Delusional disorder


Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence.

Delusional subtypes

  • Ertomanic type: when the central theme of the delusion is that another person is in love with the individual
  • Grandiose type: when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery
  • Jealous type: when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful
  • Persecutory type: when the central theme of the delusion involves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals
  • Somatic type: when the central theme of the delusion involves bodily functions or sensations
  • Mixed type: applies when no one delusional theme predominates
  • Unspecified type: applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types

Clinical Features

  • A. The presence of one (or more) delusions with a duration of 1 month or longer.[1]
  • B. Criterion A for schizophrenia has never been met.
  • C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.
  • D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.
  • E. The disturbance is not attributable to the physiological effects of a substance or an­other medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

Differential Diagnosis

Psychiatric Disorders with Psychotic Symptoms

Organic Causes

Nonorganic Causes

  • Obsessive-compulsive and related disorders
  • Depressive and bipolar disorders


Rule out other organic causes including substance abuse, medication effect or other medical conditions. Consider emergency psychiatric evaluation in addition to medical evaluation.

General ED Psychiatric Workup


Difficult to treat given limited insight, however individual outpatient psychotherapy recommended.

General ED Psychiatric Management


  • Home with outpatient psychiatric services if stable, versus inpatient psychiatric admission if unstable

See Also

External Links


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.