Delusional disorder historical perspective
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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
Historical Perspective
The concept of the delusional disorder has both a very long and a very short history: while the term of delusional disorder was only coined in 1977, the concept of paranoia has been used for centuries. Originally, the word paranoia comes from Greek para, meaning along side, and noos or nous, meaning mind, intelligence (Munro, 1999). The Greeks used this term to describe any mental abnormalities similar to how we use the word insanity. In the modern world, the term reappeared in the 17th century, and it was largely used as a generic name for mental illness. In 1863, Karl Kahlbaum introduced the concept of paranoia as a separate mental illness: "a form of partial insanity, which throughout the course of the disease principally affected the sphere of the intellect" (Manschreck, 2000). He used this term to describe an illness with persistent delusions and stable course. He noted that delusions may occur in other medical and psychiatric conditions (Manschreck, 2000). Later Emil Kraepelin, who observed 19 cases, continued to work on defining the concept of paranoia, which is reflected in several editions of his famous textbook and most closely resembles the modern definition of delusional disorder. Kraepelin viewed paranoia as uncommon, chronic condition different from dementia praecox by the presence of fixed, nonbizarre delusions, lack of deterioration over time, preserved thought process, and relatively slight involvement of affect and volition (Manschreck, 2000). He described that delusions of paranoia, contrary to the delusions of dementia praecox, are well systemized, relatively consistent, and often related to real-life events. He identified persecutory, grandiose, jealous, erotomanic, and possibly hypochondriacal types of that disorder. He believed that the illness derived from the deficit in the patients' judgments caused by constitutional factors and environmental stress (Manschreck, 2000; Munro, 1999). Later, Eugen Bleuler continued to recognize paranoia as a separate disorder and included hallucinations in its description (Fennig, 2005; Munro, 1999). After Kraepelin's death, Kurt Kolle (1931) reported a detailed follow-up of 66 cases seen in Kraepelin's former clinic in Munch (Munro, 1999). He noted a pattern of deterioration and concluded that paranoia represents a form of schizophrenia. This view continued to be popular in the psychiatric community for several decades and was reflected in DSM-I and DSM-II. Winokur (1977) had redescribed paranoia under the name of delusional disorder basing his findings on Kraepelin's definition and the observation of case types (Munro, 1999). Additionally, Kendler (1980) and Munro (1982) substantially contributed to our current understanding of nosology of this illness (Munro, 1999; Kelly, 2005). In 1987, delusional disorder was introduced in DSM-III-R and continued to be present in subsequent editions