S.M.

Nazmul Al-Deen
RN, BSN(DNC), MSS in CSW(DU)
[Link]@[Link]
Delusion

Definition:

A delusion is a fixed, false belief that is firmly maintained despite clear and obvious evidence to
the contrary. It is not influenced by culture, education, or intelligence, and the individual is
unable to alter the belief even when confronted with contradictory facts (American Psychiatric
Association, 2013). Delusions are a hallmark of psychotic disorders but can also occur in mood
disorders, neurological diseases, and substance-related conditions.

Types of Delusions:

Delusions can be categorized based on their content and nature. The major types include:

1. Persecutory Delusions
 The belief that one is being harassed, threatened, or conspired against by others.
 Example: Believing that coworkers are plotting to harm or sabotage the
individual.
2. Grandiose Delusions
 The belief that one has exceptional abilities, wealth, fame, or importance.
 Example: Believing that one is a famous historical figure or has supernatural
powers.
3. Referential Delusions
 The belief that neutral events, objects, or people are directly related to or sending
messages to the individual.
 Example: Thinking that news reports or billboards contain hidden messages
meant specifically for the person.
4. Erotomanic Delusions
 The belief that someone, often of higher status, is in love with the individual.
 Example: Believing that a celebrity is secretly in love with the person.
5. Nihilistic Delusions
 The belief that a major catastrophe is imminent, or that one’s body or the world
does not exist.
 Example: Thinking one’s organs have stopped functioning or the world has
ended.
6. Somatic Delusions
 The belief that one has a physical defect, illness, or infestation despite no medical
evidence.
 Example: Believing there are insects crawling under one’s skin or that an organ is
missing.
7. Jealous Delusions
 The belief that a partner or spouse is being unfaithful without justification or
evidence.
 Example: Constantly suspecting a partner of cheating, even in the absence of
signs.
 S.M. Nazmul Al-Deen
RN, BSN(DNC), MSS in CSW(DU)
[Link]@[Link]

8. Mixed Delusions
 A combination of two or more types of delusions without one being predominant.
9. Bizarre Delusions
 Beliefs that are implausible and not derived from ordinary life experiences.
 Example: Believing aliens have replaced one’s brain with a robotic device.
10. Non-Bizarre Delusions

 Beliefs that are false but plausible in real life.

Risk Factors for Delusions:

Several factors contribute to the development of delusions across psychiatric, medical, and
environmental contexts:

1. Psychiatric Disorders
 Schizophrenia: Delusions are a core symptom, often alongside hallucinations and
disorganized thinking.
 Schizoaffective Disorder: Delusions occur with mood disturbances.
 Delusional Disorder: Characterized by persistent delusions without other
psychotic symptoms.
 Bipolar Disorder and Major Depression: Mood-congruent delusions can appear
during manic or depressive episodes.
2. Neurological Conditions
 Disorders affecting the brain, such as temporal lobe epilepsy, brain tumors,
traumatic brain injury (TBI), and neurodegenerative diseases (e.g., Parkinson’s
disease, Alzheimer’s disease).
3. Substance Use and Withdrawal
 Chronic use of substances like methamphetamine, cocaine, alcohol, and
hallucinogens can trigger delusions.
 Withdrawal from alcohol or benzodiazepines can also induce paranoia or
persecutory delusions.
4. Genetic Predisposition
 A family history of psychotic disorders increases the risk of delusions. Shared
genetic vulnerabilities contribute to psychiatric illnesses.
5. Cognitive Impairments
 Impaired executive functioning, attention deficits, and reasoning abnormalities
make individuals more prone to delusions.
6. Environmental and Psychosocial Stressors
 Prolonged stress, trauma, social isolation, or significant life events may trigger
delusions.
 Migration, low socioeconomic status, and adverse childhood experiences are
contributing factors.
 S.M. Nazmul Al-Deen
RN, BSN(DNC), MSS in CSW(DU)
[Link]@[Link]

7. Medical Conditions
 Metabolic disorders, endocrine dysfunctions (e.g., thyroid disease), infections
(e.g., encephalitis), and autoimmune diseases can induce delusional thinking.
8. Sensory Impairments
 Hearing loss and vision impairment may lead to misinterpretations of stimuli,
triggering delusions.
9. Sleep Deprivation
 Severe sleep disruption can impair cognition, leading to transient delusions.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: American Psychiatric Publishing.

Freeman, D., & Garety, P. A. (2000). Cognitive approaches to delusions: A critical review of
theories and evidence. British Journal of Clinical Psychology, 39(2), 173–195.
[Link]

Kiran, C., & Chaudhury, S. (2009). Understanding delusions. Industrial Psychiatry Journal,
18(1), 3–18. [Link]

Miller, T. J., McGlashan, T. H., Rosen, J. L., Cadenhead, K., Ventura, J., McFarlane, W., ... &
Cannon, T. (2003). Prodromal assessment with the structured interview for prodromal syndromes
and the scale of prodromal symptoms: Predictive validity, interrater reliability, and training to
reliability. Schizophrenia Bulletin, 29(4), 703–715.
[Link]

Owen, M. J., Sawa, A., & Mortensen, P. B. (2016). Schizophrenia. The Lancet, 388(10039), 86–
97. [Link]

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Spitzer, M. (1990). On defining delusions. Comprehensive Psychiatry, 31(5), 377–397.