Delusional disorder

After twenty-two years of marriage, Mr. Karim, a successful contractor, is certain his wife is having an affair. He checks her phone each night, times her trips to the market, and reads meaning into a neighbour’s cough. She has never given him reason. His evidence, laid out on the dining table in Mirpur DOHS, would convince no one else.

An illustration drawn from common experience. The people are invented; the pattern is not.

Understanding delusional disorder

Delusional disorder is a condition in which a person holds one or more fixed, false beliefs with complete certainty, while the rest of their thinking and behaviour may seem normal. Common themes are a partner’s infidelity, being persecuted or followed, having a serious illness, or someone famous being in love with them. Jealous delusions can bring great strain, and sometimes danger, to a marriage. Some medical conditions, alcohol and drugs can cause similar beliefs, so a full assessment matters.

Signs and symptoms of delusional disorder

• A belief held with total certainty despite clear evidence against it
• Checking, following or interrogating a partner
• Growing anger or threats connected to the belief
• Otherwise ordinary functioning at work and in daily life

Treatment for delusional disorder

A psychiatric assessment confirms the diagnosis and rules out other causes. Treatment often draws on antipsychotic medication, as used in other psychotic illnesses, together with careful, respectful psychological work, although research specific to delusional disorder is small. Arguing about the belief rarely helps. Where there is any risk to a partner, safety comes first.

What getting better can look like

At the Karims’ dining table, it might be a quieter house, a phone left unchecked on the table, and a belief that has loosened its grip.

Common questions about delusional disorder

What is the difference between jealousy and delusional jealousy?

Ordinary jealousy can be eased by reassurance or by the facts. In delusional disorder, the belief that a partner is unfaithful is held with complete certainty despite clear evidence against it, and it often leads to checking, following or interrogating the partner. Some medical conditions, alcohol and drugs can cause similar beliefs, so a full assessment matters.

How can a family help someone who will not accept they are ill?

Arguing about the belief rarely helps and can increase conflict. Families can speak to a psychiatrist on their own first, to plan how to encourage an assessment. Where there is any risk to a partner, safety comes first, and in danger the number to call is 999.

When to see a psychiatrist

If someone you live with holds a fixed belief that is causing fear or conflict, please seek help. If you are in danger, call 999.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• Skelton et al., Cochrane Database of Systematic Reviews, 2015 (PMID 25997589)