Delusions: Types, Causes, & Related Disorders

What Are Delusions?

Delusions are false beliefs or ideas that aren’t based in reality but are held with strong conviction, even when presented with evidence they are untrue.^2,3,4 Having repeated delusions is a hallmark symptom of psychosis, which is an inability to accurately perceive reality.^1,2 Delusions can occur with or without other psychotic symptoms like hallucinations or disorganized thinking or speech.¹

What are Delusional Disorders?

When delusions persist for a month or more, it can be a sign that someone is suffering from delusional disorder, an uncommon type of psychotic disorder.^1,3 Delusional disorders are only diagnosed when delusions are the primary symptom a person experiences, and when the delusions cannot be attributed to another disorder.¹

In order to be diagnosed with this condition, a person’s delusions cannot be attributed to one or more of the following conditions:^1,3,4,5,6. It is much more common to have delusions as one of the symptoms in the following conditions than it is to have them as a sole issue.

• Major depressive disorder with psychotic features which usually involves delusions during severe depressive episodes
• Bipolar disorder with psychotic features or during manic episodes, where a person experiences increased energy, impulsivity, and euphoric mood
• Obsessive compulsive disorder or obsessive compulsive personality disorder which can cause irrational thoughts and worries that are obsessive in nature. Many people with OCD have a sense that their fixed thoughts are not based in reality, but still feel compelled or driven by them.
• Personality disorders that cause abnormal mood, thoughts, behaviors, and interpersonal patterns (especially schizoid, paranoid, avoidant, and narcissistic)
• Substance use disorders where delusions are often a result of the effects of using mind and mood altering drugs
• Brief psychotic disorder or delirium, which both involve a temporary state of confusion or psychosis, often in response to stress, change, or traumatic events
• Schizophrenia or schizoaffective disorder (which includes symptoms of both schizophrenia and bipolar disorder)
• Neurological issues or conditions like Alzheimers, Parkinson’s disease, dementia or traumatic brain injuries

Categories of Delusions

In the DSM 5 (the reference guide most often used to diagnose mental illnesses), there are 4 main categories of delusions. These categories can help to identify the cause of the delusions, including helping clinicians make an accurate diagnosis of a mental health disorder. They can also help determine what is a delusion vs a strongly held belief, idea, or value.

The 4 categories of delusions are:^1,4

1. Bizarre delusions: Bizarre delusions are odd, strange, and unrealistic in nature.  Examples include believing in alien abductions, supernatural powers, or that a person has visited a parallel universe.
2. Non-bizarre delusions: Non-bizarre delusions are more realistic in nature, but still unlikely to occur. They can include beliefs about being followed, poisoned or stalked.
3. Mood congruent delusions: Mood congruent delusions occur during times when people experience strong emotions. Examples include experiencing paranoid delusions when having anxiety or grandiose delusions during a manic episode.
4. Mood-neutral delusions: Mood-neutral (also called mood-incongruent) delusions don’t only occur during times when a person is having strong emotions or under a lot of stress. These delusions can seem to come “out of nowhere” and may be a sign of a neurological, psychotic, or delusional disorder.

Types of Delusions

Delusions can come in many forms, but there are some types of delusions that are more common than others. The most common delusions often have themes that either reflect strong emotions someone feels or beliefs or ideas they’ve been exposed to.^3,4 Below are some of the more common types of delusions that some people experience.

Grandiose Delusions

Delusions of grandeur, or grandiose delusions, center around an inflated sense of self.^1,3,4,7 People with grandiose delusions may believe they are superior to others or possess special abilities or talents. Some delusions of grandeur are extreme, and include religious delusions about being chosen by God or having supernatural abilities.⁴ During a manic episode, someone with bipolar disorder may become overconfident in their abilities and talents, leading to reckless acts.¹

Persecutory Delusions

Persecutory delusions are sometimes called paranoid delusions because they often involve beliefs of being hunted, followed, or targeted by someone or something.⁴ Examples of delusions that are persecutory include beliefs about someone trying to poison, kill, or cast evil spells on them. They may have surveillance delusions, and believe that a device or person is watching and tracking them. Paranoid and persecutory delusions can take many forms, but all involve a strong belief and fear of being attacked, targeted or threatened.⁷

Jealous Delusions

Jealous delusions usually involve a belief that a romantic or sexual partner is cheating or being unfaithful.^1,4,7 While jealous feelings are normal and something most people have experienced, jealous delusions are often recurring, intense, and very distressing. These types of delusions may occur in people without serious mental illnesses, but who instead struggle with insecurities, sexual dysfunctions, or codependence.⁴

Somatic Delusions

Somatic delusions often involve fears about a medical problem or underlying physical health issue.^1,4,7 For example, a person with OCD may develop intrusive thoughts and fears about having a specific disease, and spend hours researching symptoms and consulting with specialists. Other somatic delusions may involve beliefs about being infested with bugs or parasites, being pregnant, or something being wrong with a certain body part.^4,7

Erotomanic Delusions

Erotomanic delusions involve unfounded beliefs about infatuation and love. Usually, someone with erotomanic delusions believes that someone else is in love with them. This may be a person they are casually acquainted with, or it could be someone they’ve never met. A common erotomanic delusion is a person believing that a celebrity is secretly in love with them. These kinds of delusions can sometimes escalate into aggressive, jealous, or even illegal actions like stalking or harassment.^4,7

Religious Delusions

Religious delusions are sometimes misdiagnosed, and are instead the result of strongly held religious or spiritual beliefs or a person’s culture.^1,4,7 For example, there are some cultures that believe in witchcraft or voodoo, which are less common beliefs in Western cultures. Some people experience religious delusions that involve believing that God, Satan, or other entities are speaking to them, controlling them, or have a secret plan or purpose for them.

