Schizophrenia Delusions: Definition, Types, and Treatments

Schizophrenia Can be Classified Into Three Categories.

Schizophrenia is a complex and chronic mental health disorder characterized by a range of psychotic symptoms, including delusions, hallucinations, and disorganized thinking.

Schizophrenia symptoms are classified into three categories:

  1. Positive symptoms: abnormally present
  2. Negative symptoms: abnormally absent
  3. Disorganized symptoms: confused and disordered behavior and thinking

What are the positive symptoms of schizophrenia?

Positive symptoms of schizophrenia are those that represent an excess or distortion of normal functions. These include delusions, which are false beliefs that persist despite contrary evidence, and hallucinations, where individuals perceive things that are not actually present, such as hearing voices or seeing things that are not real. Disorganized thinking and speech can also fall under positive symptoms, as these reflect a significant disruption in the person’s ability to interpret reality.

What are the negative symptoms of schizophrenia?

Negative symptoms refer to the absence or reduction of normal behaviors and emotional responses. Common negative symptoms in schizophrenia include diminished emotional expression, such as flat affect, where a person shows little to no emotion. Other negative symptoms involve social withdrawal, lack of motivation, decreased speech, and difficulty in performing everyday tasks. These symptoms can significantly impair a person’s ability to function independently and are often more challenging to treat than positive symptoms.

What are the disorganized symptoms of schizophrenia?

Disorganized symptoms include confused and disordered thoughts and speech, irrational thinking, atypical behavior, and abnormal movements.

What are delusions?

Schizophrenia delusions are positive schizophrenia symptoms that cause a person to believe something that is not true, even when others try to tell them or show them their beliefs are untrue.1 Specifically, the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision (DSM-5-TR), defines delusions as “fixed beliefs that are not amenable to change in light of conflicting evidence.” The DSM-5-TR names delusions as one of the five key criteria mental health experts use to diagnose schizophrenia.

What are common delusions experienced by people with schizophrenia?

There are several types of delusions commonly experienced by individuals with schizophrenia. A person can experience multiple delusion types. Each type represents a distinct pattern of false beliefs, often reflecting distorted perceptions of reality. Healthcare professionals may call delusions “bizarre” if they are so implausible that they are difficult to understand or interpret. Here are the main types of schizophrenia delusions:

Paranoid Delusions (Persecutory Delusions)

Paranoid delusions are the most common schizophrenia delusion. Individuals believe they are being targeted, harassed, or plotted against by others. They may think that others are spying on them, poisoning them, or trying to harm them in some way.

Examples of paranoid schizophrenia delusions may include:

  • ”The FBI is following me.”
  • ”My spouse is trying to poison me.”
  • “My family is pumping medicine through the air conditioner to try and make me look crazy.”

Grandiose Delusions

Individuals with grandiose delusions have an exaggerated sense of their importance, abilities, or identity. They may believe they possess special powers, are famous, or are chosen for a great mission, like being a celebrity, deity, or political figure.
Someone might believe they are a world-famous scientist who is the only one capable of saving humanity or that they are a divine figure with supernatural powers.

Referential Delusions (Delusions of Reference)

These delusions involve believing that ordinary events, gestures, or comments are directly related to the person. For example, someone might believe that a news anchor is speaking directly to them through a broadcast or that a billboard contains a hidden message meant just for them.

Somatic Delusions

Individuals with somatic delusions believe something is wrong with their bodies. This could involve a belief that they are ill, have a severe disease, that their organs are malfunctioning, or that they have a physical defect that is nonexistent or exaggerated A person may believe they have a severe disease, like believing their intestines are rotting or that their skin is infested with parasites, despite medical evidence proving otherwise.

Erotomanic Delusions

In this type of delusion, a person believes that another individual, often someone of higher status or a stranger, is in love with them. This can lead to obsessive behavior or attempts to contact the person. For example, a person might believe that a famous movie star is secretly in love with them and is sending them hidden love messages through television interviews or social media posts.

Nihilistic Delusions

Individuals with nihilistic delusions believe that a major catastrophe is about to occur, or that parts of their body or even the entire world do not exist. These delusions are often linked to feelings of despair and hopelessness. Someone might believe that the world is ending soon, or that they have lost all their internal organs and are merely an empty shell.

