have a higher chance of being influenced by somebody with a mental illness.
* Stressful Life Events: Increased stress in the relationship can lead someone to accept delusional beliefs or reduce their ability to control their feelings and emotions.
* Communication Difficulties: If an individual has trouble discussing their ideas, they might become isolated. There have been suggestions that enhancing communication between individuals through therapies may help in understanding different perspectives, especially in situations of rigid thinking.
* Age and Gender: Older studies suggested the older person in the relationship often induces the disorder and the younger being susceptible. However, recent studies don’t support this claim. Regardless of age, the disorder is more common in females.
Risk Factors and Frequency for Shared Psychotic Disorder
The exact number of people affected by shared psychotic disorder is hard to determine. According to some research, it accounts for about 1.7% to 2.6% of all psychiatric hospital admissions. However, these numbers might be on the low side, as this disorder is often missed or not correctly diagnosed by doctors. There can be situations where one individual receives treatment without realizing that the delusions also affect others. Some experts claim that this disorder is not as rare as thought.
Signs and Symptoms of Shared Psychotic Disorder
Shared delusions often vary based on the type but generally involve two people, typically partners, having fixed, unrealistic beliefs that they steadfastly hold onto. These beliefs can often revolve around paranoia or fear and they might wrongly suspect people in their community. The distress from these delusions can sometimes lead to harmful actions or behaviors.
In many cases, one of the partners might be initially referred for a mental health evaluation due to these concerning actions or claims. It might be discovered that the other partner shares the same delusion. Sometimes, these couples can be admitted to the hospital together due to dangerous behaviors or harm to themselves or others. Delusions can often go unnoticed and unaddressed within a community for long periods of time.
Detailed observations about individuals with shared delusion includes:
- Appearance: Individuals are typically well-groomed and well-dressed.
- Behavior: There can be a defensive or angry demeanor, particularly when the delusion is challenged.
- Speech: The person’s speech is usually coherent and relevant.
- Mood and Affect: The person’s mood matches the delusion: for instance, a paranoid person could be irritable, while a grandiose person might be euphoric.
- Thoughts: Thoughts are often goal-oriented with systematically structured delusions that may include harmful thoughts. They may place excessive importance on social, cultural, or religious beliefs.
- Perceptions: Abnormal perceptions are less likely unless there are predisposing factors. In some cases, hallucinations might be experienced, usually by the secondary partner.
- Orientation and Cognition: The person often has clear awareness of time, place, and person unless affected by their delusion. Memory and cognition are generally normal.
- Risks: It’s important to evaluate the risk of harmful thoughts or actions and consider hospitalization if there’s a history of aggressive behavior with negative outcomes.
- Insight and Judgment: Most commonly, these individuals do not recognize their mental illness. Their judgment can be evaluated based on past behaviors and future plans.
Testing for Shared Psychotic Disorder
If you or a loved one are experiencing symptoms that suggest shared psychotic disorder, also known as folie à deux, there are no specific lab tests that can provide a definitive diagnosis. Medical professionals often start with a series of tests, including imaging and lab work, not to confirm the psychiatric disorder, but to rule out any other physical health conditions that might be causing similar symptoms.
One important test that doctors often use is a urine toxicology screen. This checks for the presence of substances in your system that could be causing the symptoms. Essentially, the goal with these tests is to clear away any other possible causes before a mental health diagnosis is made.
Once physical causes have been ruled out, the next step is a thorough psychiatric assessment. This assessment usually includes talking to the individual, but it can also be really helpful to get extra insight from a third party, like a friend or family member.
However, this process may prove challenging, as people with shared psychotic disorders often isolate themselves from others. This isolation means that the doctor may only be able to speak with one partner. After the interview, the psychiatrist will do a complete mental health check, looking for signs and symptoms of shared psychotic disorder.
In some cases, it may be helpful to gather more information from other family members or friends, if available, to help better understand the patient’s situation. It’s important to know that the primary partner can sometimes unintentionally give misleading information to protect the shared delusion, which can make it difficult for doctors to diagnose the condition.
