Among the various psychiatric diagnoses, one of the hardest to establish and treat is delusional disorder. Diagnosis is difficult because the patient often lives quite normally in the world, with their delusions being “non-bizarre,” or theoretically plausible. In fact, so normal can some people appear that they are convinced they don’t have a problem, and refuse to get therapy. And since paranoia is a large component of most delusions, they will believe someone is “out to get them.” This means that if they do go to a therapist, the doctor won’t be able to prescribe any drug products, nor would hospitalization be an option except in extreme cases.

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.

Medically, only a few current treatments have an effect on this disorder; therefore, the primary type of treatment will be psychosocial. And the best treatments will be indirect, with the therapist perhaps offering depression and anxiety panic treatments instead, since those may also be symptoms of the disorder. The worst thing a therapist can do for a paranoid, suspicious patient is confront them directly about their delusions. They need time to build up some trust, and only then would the doctor begin gently challenging a few of the patient’s beliefs. Drugs would only be used if the patient’s delusional disorder was becoming dangerous or the condition was making them too agitated.

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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