Delusional Disorder in Teens: Symptoms, Causes, Types and Treatment

Delusional disorder is a serious mental illness that affects teenagers marked by the presence of delusions. These false beliefs are held with strong conviction despite evidence to the contrary.

Delusional disorder in teenagers manifests through various symptoms such as non-bizarre delusions, paranoia, and suspicion.

Delusional disorder is caused by genetic factors (family history of psychotic disorders), biological factors (abnormalities in brain structures), psychological factors (hypersensitive and distrusting people), and environmental factors stress, social isolation, and substance abuse).

Treatment of delusional disorder includes pharmacotherapy (antipsychotic medication),  psychotherapy (cognitive behavioral therapy), supportive services, and addressing underlying issues.

What Is Delusional Disorder In Teens?

Delusional disorder is a severe mental illness characterized by the presence of delusions. These are false beliefs not grounded in reality and persist despite contrary evidence. While more common in adults, this disorder also manifests in teenagers, significantly impacting their daily lives and development.

In teens, delusional disorder presents unique challenges due to the developmental stage and social pressures typical of adolescence. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), delusions in individuals with this disorder are categorized into various types, including persecutory, grandiose, jealous, erotomanic, somatic, and mixed types. Each type reflects different thematic preoccupations, such as unfounded beliefs of persecution, inflated self-worth, or false medical conditions.

What Are The Different Types Of Delusional Disorders In Teens?

There are several different types of delusional disorders, including persecutory, grandiose, jealous, and somatic. According to a 2023 article, “Delusional Disorder ICD-10-CM Codes”,  from Care Patron, delusional disorder is classified under F22. It has the following types:

  1. Persecutory type: This is the most common type of delusional disorder in teens. Teens with this type of delusion believe that they are being stalked, harassed, or poisoned.
  2. Grandiose type: Teens with this type of delusion believe that they have special powers or abilities or are famous or important.
  3. Jealous type: Teens with this type of delusion believe that their romantic partner is cheating on them.
  4. Erotomanic type: Teens with this type of delusion believe that someone is in love with them, even if there is no evidence to support this belief.
  5. Somatic type: Teens with this type of delusion believe that they have a serious medical illness, even though there is no physical evidence to support this belief.

What Are The Symptoms Of Delusional Disorder In Teens?

Delusional disorder in teenagers manifests through symptoms such as non-bizarre delusions, paranoia, and suspicion. According to the article “Delusional Disorder” from Psychology Today, people with delusional disorder must exhibit at least one delusion for at least a month to be diagnosed as having the condition. Teens with delusional disorder exhibit the following symptoms:

  1. Non-Bizarre Delusions: These are false beliefs that could conceivably occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by a spouse or partner. The key factor is that these delusions are plausible and not entirely implausible or bizarre.
  2. Functional Impact: Despite the presence of delusions, teenagers with delusional disorders often continue to function relatively well in daily life. They exhibit overtly odd or bizarre behavior, making the disorder challenging to detect.
  3. Absence of Hallucinations: Unlike other psychotic disorders, delusional disorder in teens typically does not involve prominent hallucinations (such as hearing voices or seeing things that are not there). If hallucinations are present, they are not as prominent as the delusions.
  4. Mood Symptoms: Some teens experience mood disturbances, including depression or irritability, but these symptoms are secondary to delusions and are not the primary clinical feature.
  5. Suspiciousness and Paranoia: Teens with delusional disorder often display heightened suspiciousness and paranoia, believing that others are conspiring against them or plotting harm.

What Are The Causes Of Delusional Disorder In Teens?

Delusional disorder is caused by genetic factors (family history of psychotic disorders), biological factors (abnormalities in brain structures), psychological factors (hypersensitive and distrusting people), and environmental factors stress, social isolation, and substance abuse). 

According to a 2024 article, “Delusional Disorder: Types, Symptoms, and Treatment”, from WebMd, the delusional disorder has no one single cause but rather a combination of genetic, biological, and environmental factors.

Genetic Factors

Genetic predisposition plays a significant role in the development of delusional disorder. Individuals with a family history of schizophrenia or other psychotic disorders are at a higher risk of developing delusional disorders themselves. This genetic link suggests that certain hereditary factors contribute to the onset of the disorder, and having a biological relative with the condition increases the likelihood of developing it​.

Biological Factors

Biological factors, including abnormalities in brain structure and function, are implicated in the development of delusional disorder. Neurotransmitter imbalances, particularly involving dopamine, are believed to influence the manifestation of delusional symptoms. These imbalances disrupt normal brain function, leading to the perception of false beliefs. Furthermore, certain brain regions, such as the limbic system and prefrontal cortex, exhibit abnormalities in individuals with delusional disorders, affecting their ability to process information and emotions correctly​​.

