When False Beliefs Feel Real: Recognizing Delusional Disorder
When False Beliefs Feel Real: Recognizing Delusional Disorder
When someone says they've been implanted with a tracking device, believes they’re the subject of secret experiments, or insists they’re being watched by strangers, it can leave family members wondering what to do.
While these claims may sound like conspiracy theories, they can sometimes be symptoms of delusional disorder—a rare but serious mental illness.
“They’re not making it up,” says Tyler Durns, MD, a forensic fellowship director at Huntsman Mental Health Institute at the University of Utah. “A delusional disorder is a psychotic disorder characterized by one or more fixed false beliefs in isolation from other psychotic symptoms.”
Understanding what delusional disorder is—and how to respond with compassion—can help families get a loved one the care they need.
What is delusional disorder?
A delusion is a belief that remains fixed even when there is clear evidence that it isn't true.
Unlike schizophrenia, people with delusional disorder often continue to function well in many areas of life. They may work, maintain relationships, and appear logical during everyday conversations. The delusion may be the only obvious symptom.
That can make the condition difficult to recognize.
What do delusions look like?
Delusions can take many forms, but the most common type is a persecutory delusion—the belief that someone is trying to harm, watch, or conspire against you.
Examples may include believing:
- A camera or tracking device has been secretly implanted in your body
- Government agencies or neighbors are spying on you
- Someone is poisoning your food
- You’re being followed wherever you go
- You’re the subject of secret experiments or surveillance
Other types of delusions include believing:
- Someone is secretly in love with you
- Your body is severely damaged despite medical evidence
- A partner is unfaithful without evidence
- You have extraordinary abilities or an important discovery
How is delusional disorder different from a conspiracy theory?
This is an important distinction.
People can adopt false beliefs because of misinformation, social media, or online communities. That doesn’t automatically mean they have a psychiatric disorder.
With delusional disorder, the false belief is a symptom of a medical illness affecting the brain. That’s why someone experiencing a delusion usually can’t be talked out of it with facts alone.
What causes delusional disorder?
Researchers don’t know exactly what causes delusional disorder.
Like many mental illnesses, experts believe it develops through a combination of biology, genetics, and life experiences.
“We use what’s called the biopsychosocial model,” Durns says. “Some people may have a biological vulnerability, while factors like trauma or substance use can also influence whether a mental illness develops.”
Although researchers are still learning about the condition, the fact that antipsychotic medications can improve symptoms suggests that changes in brain chemistry play an important role.
Why do people with delusional disorder often fail to recognize it?
One of the biggest challenges is that people with delusional disorder often don’t recognize their beliefs are symptoms of an illness.
This lack of awareness, called anosognosia, means they usually don’t seek treatment because, to them, the belief feels completely real.
Instead, they may seek help for anxiety, depression, or another concern before eventually discussing the delusion.
How do you help someone with delusional disorder?
It can be frustrating—or even frightening—to hear someone describe beliefs that seem impossible.
Your first instinct may be to argue with them.
According to Durns, that’s usually not the best approach.
“Delusions are categorically fixed,” he says. “Challenging them directly isn’t necessarily going to change things.”
Instead, try these tips:
- Stay calm
- Listen without agreeing that the delusion is true
- Acknowledge the person’s fear or distress
- Encourage them to talk with a mental health professional
- Keep the lines of communication open
“You don’t want to validate the belief,” Durns says. “But you can validate their distress.”
Continuing to show empathy and keeping communication open may make someone more willing to accept treatment over time.
When should you seek professional help?
Safety comes first.
“If there’s any concern that the person may harm themselves or someone else, seek emergency services,” Durns says.
While most people experiencing delusions are not violent, persecutory delusions—believing others are trying to harm you—are associated with a higher risk than other psychiatric symptoms.
Call 911 if there’s an immediate emergency.
If you need crisis support or aren’t sure what to do, contact 988, the Suicide & Crisis Lifeline, for guidance.
Can delusional disorder be treated?
Delusional disorder can be difficult to treat because many people don’t realize they’re experiencing a mental illness. Since the belief feels real, they often don’t seek psychiatric care on their own.
Even so, treatments can help.
At Huntsman Mental Health Institute, treatment usually combines medication with psychotherapy.
Antipsychotic medications may reduce how distressing or consuming the delusions become, while therapy can help people gradually examine their beliefs and reduce the impact those beliefs have on daily life. Treatment looks different for every person, and recovery varies.
Where families can find support
If someone you love is experiencing symptoms of delusional disorder, you don’t have to navigate it alone.
Durns recommends reaching out to:
- A psychiatrist or licensed mental health professional
- Your primary care provider for a referral
- The National Alliance on Mental Illness (NAMI) for education and family support
- The 988 Suicide & Crisis Lifeline if you’re worried about someone’s immediate safety or need help deciding what to do next
Delusional disorder is a medical condition—not a personality flaw or a choice. While you can’t talk someone out of delusion, you can help by responding with empathy, protecting everyone’s safety, and encouraging professional care.
“Sometimes one of the kindest things you can do is help get someone into treatment before anything is too late,” Durns says.
Are You in Crisis?
For immediate emergencies, please call the 988 Suicide & Crisis Lifeline.
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