Treatment for delusional disorder often includes therapy. Medication may also be used to help manage symptoms in some cases.
Delusional disorder is a mental health condition defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), as the presence of delusions lasting 1 month or longer.
The condition’s primary symptom is delusions — enduring, unrealistic thoughts, ideas, and beliefs that remain despite evidence they’re untrue.
While hallucinations may rarely be present in delusional disorder, the DSM-5-TR notes they aren’t as significant and will follow the theme of delusions.
Treatment for this condition typically involves a combination of therapy, medication, and self-care strategies.
Delusional disorder treatment can be challenging. Many people living with this condition aren’t able to recognize the inaccuracy of their thoughts or the need for help.
“Delusional disorders are ego-syntonic, meaning the person doesn’t believe they’re sick so are unlikely to seek treatment on their own,” explains Dr. Laurence Miller, a licensed clinical and forensic psychologist from Boca Raton, Florida.
According to a
“When available, effective treatment usually involves a combination of medication and cognitive behavioral psychotherapy,” Miller says.
Cognitive behavioral therapy (CBT)
CBT is considered one of the foundational approaches to delusional disorder treatment.
It’s a methodology that centers around three core principles:
- unhelpful ways of thinking are a part of the core of psychological challenges
- learned, unhelpful behaviors directly contribute to psychological challenges
- symptoms can be effectively managed through the development of better coping strategies
So, CBT focuses on recognizing unhelpful thoughts and behaviors and their consequences.
With this understanding, you can progress through CBT by developing problem-solving skills and a sense of confidence in your decisions.
Cognitive behavioral therapy for psychosis (CBTp)
Treatment of psychosis symptoms such as delusions may involve a targeted process of CBT known as CBTp.
CBTp incorporates the same principles as CBT but focuses on ways to live with delusions, aiming to reduce symptoms of distress and improve overall functioning. It’s a therapeutic approach that involves reducing the stigma surrounding psychosis.
Cognitive behavioral worry intervention (W-CBT)
Research from 2009 suggests another form of CBT, cognitive behavioral worry intervention (W-CBT), may hold some benefit for addressing the anxiety that can accompany delusions.
There’s no medication approved by the Food and Drug Administration (FDA) to treat delusional disorder. But medication may be suggested in some cases to help address imbalances in neurotransmitters thought to contribute to symptoms.
Antipsychotic medications are often used to help manage symptoms of psychosis such as delusions or hallucinations.
While these medications aren’t often prescribed to treat this delusional disorder alone, they may help if you’re experiencing delusions.
These medications work by manipulating neurotransmitters in the brain, particularly dopamine and serotonin.
Early versions of these medications are known as first-generation antipsychotics, aka typical antipsychotics, and work primarily by influencing dopamine receptors.
Second-generation antipsychotics (atypical) include more recent, better-tolerated formulations that impact both dopamine and serotonin.
Typical that may be used for delusional disorder treatment include:
- chlorpromazine (Thorazine)
- haloperidol (Haldol)
- fluphenazine (Prolixin)
- thioridazine (Mellaril)
- perphanenazine (Trilafon)
- trifluoperazine (Stelazine)
- thiothixene (Navane)
Atypical antipsychotics that may be used for delusional disorder treatment include:
- risperidone (Risperdal)
- olanzapine (Zyprexa)
- ziprasidone (Geodon)
- clozapine (Clozaril)
- quetiapine (Seroquel)
- amisulpride (not approved for use in the U.S.)
- aripiprazole (Abilify)
- paliperidone (Invega)
- iloperidone (Fanapt)
The antipsychotic medication selected for you will be based on your medical history and personal experience of delusions.
Early formulations of these medications are known as tricyclic antidepressants. Like other types of first-generation medications, they’re less prescribed due to higher rates of side effects.
Common tricyclic antidepressants include:
- amitriptyline (Elavil)
- protriptyline (Vivactil)
- nortriptyline (Pamelor)
- doxepin (Sinequan)
- imipramine (Tofranil)
- clomipramine (Anafranil)
- desipramine (Norpramin)
- amoxapine (Asendin)
More recent formulations of antidepressants include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
Common SSRIs include:
- citalopram (Celexa)
- escitalopram (Lexapro)
- vilazodone (Viibryd)
- fluoxetine (Prozac)
- fluvoxamine (Luvox)
- paroxetine (Paxil, Pexeva)
Common SNRIs include:
- duloxetine (Cymbalta)
- desvenlafaxine (Pristiq)
- milnacipran (Savella)
- levomilnacipran (Fetzima)
- venlafaxine (Effexor)
Living with delusional disorder can mean different symptoms and experiences for each person. Delusions may be a source of anxiety, for example, or they may interfere with your sleep or concentration levels.
Sleep aids, stimulants, or anxiolytic (anti-anxiety) medications may also be considered for delusional disorder treatment.
If traditional antipsychotic approaches aren’t offering enough support, you may benefit from adjunct therapy with:
Self-care strategies can help support other traditional approaches to delusional disorder treatment.
“The best treatment option for delusional disorder is psychoeducation, which helps the client understand the nature of their symptoms and the implications of their actions,” says Monica Miner, a licensed mental health counselor from Palm Springs, Florida.
You can learn about delusional disorder through literature, videos, seminars, and group support options such as chat rooms and in-person meetings.
This means delusions may result in poor sleep, but also that poor sleep may contribute to the severity of delusions.
Focusing on optimal sleep hygiene interventions, such as limiting blue light exposure before bed, might be one way you can help manage symptoms of delusional disorder.
Delusions may not resolve completely. For this reason, a
Self-soothing approaches may include:
Delusional disorder treatment is a multi-faceted process that typically involves first-line approaches of medications and psychotherapy.
You may be able to support ongoing professional treatment through self-care strategies such as psychoeducation, self-soothing methods, and keeping up with sleep hygiene habits.