Delusional Disorder: DSM-5-TR Definition, Symptoms, and Treatments

Delusional Disorder is a serious mental health condition characterized by persistent delusions—strong beliefs in things that are not based in reality.1 Unlike other psychotic disorders such as schizophrenia, individuals with Delusional Disorder often function normally in many aspects of life, except for the impact of their delusions. According to the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision), Delusional Disorder is classified as a distinct psychiatric condition that requires specific criteria for diagnosis. Understanding the definition, symptoms, and treatment options for Delusional Disorder is crucial for effective management and improving quality of life for those affected.

How Does the DSM-5-TR Define Delusions?

Delusional Disorder, as defined by the DSM-5-TR, is a psychotic disorder characterized by the presence of one or more delusions lasting for at least one month. These delusions, which are fixed false beliefs, stand out because they persist despite clear evidence to the contrary. Unlike other psychotic disorders, individuals with Delusional Disorder do not typically exhibit other prominent psychotic symptoms such as disorganized thinking, hallucinations, or severely impaired functioning. 

Their behavior outside the delusional context often appears normal, allowing them to maintain daily activities and relationships. The DSM-5-TR sets specific criteria to differentiate Delusional Disorder from related conditions like schizophrenia, where delusions are usually accompanied by more severe cognitive and functional impairments. Understanding this disorder requires a clear distinction between the types of delusions experienced and how they affect an individual’s perception of reality.

What are the Main Symptoms of Delusional Disorder?

Non-Bizarre Delusions

In Delusional Disorder, the delusions are often non-bizarre, meaning they involve situations that could theoretically happen in real life. Examples include believing that one is being followed, loved by a famous person, or conspired against. These delusions are plausible but not true.

Lack of Other Psychotic Symptoms

Unlike other psychotic disorders, individuals with Delusional Disorder do not typically experience hallucinations, disorganized speech, or disorganized behavior. If hallucinations do occur, they are usually related to the delusional theme and are not prominent.

Intact Functioning Outside of Delusional Beliefs

Outside of their delusions, people with Delusional Disorder tend to have relatively normal thinking and functioning. Their day-to-day lives may remain relatively unaffected, unlike Schizophrenia, where functioning is more broadly impaired.

Subtypes of Delusions

The DSM-5-TR categorizes delusions into specific subtypes, which help clinicians identify the nature of the delusions:

  • Erotomanic: Belief that someone, often of higher status, is in love with the person.
  • Grandiose: Belief in having exceptional abilities, wealth, or fame.
  • Jealous: Belief that a partner is unfaithful without proof.
  • Persecutory: Belief that one is being mistreated, spied on, or plotted against.
  • Somatic: Belief related to bodily functions or sensations, such as the false belief of being physically ill or being infested with parasites.

Duration

    The delusions must last for at least one month, distinguishing Delusional Disorder from brief psychotic episodes or other short-term mental disturbances.

    How Does Delusional Disorder Compare to Schizophrenia

    While both Delusional Disorder and Schizophrenia fall under the category of psychotic disorders, they differ significantly in their symptoms and impact on functioning. In Delusional Disorder, the primary symptom is the presence of one or more delusions, fixed, false beliefs that persist despite contrary evidence, without the major impairments in thinking or behavior typically seen in schizophrenia. 

    People with Delusional Disorder often function relatively well in daily life outside of their delusional beliefs, whereas individuals with Schizophrenia experience a broader range of symptoms, including hallucinations, disorganized thinking, and significantly impaired cognitive functioning.2 Additionally, schizophrenia often involves negative symptoms such as diminished emotional expression and a lack of motivation, which are not characteristic of Delusional Disorder. The distinction made by the DSM-5-TR highlights that while delusions are a hallmark of both conditions, Schizophrenia is a more pervasive and disabling disorder affecting multiple areas of mental and emotional functioning.3

    Delusions Specific to Schizophrenia

    In addition to delusions known to occur across certain medical conditions, there are delusions specific to schizophrenia. Examples of these delusions and their symptoms include:4

    • Capgras syndrome: Belief that a loved one has been replaced by a double or alien that is not the person.
    • De Frégoli syndrome: A person believes they have met or know a person who is a stranger to them.
    • Cotard syndrome: A person believes they are dead or dying when they are not.

