Delusional disorder is very different from schizophrenia. The only thing they have in common is the presence of delusions. Schizophrenia is delusions, plus hallucinations, disorganized thoughts and behavior and other cognitive or thinking problems.
A delusion is a fixed false belief. Despite evidence that goes against what you believe, you still believe it. Delusions can be a part of other psychotic experiences like mania, depression and substance intoxication or withdrawal.
The delusions you see in schizophrenia tend to be bizarre in nature whereas the delusions you get with delusional disorder are non-bizarre and possible. An example of a bizarre delusion is believing that our insides are being replace while we sleep. A non-bizarre delusion is believing that a famous person is in love with you. It’s probably really unlikely, but it’s possible.
The main criteria for delusional disorder is that you have a delusion that lasts at least one month. There are certain personality disorders where people can experience very short-term psychotic experiences that last minutes to hours. You can see this with paranoid personality disorder and borderline personality disorder
But those very short, transient psychotic experiences would not be considered a delusional disorder.
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There are 6 types of delusions in delusional disorder.
1. Erotomanic type. This is when you believe that someone is in love with you.
2. Grandiose type. With this delusion, you believe that you have a great talent or insight that people just haven’t discovered yet or you’re on the verge of a big discovery.
3. Somatic. It involves delusional beliefs about body functions or sensations.
Common somatic beliefs are: you emit a foul odor, you’re infested by insects in your skin, you have a parasite in your body, or parts of the body are not functioning.
4. Jealous type. With this, the person believes their partner is unfaithful. They may see minor things like you have disheveled clothing as evidence of the infidelity.
5. Persecutory. With this type the person feels they are being conspired against, spied on or poisoned. The person may also feel like someone or some entity is holding them back from achieving a certain goal.
6. Mixed type. This is where no one specific theme predominates. You may have features of a few of the types.
These delusional themes can be present in illnesses that have delusions. For example mania can have grandiose delusions. With psychotic depression, people can have persecutory delusions.
Delusional disorder may not be obvious to other people. Because the delusions can be compartmentalized in a way that you can have normal functioning in every other aspect of your life that doesn’t involve the delusion.
Delusional disorder tends to remain stable over time, meaning it can intensify and cause problems or run quietly in the background of your mind. But, a small portion of people can go on to develop schizophrenia – not because it causes schizophrenia, but it may be more of what we call a prodrome to schizophrenia. A prodrome is an early stage of an illness where you can have some symptoms of a larger illness but not all of them. So in some people, delusional disorder can lead up to schizophrenia, but that’s not the usual.
If the disorder doesn’t cause a lot of dysfunction, you may not seek professional help for your beliefs. Since it doesn’t make you globally psychotic and out of touch, many people will just keep to themselves about their beliefs to reduce conflict.
Therefore, delusional disorder is something people can live with without seeking help. Sometimes the intensity of the belief can come and go such that you get less focused on it. Then under stress, the thoughts can ramp up again.
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