- 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. Much of the information in the sections on epidemiology, course, and treatment is 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".)
Prevalence — The lifetime morbid risk of delusional disorder in the general population 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 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- Kendler KS. Demography of paranoid psychosis (delusional disorder): a review and comparison with schizophrenia and affective illness. Arch Gen Psychiatry 1982; 39:890.
- Munro A. Delusional Disorder: paranoia and related illness, Cambridge University Press, New York 1999.
- Manschreck TC. Delusional disorder and shared psychotic disorder. In: Comprehensive Textbook of Psychiatry, 7th ed, Kaplan HI, Sadock BJ (Eds), Williams and Wilkins, Baltimore, MD 2000. Vol 1, p.1243.
- Perälä J, Suvisaari J, Saarni SI, et al. Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry 2007; 64:19.
- Yamada N, Nakajima S, Noguchi T. Age at onset of delusional disorder is dependent on the delusional theme. Acta Psychiatr Scand 1998; 97:122.
- Grover S, Gupta N, Mattoo SK. Delusional Disorders: An overview. Germ J Psychiatr 2006; :62.
- Thewissen V, Myin-Germeys I, Bentall R, et al. Hearing impairment and psychosis revisited. Schizophr Res 2005; 76:99.
- Munro A, Mok H. An overview of treatment in paranoia/delusional disorder. Can J Psychiatry 1995; 40:616.
- Kendler KS, Walsh D. Schizophreniform disorder, delusional disorder and psychotic disorder not otherwise specified: clinical features, outcome and familial psychopathology. Acta Psychiatr Scand 1995; 91:370.
- de Portugal E, González N, Haro JM, et al. A descriptive case-register study of delusional disorder. Eur Psychiatry 2008; 23:125.
- Kendler KS, Masterson CC, Davis KL. Psychiatric illness in first-degree relatives of patients with paranoid psychosis, schizophrenia and medical illness. Br J Psychiatry 1985; 147:524.
- de Portugal E, Martínez C, González N, et al. Clinical and cognitive correlates of psychiatric comorbidity in delusional disorder outpatients. Aust N Z J Psychiatry 2011; 45:416.
- Maina G, Albert U, Badà A, Bogetto F. Occurrence and clinical correlates of psychiatric co-morbidity in delusional disorder. Eur Psychiatry 2001; 16:222.
- Marino C, Nobile M, Bellodi L, Smeraldi E. Delusional disorder and mood disorder: can they coexist? Psychopathology 1993; 26:53.
- Hsiao MC, Liu CY, Yang YY, Yeh EK. Delusional disorder: retrospective analysis of 86 Chinese outpatients. Psychiatry Clin Neurosci 1999; 53:673.
- Kelly BD. Erotomania : epidemiology and management. CNS Drugs 2005; 19:657.
- de Portugal E, González N, Miriam V, et al. Gender differences in delusional disorder: Evidence from an outpatient sample. Psychiatry Res 2010; 177:235.
- Hui CL, Lee EH, Chang WC, et al. Delusional disorder and schizophrenia: a comparison of the neurocognitive and clinical characteristics in first-episode patients. Psychol Med 2015; 45:3085.
- Poletti M, Sambataro F. The development of delusion revisited: a transdiagnostic framework. Psychiatry Res 2013; 210:1245.
- Manschreck TC, Petri M. The paranoid syndrome. Lancet 1978; 2:251.
- Manschreck TC. The assessment of paranoid features. Compr Psychiatry 1979; 20:370.
- Garety PA, Freeman D. The past and future of delusions research: from the inexplicable to the treatable. Br J Psychiatry 2013; 203:327.
- Morimoto K, Miyatake R, Nakamura M, et al. Delusional disorder: molecular genetic evidence for dopamine psychosis. Neuropsychopharmacology 2002; 26:794.
- Huber M, Kirchler E, Karner M, Pycha R. Delusional parasitosis and the dopamine transporter. A new insight of etiology? Med Hypotheses 2007; 68:1351.
