Delusions are beliefs that persist despite evidence to the contrary. They are often associated with mental health conditions such as schizophrenia, bipolar disorder, or severe depression. Delusions can encompass a wide range of topics and are resistant to logical reasoning or contradictory evidence.
People with delusions may believe that they are being persecuted, monitored, or controlled by external forces or that they have special abilities or powers. These beliefs can be distressing and disruptive to daily life.
Delusions can be either bizarre or non-bizarre and can range from mild to severe. Bizarre delusions are characterized as beliefs about something that can never happen, e.g., the belief that an individual has been abducted and cloned by aliens.
Non-bizarre delusions, however, are beliefs that could be true, such as the belief that an individual is being stalked, that someone is in love with them, or a spouse is cheating on them.
What is Delusional Disorder?
Delusional disorder is a condition characterized by persistent non-bizarre delusions lasting at least one month (Joseph & Siddiqui, 2023). These reality-impairing beliefs could feasibly occur in real life but remain firmly held despite evidence to the contrary.
Often, with delusional disorder, the individual will socialize and function according to social norms and generally does not behave in an unusual manner, making this condition difficult to recognize from an outsider’s perspective.
Types of delusions
Many different types of delusions can be experienced, some of which include:
Erotomanic
The false belief that another person, often someone famous or of higher status, is in love with the individual.
Grandiose
The belief that the individual has an over-inflated sense of worth, knowledge, wealth, talent, power, or fame, despite a lack of evidence.
Persecutory
The belief that the individual, or someone close to them, is being spied on, followed, drugged, cheated on, or mistreated.
Jealous
The belief that a romantic partner or spouse is being unfaithful, despite a lack of evidence to prove this.
Somatic
The belief that the individual is experiencing physical sensations, bodily dysfunctions, or suffering from a medical condition.
Mixed
When the delusions being experienced do not fall into a single category, or there are two or more types of delusions being experienced, this would be labeled as having mixed or unspecified types of delusions.
Examples of common delusions
To better understand what delusions can look like in everyday life, here are some examples linked to different types:
- Erotomanic Example:
Believing a famous actor is secretly sending love messages through television broadcasts. - Grandiose Example:
Believing you have discovered a cure for all diseases or are chosen by a divine entity to lead humanity. - Persecutory Example:
Thinking that neighbors are spying on you through hidden cameras planted inside your home. - Jealous Example:
Becoming convinced that a spouse is meeting with a secret lover during lunch breaks, despite no signs of infidelity. - Somatic Example:
Being absolutely certain that insects are living under your skin, even after medical tests show no evidence. - Mixed Example:
Believing both that you have a special healing power and that government agents are trying to suppress your abilities.
Causes and Risk Factors
Although there is currently no concrete explanation for what causes delusions, researchers have some ideas as to potential causes or risk factors that may contribute to the onset of delusions.
Genetics
Genetics may play a part in someone developing delusions since it is more common that those with family members with a psychotic disorder with delusions are likely to develop delusions themselves.
For instance, a parent with a delusional disorder or schizophrenia is more likely to have a child who also develops one of these conditions.
Sensory impairments
Delusional disorder tends to be more common among those with impaired vision or hearing.
If someone has problems with vision or hearing, they may be more likely to rely upon inaccurate perceptions of reality if they are less able to see things for how they are, although this is not the case for most of those with these impairments.
This is not to say that everyone with sensory impairments will experience delusions, and not everyone with delusional disorder also has sensory impairments.
Biological causes
Some research suggests that changes in the brain’s structure and chemistry could help explain why delusions happen.
For example, Joyce (2018) found that people who had strokes affecting the right lateral prefrontal cortex — an area connected to the basal ganglia and the limbic system — were more likely to develop delusions.
This part of the brain also receives signals from dopamine neurons, and dopamine is a chemical that plays a big role in motivation, pleasure, and reward.
When dopamine levels are disrupted, it’s been linked to conditions like schizophrenia and psychosis, suggesting that faulty dopamine signaling might contribute to the development of delusions.
Another study by Devinsky (2009) looked at how damage to the brain’s frontal lobes, particularly on the right side, could lead to delusions.
The researchers suggested that when the right side of the brain is damaged, it can cause the left hemisphere (especially areas linked to language) to overcompensate.
In this case, the brain might “create a story” or belief that feels completely real, because the damaged side can no longer check or correct those false ideas against reality.
