Beliefs That Aren’t Real: How Doctors Define Schizophrenia Delusions
Schizophrenia is a severe mental health condition that can cause a number of symptoms, including problems thinking clearly, hallucinations, and delusions.
Those with schizophrenia often experience symptoms doctors describe as positive, negative, or cognitive
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(or a combination of each).1 Delusions are an example of a positive symptom along with hallucinations. Negative symptoms include lack of emotional response while cognitive symptoms include difficulty communicating with others.
This article will describe what delusions are, how they affect a person with schizophrenia, and how a doctor will treat the delusions.
What are delusions?
Schizophrenia delusions are a schizophrenia symptom that causes a person to believe something that isn’t true — even when others try to tell them or show them their beliefs are untrue.1 Specifically, the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision (DSM-5-TR), define delusions as “fixed believes that are not amenable to change in light of conflicting evidence.”2
The DSM-5-TR names delusions as one of the five key criteria mental health experts use to diagnose schizophrenia.2
A common schizophrenia delusion type is the paranoid delusion.1 Another word for these are persecutory delusions. These are delusions where a person believes they are being harassed, harmed, or otherwise watched by others. Examples of paranoid schizophrenia delusions may include:
- ”The FBI are following me.”
- ”My spouse is trying to poison me.”
- “My family is pumping medicine through the air conditioner to try and make me look crazy.”
Additional Schizophrenia Delusion Types
Paranoid delusions aren’t the only schizophrenia delusion type. Schizophrenia delusions examples may include2,3:
- Delusions of control: A person believes others are trying to control their thoughts or behaviors. An example would be: ”My doctor is trying to plant thoughts inside my head.”
- Delusions of erotomania: A person with this delusion type believes that another person or persons are in love with them. An example would be “Taylor Swift is in love with me and writes me love letters every day.”
- Delusions of grandeur: A person believes they are a historical figure of great importance. An example would be: “I am the reincarnation of Julius Caesar.”
- Delusions of reference: A person believes that messages are for them, such as something on a billboard, on the television, or in a movie. An example would be: “The President is speaking directly to me through the television.”
In one study of patients with schizophrenia delusions, delusions of reference were the most common delusion type, followed closely by persecutory delusions.3 However, some studies find persecutory delusions are the most common type. A person can experience multiple delusion types.
Doctors may call delusions “bizarre” if they are so implausible that they are difficult to understand or interpret.
Schizophrenia Delusions Treatments
Doctors may have a hard time helping a person treat delusions because the person doesn’t recognize their thoughts or beliefs are incorrect. They will use both pharmacological and non-pharmacological treatments, which include:4
Non-pharmacological Treatments
- Cognitive behavioral therapy
- Group therapy
- Social skills therapy
- Vocational/employment rehabilitation
Non-pharmacological treatments are important in treating schizophrenia and delusions because traditionally patients with schizophrenia have poor adherence to their medications.4 Using non-pharmacological approaches can help improve treatment adherence.
Pharmacological Treatments
- First-line treatments for maintenance are second-generation atypical anti-psychotics, such as aripiprazole, risperidone, and ziprasidone
- First-generation anti-psychotics usually cause more severe symptoms and aren’t first-line treatments. They include chlorpromazine and haloperidol
- Doctors may prescribe clozapine, a second-generation atypical anti-psychotic, for treatment-resistant schizophrenia. This medication can cause more side effects than other anti-psychotics (including increased risks for seizures)
When a mental health professional is establishing a therapeutic environment with a client who experiences delusions, it’s important that they recognize how the delusion may make their client feel. Some clients may find their delusion is scary or makes their client feel unsafe. While they should not validate the delusion, validating how the delusion makes the client feel can be important.
Call to Action: Ready to dig deeper into delusions associated with schizophrenia? Symptom Media’s accredited CE course includes an in-depth discussion of these delusions as well as both pharmacological and non-pharmacological treatments.
Written by Rachel Nall, RN, MSN, CRNA
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