Delirium can be considered the very essence of madness, the typical expression of what was previously called alienation, a very strong term impregnated with the poison of marginalization, which means, in essence, the loss of possession of one’s own personality. But delusions are quite common: for example, it is estimated that between 10% and 20% of hospitalized adults are at least sporadically in this condition; The percentage rises to 30-40% in the case of elderly hospitalized patients. With this Psychology-Online article we will better understand what is a delusion in psychologythe various typologies, as well as the causes and possible treatments.
What is a delirium
Delusions are a variety of confusional mental states in which the subject’s attention, perception and cognition seem significantly affected. The term “delirium” derives from the Latin lira, “furrow”, so delirium etymologically means “to leave the furrow”, that is, from the straight path of reason. The term delusion in the strict sense (incorrigible erroneous belief) refers to a thought disorder, which can be present in various psychological illnesses (psychosis), for example in , depressive or manic episodes with psychotic symptoms, in . This is an inadequate mental model of reality, since the decisions and behaviors adopted based on this model end up being unfavorable.
In itself, Delirium is not a disease, but a syndrome (a complex of symptoms) that can occur in several, acute or chronic, expression of metabolic suffering of the brain with multiple causes. The current diagnostic classification (DSM-V, 2014) inserts delusions within the “key” characteristics that define the psychotic disorders (persecutors, reference, grandeur, erotomanic, nihilistic and somatic) but the presence of persistent delusions is the main characteristic of delusional disorder. Chronic forms of delusion, based on the rational and lucid elaboration of a system of erroneous beliefs, may, in fact, be the only symptom of a psychic pathology: in this case we speak precisely of chronic delusional disorder or paranoia. They can usually seem entirely plausible; however, they are no longer required to be non-stranger, as the DSM-IV required. In any case, patients generally appear normal, until the area of one of their delusions is touched upon.
Essential features of the delusional disorder:
- The patient has delusions for at least a month, in the absence of other psychotic symptoms and relatively short mood symptoms.
- Except for delusions, behavior is not altered.
- There may be tactile or olfactory hallucinations, but only in relation to delusions (and not obvious).
Types of delusions
Delusions, which can be acute, isolated, recurrent or chronic, are classified based on their content and are distinguished by the dominant ideas, which are not convictions and certainties, but simple fears, concerns or interests that assumed importance for the subject. excessive, to the point of altering the continuity of the experience and its usual flow. The terminology of delusions provides:
- Delirium of jealousy, also called , characterized by the interpretation of the most insignificant details of the couple’s behavior as an indication and proof of betrayal. It is common in subjects affected by alcoholism.
- Compensation delusionof a situation experienced as negative or unpleasant, such as sterility, compensated by a delusion of pregnancy.
- Guilt delusiontypical of melancholic people who attribute to themselves faults never committed to give justification and a consequence to the pain they suffer.
- erotic delirium, who is convinced of being secretly loved by a usually important or exalted person. Erotomanic delirium can also be called .
- Fantastic deliriumwhich is nourished by philosophical, religious, and scientific theories that solve hitherto insoluble problems.
- Delusions of greatness, which puts the protagonist at the center of a grandiose destiny. In this article we explain.
- Delirium of interpretationcalled “reasoned madness” because it obeys a need to explain everything according to a fundamental system of private meanings.
- Delusion of denialalso called , common in depressed elderly people, convinced that the world is coming to an end and that their own body is dead or empty of viscera.
- Delusion of persecution, typical of someone who is convinced of the existence of a plot against him, and therefore is forced to defend himself and suspect everyone. In this article you will find more information about it.
- Complainer’s deliriumwhich focuses on a harm actually suffered or imagined, activating behaviors that are expressed with written requests, manifestos, summons to court and the like.
- Referral delusion, in which the subject has the impression that everyone refers to him with looks, gestures and allusions to his person. This delusion is also called paranoid.
- Delirium of ruin (economic, family, position or prestige), common in depressive forms accompanied by delusions of guilt.
Causes of delusions
Delusions usually have medical causes, such as infections or body chemical imbalances, and other medical conditions such as anesthesia or sedation. They can also be due to the consumption of substances whether medications or drugs, both in withdrawal and in overdose. Also for other toxins. Even among the causes of delusions is serious lack of sleep.
Starting from the conviction that each of us has a particular vision of the world, on the basis of which we organize what is real, when this vision, which is different in each subject, exceeds a certain limit of common experience, we are in the presence of a delusion. . G. Jervis emphasizes that what is destructured is, above all, the category of familiarity with which each of us tends to treat things as strange or familiar.
Another reason that may be at the basis of a delusional formation is, always for Jervis, the condition of passivity, which implies the feeling of being dominated by reality without being able to determine it. To free oneself from this oppression, there is the possibility, through delirium, of inventing a reality or links of reality that allow the delusional person a minimum of control.
In endogenous psychoses, delirium is the result of loss of relationship with self, with the consequent loss of control of reality, which is given a different interpretation. Semi-delusional attitudes can be found in personalities with rigid and distrustful character traitsand therefore poorly adaptable to reality, or in people who, enjoying a high social position, are inclined to suspect continuous threats to their power.
From the psychoanalytic point of view, the genesis of delirium has its explanation in the projection mechanism, by which intentions or attitudes that are actually one’s own are attributed to others.
Treatments for delusions
Treatment aims, first and foremost, to establish a good doctor-patient relationship and manage complications, since the substantial lack of insight it is a challenge to treatment (if patients are considered dangerous, hospitalization may be necessary).
Treatment usually has the purpose of moving the patient away from his pervasive beliefs by trying to interest him in something else, for example, entrusting him with a goal that is difficult but rewarding to achieve, and therefore capable of diverting his mental energies. The incommunicability and incorrigibility of the delusional experience certainly constitute a great obstacle to a psychotherapeutic approach, but it can sometimes be a very valuable instrument for reconstructing a relationship with the world that has been lost.
Although there are no special pharmacological indications for the treatment of delusional disorder, antipsychotics for symptomatic treatment. There are antipsychotic medications called “deliriotics,” which seem to have the power to correct the ideational disorder that leads to the formation of delusional ideas.
In depressive delusions, specific treatment against depression can be very effective and save the patient from the high danger of suicide.
This article is merely informative, at Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
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Bibliography
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