9 Things you must know if Delusional Disorder strikes your spouse…
Monday, October 23, 2023. I have the unique privilege of working with extremely accomplished medical professionals, helping to heal and repair their marriages.
Because of that privilege, I have a case currently involving an extremely rare disorder that many therapists never have the chance to experience, much less learn about first hand…Delusional Disorder. This is for PC & T.
What is Delusional Disorder?
Delusional Disorder is a mental health condition defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), as the presence of delusions lasting 1 month or longer.
The condition’s essential symptom are delusions, plain and simple. Delusions which persist and endure, possibly for years.
What do I mean by delusions? They are unrealistic thoughts, ideas, and beliefs that saturate awareness, despite the abundantly obvious evidence that they are untrue.
While hallucinations may rarely be present in Delusional Disorder, the DSM-5-TR notes they aren’t as significant and will follow the theme of delusions.
What causes Delusional Disorder?
The word delusional is a fighting word in American culture. We use it thoughtlessly.
I will never see that word the same way again.
As with many other psychotic disorders, researchers don’t yet know the exact cause of the heart-breaking psychic collapse that is Delusional Disorder.
Researchers are, however, currently exploring a few variables which may contribute to the onset of Delusional Disorder:
Genetic: The fact that Delusional Disorder is more common in humans who have family members with either Delusional Disorder or Schizophrenia strongly suggests that genetics may be a factor.
Biological: Researchers are studying how abnormalities of certain areas of your brain might be involved in the development of Delusional Disorder. We know that an imbalance of certain chemicals in your brain, called neurotransmitters, has been linked to the formation of delusional symptoms.
Environmental and Psychological: These are the factors that can build on the genetic and the biological. We suspect that Delusional Disorder can be triggered by stress. My client was deeply engrossed in a court case which involved the well being of his grand child, and was under relentless legal stress because of the case before his breakdown.
Alcohol Use Disorder and Substance Use Disorder might also exacerbate this condition. My client occassionally indulged, but not in an abusive way.
Hypersensitivity. Excessive use of Defense Mechanisms like Reaction Formation, Projection and Denial are some psychodynamic theories for why Delusional Disorder manifests. Researchers need to look more at this, as his defensiveness is aggressive, resilient and robust.
Social Isolation. Marinating in toxic human emotion such as distrust, envy, extended conflicts in the courts, suspicion, and low self-esteem may also be aggravating psychological factors. Unresolved feelings may lead a human to seek an explanation for these feelings and, thus, create a rich and imaginative delusion to reconcile them.
Because of my clients prominent position, he was often isolated because he was traveling to present a paper, or give a lecture. His wife and I noticed that before the final breakdown, there was a flurry of travel time alone.
Treatment for this condition typically involves a combination of therapy, medication, and self-care strategies…
As I mentioned previously, Delusional Disorder is characterized by the presence of one or more delusions, which are unshakable beliefs in something that is untrue and not part of the person's culture or subculture.
These delusions are often mundane, and typically concern situations that could occur in real life, but they are typically false, or highly distorted.
Delusional Disorder is discreet and distinct from schizophrenia in that it primarily involves delusions without the presence of any other psychotic symptoms, such as disorganized speech or hallucinations.
Here is what makes Delusional Disorder so profoundly different from other disorders that lose touch with reality. Humans with Delusional Disorder can continue to function normally, apart from the nature of their delusion, of course.
As a rule, their behavior appears perfectly normal! They don’t typically behave in a questionable manner. They tend not to attract attention, and can often elude detection that they are indeed, psychotic.
This is unlike people with other psychotic disorders, who also have delusions as a symptom, who you can often spot, as they say, a mile away. Delusional Disorder a sly disorder.
In some cases, however, humans suffering with Delusional Disorder might become overly engrossed with their delusions, and disrupt their spouse and family.
For example, my client is able to hold both private, and professional conversations. He can even carefully avoid trains of thought that might lead to him delving into, and disclosing his delusion!
The prognosis of Delusional Disorder is better when we stick to the treatment plan. Almost 50% of humans have a full recovery, more than 20% of humans report a decrease in symptoms and less than 20% of humans report little to no change in their symptoms.
Unfortunately, many with this condition don’t seek help. (that is the issue with my client, a respected scientist).
It’s often difficult for humans with Delusional Disorder to recognize they are unwell. They also might be too embarrassed or afraid to seek treatment. Here’s what’s critical…without treatment, Delusional Disorder may become a life-long condition.
Delusional Disorder treatment can be extremely challenging. Many humans living with this condition aren’t able to recognize how their minds have betrayed them, or the fact that they obviously need help.
Delusional Disorder is also ego-syntonic. What that means is that the poor suffering human doesn’t feel sick, and is extremely unlikely to self-advocate for treatment.
According to a 2015 reviewTrusted Source, we lack good research. There just isn’t enough on this rare disorder to establish an evidence-based protocol for treatment for Delusional Disorder.
In other words, there is no battle tested, go-to, science-based treatment. What seems to work is some combination of talk therapy and medication.
Cognitive Behavioral Therapy for psychosis (CBTp)
Treatment of psychosis symptoms such as delusions may involve a targeted process of Cognitive Behavioral Therapy known as CBTp.
