An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility. They will not accept any other opinions. The belief is, at the least, unlikely, and out of keeping with the individuals social, cultural, and religious background. The person is emotionally over-invested in the idea and it overwhelms other elements of his or her psyche. The delusion, if acted out, often leads to behaviors which are abnormal, and out of character, although perhaps understandable in light of the delusional beliefs. Other people who know the individual observe that the belief and behavior are uncharacteristic and alien.Additional features of delusional disorder include the following:
It is a primary disorder. It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity. The illness is chronic and frequently lifelong. The delusions are logically constructed and internally consistent. The delusions do not interfere with general logical reasoning (although within the delusional system the logic is perverted) and there is usually no general disturbance of behavior. If disturbed behavior does occur, it is directly related to the delusional beliefs. The individual experiences a heightened sense of self-reference. Events which, to others, are nonsignificant are of enormous significance to him or her, and the atmosphere surrounding the delusions is highly charged.However this should not be confused with gaslighting, where a person denies the truth, and causes the one being gaslit to think that they are being delusional.
The combination of pharmacotherapy with cognitive therapy integrates treating the possible underlying biological problems and decreasing the symptoms with psychotherapy as well. Psychotherapy has been said to be the most useful form of treatment because of the trust formed in a patient and therapist relationship.Supportive therapy has also been shown to be helpful. Its goal is to facilitate treatment adherence and provide education about the illness and its treatment. Furthermore, providing social skills training has been found to be helpful for many people. It can promote interpersonal competence as well as confidence and comfort when interacting with those individuals perceived as a threat.Insight-oriented therapy is rarely indicated or contraindicated; yet there are reports of successful treatment. Its goals are to develop therapeutic alliance, containment of projected feelings of hatred, powerlessness, and badness; measured interpretation as well as the development of a sense of creative doubt in the internal perception of the world. The latter requires empathy with the patients defensive position. Epidemiology
Delusional disorders are uncommon in psychiatric practice, though this may be an underestimation due to the fact that those with the condition lack insight and thus avoid psychiatric assessment. The prevalence of this condition stands at about 24 to 30 cases per 100,000 people while 0.7 to 3.0 new cases per 100,000 people are reported every year. Delusional disorder accounts for 1–2% of admissions to inpatient mental health facilities.