Delusional disorder is one of the hardest psychiatric disorders to diagnose or treat. This is because the delusions are “non-bizarre;” that is, they can be theoretically plausible. The sufferer functions quite normally most of the time, and will often refuse to admit there is even a problem. And since the most common form of this disorder involves some paranoia, it can be hard to find a therapist they will trust or with whom they’ll cooperate. Because they feel this paranoia, prescribing drugs may also be difficult, since their delusion frequently involves the belief that someone is “out to get them.” This usually rules out hospitalization as well, which only reinforces that belief.

While paranoia is the most common manifestation, there are other types of delusional disorders as well, such as believing one is the secret love interest of a famous person, being convinced one has extraordinary abilities or is very important, worrying about physical problems or disfigurements that don’t exist, or believing that one’s romantic partner is unfaithful. Mental health treatment is often refused because of these convictions, which are impervious to any sort of disproof. The patient is convinced they are correct; meaning there is nothing to treat.

Few medical treatments have any effect on this disorder, so the main treatment method will be psychosocial. The best treatment method involves the therapist coming at the problem obliquely; not confronting the patient directly about having a delusional disorder. Rather, the doctor may offer to treat symptoms that might attend the disorder, giving the patient depression anxiety treatment options instead. Once a good therapist-patient relationship of trust is established, the doctor might then challenge some of the delusional beliefs, in a non-condemning, non-condoning way. And only if the patient’s behavior becomes dangerous or too agitated would drugs enter the picture.

By using alternative, health treatments to the drugs or standard psychotherapy offered for other types of mental illness, a therapist can capitalize on any doubts the patient might express about his or her delusions. Working as a partner, the doctor can then help the person devise explanations for things, other than those offered by their delusional disorder, and might help reconstruct a realistic world view. Treating this disorder requires a great deal of tact and careful treading, but a trusting doctor-patient relationship can make success possible.

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