Delusional disorder diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

The diagnosis of delusional disorder is based on the DSM-5 diagnostic criteria, which include criterion A i.e the presence of one (or more) delusions with a duration of one month or longer, criterion B i.e criterion A for schizophrenia has never been met, criterion C i.e apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd, criterion D i.e if manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods, and criterion E i.e the disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

Diagnostic Criteria

DSM-5 diagnostic criteria for delusional disorder are as follows:

DSM-V Diagnostic Criteria for Delusional Disorder

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A. The presence of one (or more) delusions with a duration of 1 month or longer. AND B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation). AND C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd. AND D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods. AND E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder. Specify whether: Erotomanie type: This subtype applies when the central theme of the delusion is that another person is in love with the individual. OR Grandiose type: This subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery. OR Jealous type: This subtype applies when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful. OR Persecutory type: This subtype applies when the central theme of the delusion involves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals. OR Somatic type: This subtype applies when the central theme of the delusion involves bodily functions or sensations. OR Mixed type: This subtype applies when no one delusional theme predominates. OR Unspecified type: This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types (e.g., referential delusions without a prominent persecutory or grandiose component). Specify if: With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., an individual’s belief that a stranger has removed his or her internal organs and replaced them with someone else’s organs without leaving any wounds or scars). Specify if: The following course specifiers are only to be used after a 1-year duration of the disorder: First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled. First episode, currently in partial remission: Partial remission is a time period during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled. First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present. Multiple episodes, currently in acute episode OR Multiple episodes, currently in partial remission OR Multiple episodes, currently in full remission OR Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course. OR Unspecified Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). Note: Diagnosis of delusional disorder can be made without using this severity specifier.

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The following table illustrates the ICD-10 Diagnostic Criteria for Delusional Disorders:

Criteria	ICD-10 Diagnostic Criteria for Delusional Disorders
A	A delusion or a set of related delusions, other than those listed as typically schizophrenic in criterion G1(1B) or d for paranoid, hebephrenic or catatonic schizophrenia(i.e., other than completely impossible, or culturally inappropriate), must be present. The commonest examples are persecutory, grandiose, hypochondriacal, jealous(zelotypic), or erotic delusions
B	The delusion(s) in criterion A must be present for atleast 3 months
C	The general criterion for schizophrenia are not fulfilled
D	There must be no persistent hallucinations in any modality(but there may be transitory or occasional auditory hallucinations that are not in the third person or giving a running commentary)
E	Depressive symptoms (or even a depressive episode) may be present intermittently, provided that the delusions persist at times when there is no disturbance of mood
F	Most commonly used exclusion clause. There must be no evidence of primary or secondary organic mental disorder, as listed under organic, including symptomatic, mental disorders, or of a psychotic disorder due to psychoactive substance use
Specifications for possible subtypes	The following types may be specified if desired: persecutory; litigious; self referential; grandiose; hypochondriacal (somatic); jealous; erotomanic
Other persistent delusional disorders	This is a residual category for persistent delusional disorders that do not meet the criteria for delusional disorder. Disorders in which delusions are accompanied by persistent hallucinatory voices or by schizophrenic symptoms that are insufficient to meet criteria for schizophrenia should be coded here. Delusional disorders that have lasted for less than 3 months should, however, be coded, atleast temporarily, under acute and transient psychotic disorders
Persistent delusional disorder, unspecified

The following table illustrates the steps involved in diagnosis and management of delusional disorder:

Steps	Diagnosis and Management of Delusional Disorder
1	Rule out other causes of paranoid features
2	Confirm the absence of other psychopathology
3	Assess consequence of delusion related behavior Demoralization Despondency Anger, fear Depression Impact of search of "medical diagnosis,""legal solution," "proof of infidelity,"etc.(financial, legal, personal, occupational, etc.)
4	Assess anxiety and agitation
5	Assess potential for violence, suicide
6	Assess need for hospitalization
7	Institute pharmacological and psychological therapies
8	Maintain connection through recovery

See also

• Delusion
• Monothematic delusions
• Paranoia
• Psychosis
• Schizophrenia