- Oflaz S, Akyuz F, Hamamci A, et al. Working memory dysfunction in delusional disorders: an fMRI investigation. J Psychiatr Res 2014; 56:43.
- de Portugal E, González N, del Amo V, et al. Empirical redefinition of delusional disorder and its phenomenology: the DELIREMP study. Compr Psychiatry 2013; 54:243.
- Ibanez-Casas I, De Portugal E, Gonzalez N, et al. Deficits in executive and memory processes in delusional disorder: a case-control study. PLoS One 2013; 8:e67341.
- Bömmer I, Brüne M. Social cognition in "pure" delusional disorder. Cogn Neuropsychiatry 2006; 11:493.
- González-Rodríguez A, Molina-Andreu O, Navarro Odriozola V, et al. Suicidal ideation and suicidal behaviour in delusional disorder: a clinical overview. Psychiatry J 2014; 2014:834901.
- Opjordsmoen S. Long-term course and outcome in delusional disorder. Acta Psychiatr Scand 1988; 78:576.
- Manschreck TC. Delusional disorder. In: The Spectrum of Psychotic Disorders: Neurobiology, Etiology, and Pathogeneses, Fujii D, Ahmed I (Eds), Cambridge University Press, Cambridge 2007. p.116.
- Retterstol N. Prognosis In Paranoid Psychoses, Charles Thomas Publishers, Springfield, IL 1970.
- Opjordsmoen S. Delusional disorder as a partial psychosis. Schizophr Bull 2014; 40:244.
- Stephens JH, Richard P, McHugh PR. Long-term follow-up of patients with a diagnosis of paranoid state and hospitalized, 1913 to 1940. J Nerv Ment Dis 2000; 188:202.
- Hylwa SA, Foster AA, Bury JE, et al. Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic. Psychosomatics 2012; 53:258.
- Manschreck TC, Khan NL. Recent advances in the treatment of delusional disorder. Can J Psychiatry 2006; 51:114.
- Ungvári G, Vladár K. Pimozide treatment for delusion of infestation. Act Nerv Super (Praha) 1986; 28:103.
- Hamann K, Avnstorp C. Delusions of infestation treated by pimozide: a double-blind crossover clinical study. Acta Derm Venereol 1982; 62:55.
- Lepping P, Russell I, Freudenmann RW. Antipsychotic treatment of primary delusional parasitosis: systematic review. Br J Psychiatry 2007; 191:198.
- Grover S, Biswas P, Avasthi A. Delusional disorder: Study from North India. Psychiatry Clin Neurosci 2007; 61:462.
- Muñoz-Negro JE, Cervilla JA. A Systematic Review on the Pharmacological Treatment of Delusional Disorder. J Clin Psychopharmacol 2016; 36:684.
- González-Rodríguez A, Molina-Andreu O, Penadés R, et al. Effectiveness of long-acting injectable antipsychotics in delusional disorders with nonprominent hallucinations and without hallucinations. Int Clin Psychopharmacol 2014; 29:177.
- O'Connor K, Stip E, Pélissier MC, et al. Treating delusional disorder: a comparison of cognitive-behavioural therapy and attention placebo control. Can J Psychiatry 2007; 52:182.
- Skelton M, Khokhar WA, Thacker SP. Treatments for delusional disorder. Cochrane Database Syst Rev 2015; :CD009785.
- Myers E, Startup H, Freeman D. Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: a pilot trial. J Behav Ther Exp Psychiatry 2011; 42:330.
- Hepworth C, Startup H, Freeman D. Developing treatments of persistent persecutory delusions: the impact of an emotional processing and metacognitive awareness intervention. J Nerv Ment Dis 2011; 199:653.
- Roudsari MJ, Chun J, Manschreck TC, et al. Current treatments for delusional disorder. Curr Treat Options Psych 2015; 2:151.
- Risk factors
- Comorbid conditions
- First episode cases
- 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