In both cases, damage or dysfunction in key brain areas makes it harder for a person to separate what’s real from what’s imagined — helping explain why some delusions are so persistent.
Environmental factors
Some environmental factors may contribute to the development or exacerbation of delusions, e.g.,
- Stressful life events: Experiencing traumatic or stressful events, such as abuse, violence, or loss, may increase the risk of developing delusions.
- Social isolation: Lack of social support and social isolation may contribute to the development of delusions, as individuals who are socially isolated may be more prone to feelings of paranoia and mistrust.
- Substance use: Substance use, particularly drugs like amphetamines or hallucinogens, can trigger delusions in some individuals.
It’s important to note that while these environmental factors may contribute to the development of delusions, they do not necessarily cause delusions on their own.
Attributional Biases
Some researchers have looked at how thinking patterns, called attributional biases, might play a role in developing and maintaining delusions (Humphreys & Barrowclough, 2010).
Attributional bias means that people tend to take credit for positive events (“I made that happen”) but blame outside forces for negative ones (“It’s someone else’s fault”).
Studies have found that this self-protective thinking style appears more often in people with persecutory delusions, possibly as a way to defend their self-esteem (Bentall, 2019).
However, not all research agrees. Some studies suggest this bias might not be unique to delusions, but instead part of broader coping strategies seen in psychosis (Humphreys & Barrowclough, 2010). Other reviews have pointed out that inconsistencies in research methods make it hard to draw firm conclusions (Zhu et al., 2017).
Even so, understanding how attributional biases work could help shape therapies that focus on improving reasoning and making thinking patterns more flexible.
Mental Health Conditions Linked to Delusions
Delusions can occur as a feature of several different mental health conditions. Understanding these links can help differentiate whether delusions are part of a broader psychiatric disorder or occur in isolation. Some of the key conditions associated with delusions include:
- Schizophrenia:
Delusions are one of the hallmark symptoms of schizophrenia. Individuals may experience bizarre or highly implausible beliefs, often accompanied by hallucinations, disorganized thinking, and changes in behavior. - Delusional Disorder:
In delusional disorder, individuals experience persistent delusions that are often non-bizarre (e.g., believing they are being followed or deceived) without the broader deterioration of functioning typically seen in schizophrenia. - Bipolar Disorder:
During manic or depressive episodes, individuals with bipolar disorder may develop mood-congruent delusions — for example, grandiose delusions during mania (believing they have special powers) or persecutory delusions during depression (believing others are plotting against them). - Major Depressive Disorder with Psychotic Features:
Some individuals with severe depression may experience delusions that are typically negative or self-blaming in nature, such as believing they have committed terrible sins or are responsible for disasters. - Dementia (e.g., Alzheimer’s Disease):
Cognitive decline in dementia can lead to delusions, such as believing loved ones have been replaced (Capgras delusion) or that belongings have been stolen. - Postpartum Psychosis:
Occurring shortly after childbirth, postpartum psychosis can involve mood disturbances alongside delusions, posing significant risks if not treated promptly. - Substance-Induced Psychotic Disorder:
The use of substances such as amphetamines, cocaine, hallucinogens, or alcohol can sometimes trigger psychotic symptoms, including delusions, especially during intoxication or withdrawal periods. - Posttraumatic Stress Disorder (PTSD):
In some cases, individuals with PTSD may experience persecutory delusions related to their trauma history, although this is less common.
While delusions are a prominent symptom in many of these conditions, their nature, intensity, and accompanying symptoms can vary widely. A thorough assessment by a mental health professional is crucial to determine the underlying cause and guide appropriate treatment.
How To Manage Delusions
Managing delusions often involves a combination of medication, therapy, and supportive strategies.
Treatment can be challenging, especially if a person doesn’t recognize that their beliefs are false. A compassionate, patient-centered approach is crucial.
Medications
Antipsychotic medications are the primary treatment for delusions. They work by adjusting brain chemicals like dopamine, which are linked to psychotic symptoms.
- Typical antipsychotics (e.g., Haloperidol, Fluphenazine) have been used since the 1950s and mainly block dopamine receptors.
- Atypical antipsychotics (e.g., Risperidone, Olanzapine) also target serotonin and tend to have fewer side effects.
Sometimes, antidepressants or tranquilizers may be added to help manage anxiety or mood symptoms that accompany delusions.
Psychotherapy
Talk therapies can also help individuals cope with delusions, either alongside or instead of medication.
- Cognitive Behavioral Therapy (CBT): Helps individuals challenge unhelpful beliefs and reframe thinking patterns (Sitko et al., 2020).