    These delusions can severely impact a person’s quality of life as well as their ability to interact with others.

    Treatments for Schizophrenia With Delusions

    Delusions can be difficult to treat because a person believes they are real. However, most doctors will treat them with medications known as antipsychotics.5 Examples of first-generation antipsychotics include:5

    • chlorpromazine
    • thioridazine
    • haloperidol
    • perphenazine

    There are also second-generation antipsychotics.5 These work slightly differently on the body, and are often the first line of treatments that doctors prescribe because they may have fewer side effects. Examples include:

    • Aripiprazole
    • Clozapine
    • Olanzapine
    • Quetiapine
    • Risperidone

    Unfortunately, antipsychotics can cause side effects. These include weight gain, glucose intolerance, and a set of symptoms called extrapyramidal movements, such as lip smacking.5 The symptoms may be very hard for a person to tolerate, which is why some people discontinue antipsychotics.

    Encouraging a person with schizophrenia to seek psychotherapy for their delusions can significantly enhance their medication adherence, which often helps to reduce their delusions.

    How is Delusional Disorder Treated and how does it Differ from how Schizophrenia is Treated?

    The treatments for delusional disorder and schizophrenia can oftentimes be similar although the treatment of Schizophrenia is typically more comprehensive and intensive due to the disorder’s broader range of symptoms, including hallucinations, disorganized thinking, and severe cognitive impairments. 

    Medications, particularly antipsychotics, are central to treatment, but higher doses or more potent medications are often necessary to control both hallucinations and delusions. Psychosocial interventions, including cognitive remediation therapy, are used to address cognitive deficits, and social skills training can help individuals with schizophrenia manage the functional impairments they face in everyday life. 

    Schizophrenia often requires a combination of medication, therapy, and ongoing psychiatric care to manage the disorder over the long term, whereas individuals with Delusional Disorder may experience more targeted treatment focused on their specific delusions and maintain higher levels of functioning outside of their beliefs.

    The key difference lies in the broader scope of symptoms in Schizophrenia, requiring a multi-faceted, long-term approach, while Delusional Disorder treatments are more focused on delusional beliefs and generally involve less intensive management of overall functioning.

    Want to know more about delusional disorder? Take an in-depth approach to learning through our Symptom Media Delusional Disorder education and training film.

    References:

    1Joseph SM, Siddiqui W. Delusional Disorder. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539855/

    2Impact of the DSM-IV to DSM-5 changes on the National Survey of Drug Use and Health. (2016). Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t20/

    3González-Rodríguez A, Seeman MV. Differences between delusional disorder and schizophrenia: A mini narrative review. World J Psychiatry. 2022 May 19;12(5):683-692. doi: 10.5498/wjp.v12.i5.683. PMID: 35663297; PMCID: PMC9150033.

    4Naguy A. Eponymous psychiatric syndromes revisited. Prim Care Companion CNS Disord. 2018;20(1):17br02195.

    4Munoz-Negro,  J. E. & Cervilla, J.A. (2016). A systematic review on the pharmacological treatment of delusional disorder. Journal of Clinical Psychopharmacology. 36(6): 684-690. Doi: 10.1097/jcp.000000000000595

    Beth A. Pratt earned a Doctor of Philosophy in nursing and Master of Science in nursing education from Florida Atlantic University, a Master of Science in forensic science from Florida International University, a Bachelor of Science in nursing from Johns Hopkins University, a Bachelor of Arts in biology from St. Olaf College and a Second Major in Spanish from St. Catherine University. Dr. Pratt began her career in labor and delivery and had the opportunity to nurse in other areas, including public health, infertility, antepartum home health, and nursing education. Dr. Pratt is passionate about holistic health and conducts research on complementary interventions to enhance wellness.

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