Psychological Factors

Psychological factors, including personality traits and coping mechanisms, contribute to the development of delusional disorder in teens. According to a 2022 article” What Is Delusional Disorder?” from Verywell Mind, adolescents who exhibit traits such as hypersensitivity, envy, suspicion, and distrust are more prone to developing delusions. These traits lead individuals to misinterpret and exaggerate external stimuli, fostering false beliefs. Low self-esteem and feelings of insecurity also prompt teens to create delusional explanations for their experiences as a means of coping with their emotional distress​.

Environmental Factors

Environmental factors, including stress, social isolation, and substance abuse, significantly impact the onset of delusional disorder. Teens who experience high levels of stress, whether from academic pressure, family conflict, or social challenges, are at increased risk. Social isolation exacerbates feelings of paranoia and suspicion, while substance abuse, particularly alcohol and drugs, alters brain chemistry and triggers delusional thinking. Environmental stressors thus interact with genetic and biological predispositions to precipitate delusional disorder.

What Is The Treatment Of Delusional Disorder In Teens?

Treatment of delusional disorder includes pharmacotherapy (antipsychotic medication),  psychotherapy (cognitive behavioral therapy), supportive services, and addressing underlying issues.

According to the article “ Delusional Disorder” from Texas A&M University, treatment for delusional disorders in teenagers typically involves a combination of pharmacotherapy and psychotherapy. However, treating the condition is usually challenging due to the individual’s suspicions and beliefs, leading them to believe that loved ones and healthcare professionals intend to harm them. 

  1. Pharmacotherapy: Antipsychotic medications are the cornerstone of treatment for delusional disorders. These medications help reduce the severity of delusions and improve overall functioning. Commonly used antipsychotics include risperidone, olanzapine, and aripiprazole. The choice of medication depends on the teen’s specific symptoms and their response to treatment.
  2. Psychotherapy: Cognitive-behavioral therapy (CBT) is highly effective in treating delusional disorders. CBT helps teens identify and challenge their delusional beliefs, develop healthier thought patterns, and improve coping strategies. Family therapy is also beneficial, as it provides support and education to family members about the disorder and how to assist the teen.
  3. Hospitalization: In severe cases, where the teen poses a risk to themselves or others, hospitalization is necessary. Inpatient care provides a safe environment for intensive treatment and stabilization.
  4. Supportive Services: Teens with delusional disorders usually benefit from additional support services, including case management, educational support, and social skills training. These services help the teen reintegrate into their community and improve their quality of life.
  5. Addressing Underlying Issues: Addressing any underlying psychological or environmental issues that contribute to the disorder is essential. This includes treating co-occurring mental health conditions, managing stress, and improving the teen’s social support network.

How Does Delusional Disorder Differ From Schizophrenia?

According to a 2022 study, “ Differences Between Delusional Disorder And Schizophrenia”, by González-Rodríguez, A. et al., published in the World Journal of Psychiatry, the key difference between delusional disorder and schizophrenia involves hallucinations (seeing or hearing things that are not there) in addition to delusions, whereas delusions are typically the main feature in delusional disorder.

What Is The Prevalence Of Delusional Disorder?

According to the article from Psychology Today, the condition is more common in males compared to females. Additionally, delusional disorder affects about 0.2% globally.

Can Early Intervention Improve Outcomes For Teens With Delusional Disorder?

Yes, early intervention is crucial for improving outcomes. Early detection and comprehensive treatment can significantly reduce the severity of symptoms and enhance the teen’s quality of life.

What Is Shared Delusional Disorder?

According to a 2023 study by All-Saif et al., “ Shared Psychotic Disorder”, shared delusional disorder, also known as folie à deux (French for “madness of two”), or shared psychotic disorder, is a rare mental illness where a person who does not have a mental illness develops the delusions of someone who does. This happens in close relationships, such as between romantic partners, parents and children, or siblings.

Can Delusional Disorder Be Cured?

Delusional disorder is not necessarily cured, but it is effectively managed with treatment. According to the WebMD article on Delusional Disorder, it is a chronic condition that improves when treated.

Author: Shantel Sullivan Ed.D., LCSW
Dr. Shantel Sullivan, Ed.D., LCSW, serves as the CEO of Bright Path with a rich background in residential adolescent treatment, adult outpatient services, and academia, leveraging over a decade of licensed social work experience in New York and North Carolina. Her academic credentials include a BA in Sociology, an MSW and a graduate certificate in addictions counseling from the University of New England, culminating in a doctoral degree in Educational Leadership focused on transformational leadership. Beyond her clinical expertise, Dr. Sullivan contributes to the field as a national speaker, educator, and editor of the Bright Path Teen Mental Health Blog, committed to enhancing access to evidence-based mental health care for adolescents and their families.
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