Friday, January 10, 2014

Lexicon of Madness -- Delusion

Delusion: A fixed, false belief, typically not shared by others, that is not the result of ignorance or cultural influences, but rather a misinterpretation of reality. Delusional people cannot be talked out of their delusional beliefs. Presentation of contrary evidence is not persuasive ("How do I know that those are really my x-rays? Maybe you don't want me to know that I have a radio transmitter in my stomach"). A common positive symptom of schizophrenia, but also observed in psychotic depression. Delusions can be bizarre (e.g., "Aliens have replaced my blood with typing correction fluid") or non-bizarre (e.g., "My wife is poisoning me"). Non-bizarre delusions, while perhaps very unlikely, could conceivably occur in reality (e.g., "The CIA and mafia are trying to kill me"). Delusions can be mood-congruent (e.g., a severely depressed patient believes that he is the cause of a deadly tsunami halfway across the world). Somatic delusions involve the false belief that one's body is malfunctioning (e.g., a patient asks for his healthy arm to be amputated because it is "sick, gangrenous, rotting -- I can't stand the smell"). Paranoid delusions place the patient at the center of a web of harassment, ridicule, or persecution. Sufferers may arm themselves or use violence to protect themselves from their "persecutors." For some people, paranoid delusions might serve to defend against feelings of utter insignificance (i.e., it is preferable to feel followed, spied upon, harassed, and plotted against than to feel disregarded, ignored, or overlooked). Delusions of grandeur involve the exaggeration of one's own importance or powers, or the belief that one is a special person (e.g., Jesus Christ's younger brother). Delusions of reference involve the belief that other people are talking about you or otherwise doing things with you in mind (e.g., a news announcer wears a blue tie one evening in order to signal you to go to the beach). Delusional jealousy involves the false belief (again, invulnerable to exculpatory evidence) that one's partner is unfaithful. (This is sometimes called "Othello syndrome," even though Othello was misled, not delusional.) Erotomania (de Clerambault's syndrome) involves the delusion that a famous or powerful person is in love with you and won't leave you alone. Antipsychotic medications can be effective in the treatment of delusions.

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