- Acceptance and Commitment Therapy (ACT): Focuses on accepting thoughts without judgment and building psychological flexibility (Burhan & Karadere, 2021).
- Family Therapy and Group Therapy: Offer support, education, and strategies for dealing with social and relational challenges.
The best treatment plan is personalized to the individual’s needs, symptoms, and willingness to engage in care.
Self-Help Coping Skills for Living with Delusions
While professional treatment is important, self-help strategies can also make a big difference in daily life. Some useful coping tools include:
- Mindfulness Techniques:
Ground yourself in the present moment through breathing exercises, meditation, or sensory awareness practices. Mindfulness can help reduce the emotional intensity of delusional thoughts (Ellett, 2023). - Emotion Regulation Skills:
Use techniques like deep breathing, journaling, or progressive muscle relaxation to manage strong feelings and stay calm during distressing episodes. - Engaging in Meaningful Activities:
Regularly participating in hobbies, exercise, creative arts, or social groups helps provide structure, enjoyment, and distraction from intrusive thoughts. - Peer Support and Reality-Checking:
Connecting with others who understand your experiences — through support groups or trusted friends — can help you reality-test beliefs and feel less isolated. - Building a Safety Plan:
Have a clear plan for what to do if delusions become overwhelming, including people to contact and coping steps to follow. - Practicing Self-Compassion:
Recognize that experiencing delusions is not a personal failing. Be kind to yourself, celebrate small victories, and remember that healing takes time.
These strategies won’t erase delusions entirely but can make them more manageable, helping individuals live fuller, more connected lives.
Do you or a loved one need mental health support?
USA
Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/
1-800-273-8255
UK
Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; email jo@samaritans.org .
Available 24 hours a day, 365 days a year (this number is FREE to call):
116-123
Rethink Mental Illness: rethink.org
0300 5000 927
References
Bentall, R. P. (2019). Cognitive biases and abnormal beliefs: Towards a model of persecutory delusions. The neuropsychology of schizophrenia, 337-360.
Burhan, H. Ş., & Karadere, E. (2021). Effectiveness of Acceptance and Commitment Therapy for Patients with Psychosis Being Monitored at a Community Mental Health Center: A Six-Month Follow-up Study. Alpha Psychiatry, 22(4), 206.
Devinsky, O. (2009). Delusional misidentifications and duplications: right brain lesions, left brain delusions. Neurology, 72(1), 80-87.
Drake, M. E. (n.d.). Delusional Disorder DSM-5 297.1 (F22). Theravive. Retrieved 2021, August 18, from: https://www.theravive.com/therapedia/delusional-disorder-dsm–5-297.1-(f22)
Ellett, L. (2023). Mindfulness for psychosis: Current evidence, unanswered questions and future directions. Psychology and Psychotherapy: Therapy, Research and Practice.
Humphreys, L., & Barrowclough, C. (2010). Attributional style, defensive functioning and persecutory delusions: Symptom-specific or general coping strategy? The British Journal of Clinical Psychology, 49(2), 231–246.
Joseph, S. M., & Siddiqui, W. (2023). Delusional disorder. In StatPearls [Internet]. StatPearls Publishing.
Joyce, E. M. (2018). Organic psychosis: the pathobiology and treatment of delusions. CNS neuroscience & therapeutics, 24(7), 598-603.
Kalayasiri, R., Kraijak, K., Mutirangura, A., & Maes, M. (2019). Paranoid schizophrenia and methamphetamine-induced paranoia are both characterized by a similar LINE-1 partial methylation profile, which is more pronounced in paranoid schizophrenia. Schizophrenia research, 208, 221-227.
Nygaard, M., Sonne, C., & Carlsson, J. (2017). Secondary psychotic features in refugees diagnosed with post-traumatic stress disorder: a retrospective cohort study. BMC psychiatry, 17(1), 1-11.
Sitko, K., Bewick, B. M., Owens, D., & Masterson, C. (2020). Meta-analysis and meta-regression of cognitive behavioral therapy for psychosis (CBTp) across time: the effectiveness of CBTp has improved for delusions. Schizophrenia Bulletin Open, 1(1), sgaa023.
Zhu, C., Sun, X., & So, S. H. W. (2017). Associations between belief inflexibility and dimensions of delusions: A meta-analytic review of two approaches to assessing belief flexibility. British Journal of Clinical Psychology, 56(1), 59–81.
Related Articles
