Delusional disorder classification

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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

According to the Diagnostic and Statistical Manual of Mental Disorders, delusional disorder may be classified into seven types based on content of delusions.

Classification

Diagnosis of a specific type of delusional disorder can sometimes be made based on the content of the delusions. The Diagnostic and Statistical Manual of Mental Disorders (DSM) enumerates seven types:

Subtypes of delusional disorder	Description
Erotomanic	The patient believes that another person is secretly in love with her or him. That person may be famous or have some kind of higher status, usually not part of the patient’s social circle, and not likely to be attainable. Affected individuals may attempt to communicate with the object of their affection and attempt to meet him/her in person. Such effort can lead to stalking in some cases, with some risk for assaultive behavior. Expressions of love may be intense, and rejections by the loved person interpreted oddly as affirmations of love to deflect suspicions or jealousy from the loved person’s spouse. Other names: DeClerambault syndrome, erotomania, psychose passionelle.
Grandiose	The patient believes he/she has special prominence or talent, unusual fame, or major achievements. Features of the patient’s thinking may suggest the grandiosity associated with mania, but in the delusional disorder, the mood disturbance and behaviors characteristic of mania are not present.
Jealous	The delusional theme is the patient believes that a spouse or lover is unfaithful and finds "evidence" to support the delusion, accuses him or her, and relentlessly tries to substantiate the offense. The delusion of jealousy can lead to aggressive, threatening, and possibly violent behavior, including homicide and suicide. In some cases delusional jealousy and its disruptive impact may only improve through separation from the suspected unfaithful partner. Other names: pathological or morbid jealousy, Othello syndrome, conjugal paranoia.
Persecutory	The patient is typically preoccupied by a delusion that he or she is being persecuted, conspired against, or potentially harmed. His/her resulting actions are generally consistent with these concerns; they are well planned and executed, and carried out with emotional fervor and determined effort. These individuals may resort to the courts and even to violence to right the wrongs directed at them.
Somatic	The patient believes that something awful is wrong with his/her body. There are several forms: that one is ill with undiagnosed disease; that one is infested with parasites or insects (delusional parasitosis); or that parts of the body are misshapen, ugly, or emanate a foul odor. Individuals generally go from one doctor to another, specialist to specialist, usually disappointed by the failure to detect and diagnose the medical problem that haunts them. Suicide may be a risk, thought due to frustration and lack of effective clinical intervention. Other names: hypochondriacal delusion, monosymptomatic hypochondriasis.
Mixed	No one delusional theme predominates.
Unspecified	The dominant delusional belief cannot be clearly determined or is not described by the subtypes above.

Other notable differences between the DSM-IV and DSM-5 diagnostic criteria are a clearer demarcation of delusional disorder in DSM-5 from psychotic variants of obsessive–compulsive disorder and body dysmorphic disorder that is made explicit with a new exclusion criterion. Such a presentation must not be better explained by obsessive compulsive or body dysmorphic disorder with lack of insight/delusional beliefs. Shared delusional disorder is no longer separated from delusional disorder as in DSM-IV. If the criteria for delusional disorder are met, delusional disorder is the appropriate diagnosis. If that diagnosis cannot be made yet shared delusional beliefs are present, the appropriate diagnosis is "other specified schizophrenia spectrum and other psychotic disorder."

• Erotomanic type (erotomania): delusion that another person, often a prominent figure, is in love with the individual. The individual may breach the law as he/she tries to obsessively make contact with the desired person.
• Grandiose type: delusion of inflated worth, power, knowledge, identity or believes himself/herself to be a famous person, claiming the actual person is an impostor or an impersonator.
• Jealous type: delusion that the individual's sexual partner is unfaithful when it is untrue. The patient may follow the partner, check text messages, emails, phone calls etc. in an attempt to find "evidence" of the infidelity.
• Persecutory type: This delusion is a common subtype. It includes the belief that the person (or someone to whom the person is close) is being malevolently treated in some way. The patient may believe that he/she has been drugged, spied upon, harassed and so on and may seek "justice" by making police reports, taking court action or even acting violently.
• Somatic type: delusions that the person has some physical defect or general medical condition
• Mixed type: delusions with characteristics of more than one of the above types but with no one theme predominating.
• Unspecified type: delusions that cannot be clearly determined or characterized in any of the categories in the specific types.

Among them persecutory and jealous subtypes are the most common, and erotomanic and grandiose are the least common.