Treatment Options for Shared Psychotic Disorder
Treatment usually needs to be customized for each individual patient. If it seems like a patient is not getting better, it might be necessary to persuade them to stick closer to their treatment plan.
Some people assume that if a patient is separated from their primary partner, it can substantially improve their health condition. After being admitted to the hospital, any negative influence from the primary partner usually lessens. However, it’s important to recognize that recent studies indicate simply separating from the partner might not be enough, or might even worsen the situation.
One suggested approach is to provide both partners with medication. This could include a variety of drugs such as antipsychotics or antidepressants, either used alone or combined with mood stabilizers. Starting medication typically signifies the patient’s condition is serious with probable remaining symptoms.
Because the condition could be confused with something else, it’s extremely important to regularly check up on the patient’s health progress. Psychotherapy, which is a type of therapy that aims to improve mental health, could be an option for both partners, either separately or together.
Additionally, a treatment procedure known as electroconvulsive therapy might be considered. This involves sending a small electrical current through the brain to trigger a brief seizure, which can help reset the brain’s wiring and improve symptoms of certain mental health conditions.
What else can Shared Psychotic Disorder be?
Creating a diagnosis involves understanding the history and interactions of both partners. Usually, the issue starts before the shared delusion kicks in. It’s important to rule out any conditions caused by physical illnesses or drugs before diagnosing shared psychotic disorder. Two main conditions to consider include:
- Schizophrenia/Schizoaffective: This can be told apart from shared psychotic disorder by the presence of symptoms that the primary individual does not influence, such as hallucinations, confused speech, or “negative” symptoms (like loss of interest in daily activities). If there are also emotional symptoms, then it could be schizoaffective disorder.
- Mood Disorder with Psychotic features: This condition is characterized by a specific false belief that aligns with the individual’s mood and is not shared, but expressed independently.
If the false beliefs do not go away when the partners are separated, it might be necessary to rethink the diagnosis and consider other possible conditions.
What to expect with Shared Psychotic Disorder
The chances of recovering from a shared psychotic disorder can be tough to predict because several things factor into it. These include the mental health of the primary person involved (usually the person from whom the disorder originates) and any predisposing factors like biology, psychology, or social circumstances that might affect the secondary person (the person ‘catching’ the disorder).
In general, children have a better chance of recovery when they’re separated from the primary person, compared to adults. Following a treatment plan by both partners involved is more likely to yield a better result than leaving the disorder untreated.
Looking closely at the nature and duration of the delusion (a strong belief held despite contradictory evidence) can provide some insight into how the disorder might play out. However, if the secondary person already has certain personality traits or is at risk due to other factors, this could make the condition more complex and warrant consideration of a different diagnosis.
Possible Complications When Diagnosed with Shared Psychotic Disorder
Patients with these problems can be hard to identify because they often don’t realize they have an issue. Generally, they are referred to medical professionals after a crisis occurs – typically, this crisis involves acting upon their false beliefs in a way that endangers their own lives or the lives of others. For instance, a person might believe things that aren’t true (delusions) and make numerous accusations, ultimately leading to an assault. If someone has delusions that they are very important or chosen for a special religious mission, this can also be risky for people around them.
Experiences These Patients Could Have:
- Not realizing they have a problem
- Experiencing a crisis due to their false beliefs
- Acting upon these false beliefs in a dangerous manner
- Making multiple accusations stemming from these false beliefs
- Assaulting others due to these false beliefs
- Possessing a false belief of their importance or religious destiny
- Putting others at risk due to these beliefs
Preventing Shared Psychotic Disorder
Patients and their loved ones can find helpful information on the internet about shared psychotic disorder, a mental health condition where two people share the same delusional beliefs. Many websites also provide details about support programs and resources which can be of great use during this time. Furthermore, any member of the patient’s medical team, such as doctors or nurse, is well-equipped to provide this information and educate the patients and their family about the condition. This education can help everyone involved better understand and manage the disease.
