Delusional Disorder: DSM-5-TR definition, symptoms, and treatments

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Delusions are a common feature of schizophrenia, a severe mental illness that can cause a person to lose touch with reality. Delusions are one of five major criteria for schizophrenia as outlined in the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision or DSM-5-TR.1

While there are different delusional disorder symptoms that a person can experience, this article will highlight the subject of our learning, which is delusions associated with schizophrenia. By participating in this course, you can learn about delusions, their symptoms, and how medical providers use pharmacological and non-pharmacological treatments for delusions.

How Does the DSM-5-TR Define Delusions?

The DSM-5-TR has a specific criteria for delusions, which are “fixed beliefs that are not amenable to change in light of conflicting evidence.”1 For a doctor to diagnose a person with schizophrenia, they must experience some form of delusions.

However, there are different types of delusions. Examples of these delusional disorder types include:2

  • persecutory delusions: The most common delusion type associated with schizophrenia, these delusions cause a person to believe they are going to be harassed or otherwise harmed by an individual, group, or other organization.
  • referential delusions: Another common delusion type in schizophrenia, these delusions cause a person to believe that gestures, comments, or environmental cues are directed at the person. A person with referential delusions may appear very paranoid, such as if they hear people laughing, they assume people are laughing at them.
  • grandiose delusions: These are delusions when a person believes they are exceptionally famous, wealthy, or has special abilities.
  • erotomanic delusions: These are delusions where a person falsely believes another person is in love with them.
  • nihilistic delusions: These are delusions where a person believes that a major disaster, such as the end of the world, will occur.
  • somatic delusions: These are delusions where a person is very concerned with their body and health, such that they believe something is always wrong or going on with them, even though a doctor can find nothing physically wrong.

It’s possible that a person with schizophrenia can have different types of delusions.2

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:1

  • Capgras syndrome: Belief that a loved one has been replaced by a double or alien that is not the person.
  • Fregoli syndrome: A person believes they have met or know a person who is a stranger to them.
  • Cotard’s 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 by definition, a person believes they are real. However, most doctors will treat them with medications known as anti-psychotics.3 Examples of first-generation anti-psychotics include:3

  • chlorpromazine
  • thioridazine
  • haloperidol
  • perphanazine

There are also second-generation anti-psychotics.3 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, anti-psychotics can cause side effects. These include weight gain, glucose intolerance, and a set of symptoms called extrapyramidal movements, such as lip smacking.3 The symptoms may be very hard for a person to tolerate, which is why some people try to discontinue anti-psychotics.

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

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

Written by Rachel Nall, RN, MSN, CRNA