Delusional disorder natural history, complications and prognosis
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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
Natural History
The onset of delusional disorder can be acute, even sudden, or less commonly the disorder develops gradually. An acute onset has been associated with the presence of a precipitating event [30]. Delusions are often the initial manifestation of the disorder, but premorbid traits, including odd behavior and personality changes, have been reported in some cases [31].Delusional disorder is typically a chronic (ongoing) condition, but when properly treated, many people with this disorder can find relief from their symptoms. Some people recover completely and others experience episodes of delusional beliefs with periods of remission (lack of symptoms). Delusional disorder is often a disabling illness. The condition often disrupts progress toward personal and occupational goals; patients with the disorder typically achieve less in their lives than their innate abilities would suggest. In our clinical experience, the course can be influenced by personal circumstances (eg, education, socioeconomic status, and physical health), the availability of personal support, and willingness to maintain treatment. Delusional disorder can be a source of profound individual and familial suffering. In cases of delusional jealousy and erotomania, the suffering can extend to other victims as well. Available data suggest that patients with delusional disorders have a better global outcome than patients with schizophrenia [10]. Unfortunately, patients with delusional disorder do not have good insight into their pathological experiences. Interestingly, despite significant delusions, many other psychosocial abilities remain intact, as if the delusions are circumscribed. Indeed, this is one of the key differences between delusional disorder and other primary psychotic disorders. However, the individual may rarely seek psychiatric help, remain isolated, and often present to internists, surgeons, dermatologists, policemen, and lawyers rather than psychiatrists. Unfortunately, many people with this disorder do not seek help. It often is difficult for people with a mental disorder to recognize that they are not well, or they may attribute their symptoms to other factors, such as the environment. They also might be too embarrassed or afraid to seek treatment. Without treatment, delusional disorder can be a life-long illness.
Complications
Complications of delusional disorder include the following:
- Depression
- Acting on the delusions also can lead to violence or legal problems
- People with the delusional disorder can eventually become isolated from others, especially if their delusions interfere with their relationships.
Prognosis
The outlook for people with delusional disorder varies depending on the person, the type of delusional disorder, and the person's life circumstances, including the availability of support and a willingness to stick with treatment. Delusional disorder is typically a chronic (ongoing) condition, but when properly treated, many people with this disorder can find relief from their symptoms. Some people recover completely and others experience episodes of delusional beliefs with periods of remission (lack of symptoms). Unfortunately, many people with this disorder do not seek help. It often is difficult for people with a mental disorder to recognize that they are not well, or they may attribute their symptoms to other factors, such as the environment. They also might be too embarrassed or afraid to seek treatment. Without treatment, delusional disorder can be a life-long illness.A commonly held view is that the course of the disorder is relatively persistent and stable; in fact, limited study suggests a more varied course. A study of 301 cases reported remission in about one-third of cases [30]. In approximately two-thirds of cases, the course of the disorder is life-long, with delusions present continuously in some cases and periodically in others [30,32]. The diagnostic stability of delusional disorder is less than that of some psychotic disorders; the most frequent change in diagnosis is to schizophrenia [33].