CBTp incorporates the same principles as CBT but focuses on ways to live with delusions, aiming to reduce symptoms of distress and improve overall functioning. It’s a therapeutic approach that involves reducing the stigma surrounding psychosis.
Here are 9 things you must know about Delusional Disorder:
Types of Delusional Disorder: Delusional disorder can manifest in different types, based on the main theme of the delusions. These types include erotomanic (believing someone is in love with you), grandiose (having an inflated sense of your own self-importance), jealous (believing your spouse is unfaithful), delusions of persecution (feeling abused mistreated or harmed by others), atmospheric, (believing something is wrong or false in the world) somatic (believing in a physical illness), and mixed (having multiple types of delusions simultaneously).
Common Symptoms: The primary symptom of delusional disorder is the presence of delusions. People with this disorder often do not recognize that their beliefs are irrational or incorrect. Depending on the type of delusion, other symptoms may include anger, violent behavior, anxiety, or depression.
Onset and Demographics: Delusional Disorder typically emerges in middle to late adulthood, with an average onset age of around 40 years. Some types of Delusional Disorder may be more common in humans assigned male at birth (AMAB) or assigned female at birth (AFAB). Socially isolated populations, such as immigrants with language barriers, people with sensory impairments, and elderly humans, may be at a higher risk.
Prevalence: Delusional Disorder is exceedingly rare, with an estimated prevalence of 0.05% to 0.1% in the adult population.
Diagnosis: Diagnosis is based on the presence of delusions that persist for at least one month and cannot be attributed to other conditions. Differential diagnosis is arrives at by use of interviews, assessments, and potentially laboratory tests to rule out other causes of the symptoms.
Treatment: This is an entirely different sandbox than couples therapy. You’ll need a good psychiatrist familiar with this rare condition. Treatment typically involves a combination of psychotherapy (talk therapy) and medication. Psychotherapy can help individuals manage their symptoms and develop coping strategies. Medications, such as antipsychotics, may be prescribed to reduce the intensity of delusions and associated symptoms.
Prognosis: The outlook for Delusional Disorder is a YMMV situation. Successful outcomes vary, depending on the type and severity of delusions, adherence to treatment, and the human’s life circumstances. Many can maintain their daily functioning with treatment, but some humans may continue to experience relapses into delusional thinking.
Complications: If left untreated, Delusional Disorder can lead to complications with unwelcome co-morbidities, such as depression, social isolation. Legal issues (particularly for inter-personal conflicts), and self-harm or harm to others.are pressing concerns. While far less dangerous than other disorders, these humans need to be watched closely.
Support: Friends and family members can provide support to loved ones with Delusional Disorder by urging them to seek treatment, offering emotional support, and promoting a positive and peaceful home life. However one the abiding characteristics of this disorder, is patient resistance.
It's important to remember that Delusional Disorder is a mental health condition, and not a personality disorder.
Early intervention and treatment can lead to improved outcomes and a better quality of life for humans enduring Delusional Disorder. The earlier we deal with this the better…
Final thoughts…
Which is easier said than done. The real issue is psycho-education.
My client has already had 2 incidents involving the police, and has told his wife.. “Ever since before we even met in person…I knew you were grooming me to become the first foreign-born President of the United States.”
Recently my client attended a professional conference. He left early, but not before complaining that the reason he was leaving was because the panel discussion stage on which was was supposed to participate…was “all, entirely fake.”
He has made numerous comments about various real-life situations being staged for effect to a number of other folks already. His immediate circle is profoundly aware that he is decidedly unwell. It is clear that the dominant delusion he is suffering from is that the world we see is a deliberate lie.
This type of delusion is called atmospheric. The delusion is that the world we see is a false front for a hidden world. The other delusional element involves “going to Washington to save the world”, and being the first foreign-born President is obviously grandiose.
Mixed Atmospheric Delusional Disorder with Grandiose Features is certainly a mouthful…
But even though my client, in an awful irony, is a renowned neuroscientist, he has to hit rock bottom.
He was just informed that his medical license was suspended. But of course, he knows that’s completely fake…..
It’s so profoundly painful to watch. His wife has moved out… and the only advice she is getting from the medical establishment is to wait for him to publicly self-destruct, and then usher him to a facility for treatment.
Geez…. I speak with his wife most every day. This is an awful burden for her.
As their couples therapist, I needed to learn what was going on, to find someway to bring in resources.
Before this case I knew virtually nothing about Delusional Disorder. It’s not exactly a common topic in Marriage and Family Therapy.
Instead, I wound up learning that behind a word that we careless toss about and trivialize in public discourse, there is a real disorder, which is resistant to treatment, and utterly heartbreaking for all involved…
Be well, stay kind, and Godspeed.
Please note that some details have been altered to assure my clients anonymity, but he is a prominent neuroscientist.
REFERENCES:
Roudsari MJ, et al. (2015). Current treatments for delusional disorder.
https://link.springer.com/article/10.1007/s40501-015-0044-7
Foster C, et al. (2010). A randomized controlled trial of a worry intervention for individuals with persistent persecutory delusions.
https://www.sciencedirect.com/science/article/pii/S0005791609000585
González-Rodríguez A, et al. (2020). Addressing delusions in women and men with delusional disorder: Key points for clinical management.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344970/
