Carefully Treating Delusional Disorder

One disorder that the psychiatric profession finds hard to diagnose and treat, is delusional disorder. Diagnosis is difficult because delusions are considered “non-bizarre,” meaning the patient’s beliefs might theoretically be plausible, and they often function in the world. The person may not believe they have a problem, and since the most common form of the illness creates paranoia, they often refuse to find a therapist at all. Even if they do, the doctor can’t prescribe any drug products, since the delusion usually convinces the person that someone is “out to get them”. Hospitalization, too, would only reinforce that belief.

While paranoia is the most common manifestation, there are other types of delusional disorders as well, such as believing one is the secret love interest of a famous person, being convinced one has extraordinary abilities or is very important, worrying about physical problems or disfigurements that don’t exist, or believing that one’s romantic partner is unfaithful. Mental health treatment is often refused because of these convictions, which are impervious to any sort of disproof. The patient is convinced they are correct; meaning there is nothing to treat.

Medically, only a few current treatments have an effect on this disorder; therefore, the primary type of treatment will be psychosocial. And the best treatments will be indirect, with the therapist perhaps offering depression and anxiety panic treatments instead, since those may also be symptoms of the disorder.

The worst thing a therapist can do for a paranoid, suspicious patient is confront them directly about their delusions. They need time to build up some trust, and only then would the doctor begin gently challenging a few of the patient’s beliefs. Drugs would only be used if the patient’s delusional disorder was becoming dangerous or the condition was making them too agitated.

Therapists who are ready to use slightly different treatments, rather than adopt the more usual drugs or typical psychotherapy approaches, may gain the patient’s trust enough to begin exploring any doubts the person expresses about their own beliefs. The two of them can work in partnership, gradually discovering real-world explanations for those beliefs. If the therapist treads carefully and uses tactfully, then the two together may work through the delusional disorder and affect a cure.

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