Stroke of Panic

One disorder that the psychiatric profession finds hard to diagnose and treat is delusional disorder. Diagnosis is difficult because the delusions are considered "non-bizarre," meaning the patient's beliefs might theoretically be plausible, and they often function in the world. The person may not believe they have a problem, and since the most common form of the illness creates paranoia, they often refuse to find a therapist at all. Even if they do, the doctor can't prescribe any drug products, since the delusion usually convinces the person that someone is "out to get them." Hospitalization, too, would only reinforce that belief.

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.

Few medical treatments have any effect on this disorder, so the main treatment method will be psychosocial. The best treatment method involves the therapist coming at the problem obliquely; not confronting the patient directly about having a delusional disorder. Rather, the doctor may offer to treat symptoms that might attend the disorder, giving the patient depression anxiety treatment options instead. Once a good therapist-patient relationship of trust is established, the doctor might then challenge some of the delusional beliefs, in a non-condemning, non-condoning way. And only if the patient's behavior becomes dangerous or too agitated would drugs enter the picture.

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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