DELUSIONS - THEORIES

Presented by- Lyn Elsa Georgy

definition

Karl Jaspers was the first to define the three main criteria for a belief to be considered delusional in his 1913 book General Psychopathology. These criteria are:

certainty (held with absolute conviction) incorrigibility (not changeable by compelling

counterargument or proof to the contrary) impossibility or falsity of content

(implausible, bizarre or patently untrue)

Delusions are categorized into four different groups

Bizarre delusion: A delusion that is very strange and completely implausible; an example of a bizarre delusion would be that aliens have removed the affected person's brain.

Non-bizarre delusion: A delusion that, though false, is at least possible, e.g., the affected person mistakenly believes that he is under constant police surveillance.

Mood-congruent delusion: Any delusion with content consistent with either a depressive or manic state, e.g., a depressed person believes that news anchors on television highly disapprove of him, or a person in a manic state might believe he is a powerful deity.

Mood-neutral delusion: A delusion that does not relate to the sufferer's emotional state; for example, a belief that an extra limb is growing out of the back of one's head is neutral to either depression or manic.

Themes Delusion of control: This is a false belief that

another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behavior.

Nihilistic delusion: This is a false belief that one does not exist or has become deceased.

Delusional jealousy (or delusion of infidelity): A person with this delusion falsely believes that a person is lying to them or that a spouse or lover is having an affair, with no proof to back up their claim.

Delusion of guilt or sin (or delusion of self-accusation): This is a false feeling of remorse or guilt of delusional intensity.

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Delusion of mind being read: The false belief that other people can know one's thoughts.

Delusion of reference: The person falsely believes that insignificant remarks, events, or objects in one's environment have personal meaning or significance.

Erotomania : A delusion where someone believes another person is in love with them.

Religious delusion: Any delusion with a religious or spiritual content. These may be combined with other delusions, such as grandiose delusions (the belief that the affected person is a god, or chosen to act as a god, for example).

Somatic delusion: A delusion whose content pertains to bodily functioning, bodily sensations, or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal, or changed—for example, infested with parasites.

Delusion of poverty: The person strongly believes that he is financially incapacitated. Although this type of delusion is less common now, it was particularly widespread in the days before state support

Theories

Delusion formation- factors

Disorders of brain functioning Influences of personality and

temperament Self esteem Role of affect Resultant of Perceptual disturbances Result of depersonalization Cognitive overload, styles - Brockington, 1991

Biological theories

Damage to frontal lobes (pre) – responsible for self analysis, control, executive functions can precipitate delusions- Stuss and Buss (1986, 1990).

Increased dopamine can result in delusional and hallucinatory behavior ( Sherer, Kumor, Cone & Jaffe, 1988)

Left temporal brain lesions-correlated with hallucinatory and delusional states. Cutting, 1985)

Freudian hypothesis

Basic hypothesis- delusions stem from repressed homosexual tendencies. Based on his case study reviews of judge Schreber.

The basic proposition is that “ I a man cannot love a man , therefore its repressed, however it manages to find a way out of the unconscious after some distortions, ultimately in the form of delusions-

Propositions in the unconscious- Delusions of persecution- I hate him, he hates me, hence he is

after me. Delusions of love- I love her and she loves me. Delusions of jealousy- I do not love him, she loves him and he

love her. Delusions of grandeur- I do not love him, I love me, and others

love me.

Griesinger (1845)- delusions of nihilism- subjective within is misplaced on to outside things. Everything is dead.

Delusions of guilt, unworthiness, religious delusions predominantly seen as secondary to depressive mood. Higgins,(1990).

Delusions and attention

Psychotic patients also exhibit similar unhelpful cognitive styles like patients with neurotic disorders like anxiety and depression. For example their delusional beliefs may be based on the operation of catastrophisation of bodily sensations, selective attention to threatening stimuli, (or a all or none thinking style).

Differences in paranoid vs non paranoid schizophrenics (Magaro, 1980); former extensive scanners of environment, latter poor.

