What is delusional thinking?

We look at the facts behind this complex psychological disorder, bust the myths surrounding it, and give tips on how to help someone who is struggling

The concept of delusions is a scary and confusing thing for many people, and as such they are an often-misunderstood symptom of mental illness. They can provoke harmful and stigmatising reactions, which may leave those who experience delusions feeling isolated and victimised. This is why it is vital to educate ourselves on what it really means to have delusions, break down the misconceptions, and understand how we can better support someone who is struggling.

What is delusional thinking?

Dr Elena Touroni, a consultant psychologist and co-founder of the Chelsea Psychology Clinic, says: “Delusional thinking is often a symptom of delusional disorder, and it is characterised by a person having strong or unreasonable beliefs that are out of touch with reality.”

Delusional thinking can be a symptom of schizophrenia, schizoaffective disorder, postnatal psychosis, severe depression, and bipolar disorder. To get to the nitty gritty of what delusions are, it helps to break it down. Delusional thinking is one side of psychosis, the other is hallucinations (hearing, seeing, feeling things that aren’t really there). Delusions appear in two ways – paranoid delusions and delusions of grandeur.

Paranoid delusions include feeling like some unknown force is out to get you, or that everyone is watching your every move and is against you – you may believe the government is spying on you. Delusions of grandeur include feeling invincible and/or all-powerful. People have described believing they are God, or are the only person who can stop a disaster from happening.

I’ve experienced delusions since my teens. I also live with bipolar disorder, and during a manic episode I may hear voices or have outlandish thoughts. For me, delusions come in the form of believing I’m invincible.

I’d be walking on a busy street, and believe if I stepped into the road, I wouldn’t be hurt. I’d truly believe that the traffic would stop for me, because I was so important, I couldn’t be harmed.

These beliefs can seem outlandish and totally unbelievable. It’s difficult to understand how someone who is usually level-headed can suddenly be so detached from the real world. But this is why it’s important to clarify that delusions can’t be changed with facts. To the person experiencing them, it’s as much a fact as the sky being blue.

This is why it can be helpful to recognise behavioural changes as a sign, as there will be an obvious and significant change in the way a person acts when they’re delusional. Someone experiencing delusions will feel distressed and frightened, or elated and reckless.

"38% of people recover after their first psychotic episode"

Mythbusting common misconceptions

1. It isn’t just an opinion different to your own. I often hear people describing someone they disagree with as “delusional”. It’s typically a throwaway phrase people use in arguments, without thinking about the repercussions. By using it this way, it insinuates that those who do experience delusions are deceitful, in the wrong, or are bad people. Instead, try to use ‘inaccurate’, ‘false’, ‘unbelievable’, ‘fantasy’ or ‘pipe dream’.

2. Delusions don’t automatically make someone dangerous to others. People who experience delusions are far more likely to be a danger to themselves than others. In fact, delusional thinking can make people extremely vulnerable. It can cause them to be physically hurt – as I’ve experienced myself. People experiencing delusions are also often taken advantage of, and can find themselves in dangerous situations. They can’t rely on keeping themselves safe in daily life, because their view of the world is temporarily skewed.

3. It’s not an isolated symptom. Delusions are usually a symptom of a wider mental illness, that someone has been diagnosed with. One person may only experience delusional thinking once in their lifetime, while another might have numerous instances where they become unwell.

4. People with delusions are not a lost cause. They don’t need to be constantly hospitalised, and can often be treated as an out-patient. With the right diagnosis, treatment, and therapy, people who experience delusional thinking can lead healthy lives.

How to help

“Delusional thinking is a complex psychological difficulty, and often part of a severe mental illness,” Dr Touroni says. “Therefore, if you believe a loved one is experiencing delusions, it’s important they seek professional help as soon as possible.”

If you experience delusions personally, you might not realise you’re unwell as it’s happening. It’s therefore important to plan for when you might become poorly in the future. Make sure loved ones are aware of the signs and symptoms, and how to get in touch with medical professionals if they’re concerned for your welfare. It might also be helpful to carry a crisis card, which can be carried in your pocket or wallet, and explain who to contact when you’re experiencing a crisis.

Someone experiencing delusional thinking won’t usually ask for help because what they believe, their words and actions, will all seem completely natural, to them. They might instead express to you that they’re frightened and anxious.

It might, for example, be that they feel they can’t go outside because they’re being spied on. This is where you can help practically. Ask them if they need groceries. Ask them if they’re eating and getting enough sleep. Encourage them to take a shower and look after themselves.

It can be difficult to see past what someone is saying when, to you, it seems ridiculous. Shutting them down and telling them so will only push them away – it won’t snap someone out of the delusion. The opposite is also true, so it’s important not to feed the belief by asking questions, or playing along.

What you can do is focus on their feelings. If they’re scared, worried, angry, elated, then talk about it and identify what you can do to help. Try to stay calm, and be gentle with any suggestions or questions. You could also try to distract them from their delusion – but make sure they still feel listened to and reassured.

Usually a person who experiences delusions will already have a diagnosis of a mental illness. In this case, they may have a crisis plan in place, including who to call (such as their psychiatrist), the treatment they have agreed on, and what helps them during this time.

To speak with a counsellor and explore your thoughts and feelings, you can visit counselling-directory.org.uk