- Theo Manschreck, MD
Theo Manschreck, MD
- Professor of Psychiatry
- Harvard Medical School
Delusional disorder is characterized in DSM-5 as the presence of one or more delusions for a month or longer in a person who, except for the delusions and their behavioral ramifications, does not appear odd and is not functionally impaired . Prominent hallucinations and other psychotic or marked mood symptoms are absent. Nonprominent hallucinations and odd behaviors related to the delusional theme may be present.
Delusional disorder is not well studied relative to other psychotic disorders, such as schizophrenia and bipolar disorder. Much of the information in the sections on epidemiology, course, and treatment are drawn from small samples or based on clinical experience. Longitudinal and population-based studies are needed to better characterize the disorder, and clinical trials are needed to identify effective treatments.
This topic discusses the epidemiology, pathogenesis, clinical manifestations, course, diagnosis, and treatment of delusional disorder. Clinical manifestations, differential diagnosis, and initial management of psychoses are discussed separately. The epidemiology, pathogenesis, clinical manifestations, course, diagnosis, and treatment of delusional parasitosis, a delusional disorder of the somatic type, are described separately. (See "Clinical manifestations, differential diagnosis, and initial management of psychosis in adults" and "Delusional parasitosis: Epidemiology, clinical presentation, assessment and diagnosis" and "Treatment of delusional parasitosis".)
The lifetime morbid risk of delusional disorder has been estimated to range from 0.05 to 0.1 percent [2-4], based on data from various sources including case registries, case series, and population-based samples. The epidemiology of delusional disorders has not been studied in large, community-based samples. These findings and the DSM-5’s estimated lifetime prevalence of delusional disorder (0.2 percent)  are far lower than the estimated lifetime prevalence for other major psychotic disorders, such as schizophrenia (0.3 to 0.87 percent) and bipolar I disorder (0.24 to 0.6) . Rates of delusional disorder reported in samples of patients receiving mental health treatment have ranged from 0.5 to 1.2 percent [2,6,7].
Attempts to quantify incidence estimates (0.7 to 3.0/100,000) have been based on hospital admission data of uncertain accuracy .
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- Risk factors
- Comorbid conditions
- CLINICAL MANIFESTATIONS
- - Erotomanic type
- - Grandiose type
- - Jealous type
- - Persecutory type
- - Somatic type
- - Mixed type
- - Unspecified type
- Differential diagnosis
- - Efficacy
- Psychosocial interventions
- - Cognitive-behavioral therapy
- - Supportive psychotherapy
- Involuntary treatment
- SUMMARY AND RECOMMENDATIONS