Delusions and perception

Pavlov (1934) first proponent that perceptual anomalies can cause delusions(reference and of being controlled), the explanation he gave was that a pathological inertness of cells in the sensory cortex, which results in hyperarousal of other surrounding cells, which causes irrelevant ideas to enter the conscious, acc to pavlov, delusion is a reflection on these irrelevant ideas.

Kays (1972), Cooper and Potter(1976)- higher incidences of perceptual difficulties in visual and auditory modality in paranoid patients, when compared to affective ones.

Delusions and emotions, motivation Bleuler (1906) suggested emotions

weaken normal associations between normal thoughts and leads to the development of schizophrenic patients, whereas in paranoia, emotions lead to the pathological adherence to the delusion.

In contrast Jaspers and Scheinder differentiated between primary and secondary delusions based on the affective component.

Cognitive styles and processes1. Jumping to conclusions- A number of research

studies that people with delusions have a tendency to seek relatively less information before reaching a conclusion, this has been more specifically described as “ Data Gathering Bias” –( Garety and Freeman, 1999)

2. Attribution bias- people with persecutory delusions generally tend to blame other people (rather than by chance than by themselves) for bad events happening to them, which is an exaggeration of the self serving bias that normals usually show. (Bentall, 1996)

Theory of Mind (ToM)/ meta representations Theory of Mind is the ability - displayed by adult humans - of making

inferences about the content of other people’s minds. It has recently been noted that the subject matter of Delusional

disorders is distinctive, since the false beliefs are ‘social’ in content, and typically concerned with the assumed dispositions, motivations and intentions (DMIs) of other people. For this reason, Delusional disorders have been labelled ‘Theory of Mind’ delusions, because they seem to involve inferences (or theories) about what is going on in the minds of other people (Charlton & McClelland, 1999).

For example the commonest types of Delusions of jealousy over sexual infidelity and those in which there is a false belief of persecution. It has been suggested that these delusions derive from errors of inference relating to the contents of other people’s minds.

Since Delusional disorder is related to reasoning about the dispositions, motivations and intentions of other people, the mechanism by which such reasoning is performed in humans requires consideration.

Sexual jealousy in evolutionary context

Jealousy in men can be seen as an evolved psychological adaptation that operates to reduce the chance of sexual infidelity in a partner, and reduce the chance of misdirected investment (even the act of mating typically requires substantial investment of resources, and loss of the opportunity to invest these in courting other mates; Buss, 1994).

Jealousy in women is significantly different since female mammals do not suffer from uncertainty as to the identity of their offspring, and sexual infidelity per se is not a problem. The problem for a female is to secure investment to help in rearing offspring, and jealousy is primarily concerned with ensuring that the male partner directs his investment efforts towards the woman’s own offspring. So female jealousy is less concerned with the act of sexual infidelity and more with the danger of a male partner transferring his affections (and resources) to another female (Wiederman & Allgeier, 1993; Buss, 1994).

Hence selection pressures have led to different cues that stimulate the emotion of jealousy in men and women: men primarily fear physical infidelity (the partner having sexual intercourse with another man) while women primarily fear emotional infidelity (the partner falling in love with another woman) (Townsend, 1995; Geary et al, 1995; Mullen & Martin, 1994).

Enoch (1991) regards th nature of the relationship between the partners as a key aspect, the deluded partner is very attached to emotionally dependent and may have a misplaced sense of owning that person completely. The victim is much more sexually attractive that the deluded.

References-

Smith, L., Nathan, P., Juniper, U., Kingsep, P., & Lim, L. (2003). Cognitive Behavioral Therapy for psychotic symptoms: a treatment manual. Perth : Australia.

Adams, H.E., & Sutker, P.B. (2001). Comprehensive handbook of psychopathology. Gulf Professional Publishing.

Sims, A. C. P. (2002). Symptoms in the mind. Elsevier Science Ltd: London.