Guilty Delusions

Guilty delusions often stem from regrets or feelings of shame about a past mistake or action. One example is a person who is convinced they are going to hell or being punished because of certain bad deeds or ‘sins’. People with guilty delusions may struggle with depression, shame or low self-esteem, and may believe they’re bad or evil people who aren’t deserving of kindness. ⁴

Nihilistic Delusions

Nihilistic delusions involve beliefs that there is no meaning or point in life, or cynical beliefs about a person’s own existence. For example, a person with nihilistic delusions may be convinced that they do not really exist or that their life isn’t real. ^4,7 They may believe that their reality is artificially constructed, similar to what’s portrayed in the movies the Matrix or the Truman Show. Other nihilistic delusions may involve a true belief that they are already deceased or that their soul has left their body.⁴

Other Types of Delusions

There are instances where people experience ‘mixed’ delusions, or more than one type of delusion.¹ There are other instances where the delusions don’t fit into one of the common categories listed above.

Some of the other types of delusions that may be experienced by people include:^1,3,7

• Bizarre delusions: Delusions involving strange or unrealistic ideas, like beliefs about parallel dimensions, extraterrestrial origins, or monsters. Other bizarre delusions may involve strong beliefs that certain extraordinary things happened to them in the past, like that they had a brain or alien microchip implanted as a child.
• Thought broadcasting: delusions that involve a belief that other people can hear their thoughts or read their minds. Thought broadcasting can also involve the belief that a person can communicate telepathically with others or that their thoughts can be broadcast through devices or machines.
• Thought insertion or thought withdrawal: delusions that involve the belief that other people, objects or entities are ‘inserting’ thoughts into their mind, as in a form of mind control. Thought withdrawal delusions involve the belief that thoughts are being or have been taken or extracted from the mind.
• Thought control: The belief that someone or something is exerting control over their thoughts or that their thoughts, feelings, and ideas are not their own. These delusions often involve the belief that the person has no ability to control their thoughts, feelings, or actions.
• Delusions of reference: Reference delusions involve irrational beliefs about a secret connection between unrelated events, objects, people, or situations. Finding hidden connections is a common theme in delusions of reference, and may involve believing that they are receiving coded or secret messages from TV or other media.

Causes of Delusions

Most people who experience persistent delusions are suffering from an underlying physical or mental health issues or a neurological condition.^1,3,4 Delusions are more common in people with mood disorders, psychotic disorders, substance use and personality disorders. In some instances, delusions can occur in response to high levels of toxic stress, trauma, or sudden and distressing life changes. ^3,5,6

Genetic makeup and personality traits can make some people more prone to psychotic symptoms, including delusions.⁶ Also, people who experienced certain types of childhood trauma are more likely to develop psychiatric conditions known to cause delusional thinking.⁸ In many cases, delusions may even be an attempt to cope or make sense of these events.^3,4

Some experts theorize that delusions are a result of faulty logic or errors in thinking, like linking unrelated events together in an attempt to organize information or make sense of experiences.⁴ Cultural factors can also cause differences in the way people perceive reality. People who immigrate from other countries are more likely to report delusional thoughts, which may actually be a result of their culture, and not a sign of a mental illness.³

How to Help Someone With Delusions

It’s usually not a good idea to try to stage an intervention with someone experiencing delusions. Trying to confront them, challenge them, or prove them wrong is unlikely to change their beliefs, and more likely to agitate them. In some cases, these kinds of confrontational approaches (even from loved ones) can further isolate the person, worsen their delusions, and cause them to experience more severe psychotic symptoms.⁷

Expressing concern for them is usually the best way to initiate a conversation with them about their mental health. Use a non-judgemental approach and try to avoid debating or challenging their delusional ideas.⁷ If possible, encourage them to seek out counseling or talk to a mental health professional, but try not to do this in a way that seems like you’re calling them crazy. For example, express concern about their stress levels or mention that therapy has really helped you.

If you have reason to believe they’re unsafe (a danger to themselves or others), it may be necessary to involve the officials or initiate an involuntary commitment order (IVC order). Always use this as a last resort, and remember that seeking treatment on a voluntary basis is the most ideal outcome. In most states, you can initiate an IVC order by going to your local magistrate’s office. If there’s an immediate danger, call 911 and request a CIT trained officer, which is a police officer who has received special treatment in handling mental health crises.

Treatment for Delusions

Someone experiencing delusions is usually in need of immediate mental health treatment. If the delusions are leading to dangerous or harmful behaviors (like suicidal, homicidal, or aggressive behavior), some may even require inpatient treatment. Many people with persistent delusions are suffering from a serious underlying mental health issues, which may require long term therapy as well as psychiatric medication.⁵

Because there are so many different kinds of mental health conditions that can cause delusions, it’s important for a person to receive a full diagnostic evaluation. The type of treatment needed depends on the underlying cause or condition causing the delusions. In many instances, a combination of medication and therapy is effective at managing symptoms of psychosis. In some cases, treatment can even help someone experiencing delusions make a full recovery.³

Most people begin this process by finding a therapist, using an online therapist directory, or visiting a local mental health inpatient or outpatient clinic. It’s important to find a therapist who is experienced in treating delusions and if needed, has crisis support at their agency (like a 24 hour crisis line, on-site psychiatrist, or more intensive levels of care).

Final Thoughts

Delusions are false, irrational, but strongly held ideas or beliefs.^1,2,3,4 Delusions are sometimes caused by high levels of stress, anxiety, or traumatic experiences, but are often a sign of a more serious mental illness.¹ If you or someone you care about is experiencing delusions, it’s a good idea to seek treatment right away, which may involve a combination of inpatient or outpatient therapy and medication.⁵