Control Delusions

In control delusions, individuals believe that their thoughts, feelings, or actions are being controlled by external forces, such as an outside entity or another person. This can include beliefs that their mind is being read or manipulated. A person might believe that aliens or the government are controlling their thoughts or movements through invisible technology implanted in their brains.

 

Schizophrenia Delusions Treatments

Healthcare professionals may have a hard time helping a person treat delusions because the person does not recognize their thoughts or beliefs are incorrect. Examples of pharmacological and non-pharmacological treatments used to treat schizophrenia delusions include:

Non-pharmacological Treatments

  • Cognitive behavioral therapy – Cognitive behavioral therapy (CBT) is a structured, goal-oriented form of psychotherapy that helps individuals with schizophrenia challenge and modify negative thoughts, beliefs, and behaviors associated with delusions and hallucinations. By learning to reframe irrational thoughts and develop healthier thinking patterns, patients can reduce the distress caused by symptoms and improve coping strategies. CBT also promotes reality testing, helping individuals recognize when their perceptions may not align with reality.
  • Group therapy – Group therapy provides individuals with schizophrenia a supportive environment where they can share experiences and learn from others who face similar challenges. Led by a trained therapist, group sessions offer social interaction and peer support, which can reduce isolation and foster a sense of community. This therapeutic setting also allows participants to practice communication and social skills, while learning coping strategies to manage their symptoms in everyday life.
  • Social skills therapy – Social skills therapy focuses on improving the interpersonal abilities of individuals with schizophrenia. This therapy teaches essential social behaviors such as effective communication, listening, conflict resolution, and relationship-building. Through role-playing, modeling, and reinforcement techniques, individuals learn how to navigate social situations, which can improve their relationships and reduce feelings of isolation. Enhanced social competence can lead to better community integration and improved quality of life.
  • Vocational/employment rehabilitation – Vocational rehabilitation helps individuals with schizophrenia develop the skills necessary to obtain and maintain employment. This therapy provides job training, career counseling, and support for workplace adaptation. By addressing both the cognitive and social challenges associated with schizophrenia, vocational rehabilitation enables individuals to achieve greater independence and contribute to society. It also helps build self-esteem and offers structure, which can be beneficial in managing symptoms.

Non-pharmacological treatments are important in treating schizophrenia and delusions because traditionally patients with schizophrenia have poor adherence to their medications.4 Using non-pharmacological approaches can help improve treatment adherence.

Pharmacological Treatments

  • First-line treatments for maintenance are second-generation atypical antipsychotics, such as aripiprazole, risperidone, and ziprasidone.
  • First-generation typical antipsychotics, such as chlorpromazine and haloperidol, usually cause more severe symptoms and are not first-line treatments.
  • Doctors may prescribe clozapine, a second-generation atypical antipsychotic, for treatment-resistant schizophrenia. This medication can cause more side effects than other antipsychotics (including increased risks for seizures).

When a mental health professional is establishing a therapeutic environment with a client who experiences delusions, they must recognize how the delusion may make their client feel. Some clients may find their delusion is scary or makes them feel unsafe. While they should not validate the delusion, validating how the delusion makes the client feel is important.

Symptom Media’s accredited CE course includes an in-depth discussion of these delusions as well as pharmacological and non-pharmacological treatments.

 

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), 5(5). https://doi.org/10.1176/appi.books.9780890425787 

Fariba, K., & Fawzy, F. (2022, September 26). Delusions. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563175/ 

Jauhar, S., Johnstone, M., & McKenna, P. J. (2022). Schizophrenia. The Lancet, 399(10323), 473–486. https://doi.org/10.1016/s0140-6736(21)01730-x 

National Institute of Mental Health. (2024, April). Schizophrenia. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/schizophrenia 

Torres, F. (2024, March). What is schizophrenia? American Psychiatric Association. https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia 

Elissa Singson, MSN, APRN, PHN, CPNP-AC is an infectious disease pediatric nurse practitioner, health writer, and mother of two. She writes content to empower healthcare professionals, patients, and families with health and medical knowledge. She also loves to share tips on work productivity and efficiency to prevent healthcare provider burnout.

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