• Persecutory Delusions
• Grandiose Delusions
• Jealous Delusions
• Erotomanic Delusions
• Somatic Delusions
• Mixed Delusions
• Unspecified Delusions

The risk of delusional disorder in the general population is estimated between 0.05% to 0.1% and affects individuals from the age of 18 years to 90 years [1].

The persecutory and jealous delusions are common in males, while the erotomanic delusions are more common in females.

1- What Is a Persecutory Delusion?

A persecutory delusion or paranoia delusion is a fixed belief of being persecuted, potentially harmed, or conspired against resulting in emotional and behavioral actions that can be extreme.

2- What Is a Grandiose Delusion?

A grandiose delusion is a fixed belief of being famous or having prominence, talent, and great achievements (Megalomania).

3- What Is a Jealous Delusion?

A jealous delusion or Othello syndrome is a fixed belief of being betrayed by the partner (unfaithful) and having evidence to support the delusion. This type of delusion can lead to extreme violence such as suicide and homicide.

4- What Is a Erotomanic Delusion?

An erotomanic delusion is a fixed belief of being secretly loved by an individual who may be known, or famous and outside the circle of the delusional individual.

This type of delusion is associated with intense expressions of love that can lead to stalking and assaultive behavior.

5- What Is a Somatic Delusion?

A somatic delusion is a fixed belief of individuals in having something wrong with their bodies, such as having an ugly body, an unknown disease, or being infected with parasites and insects, leading them to visit many doctors to determine their delusional illness.

6- What Is a Mixed Delusion?

A mixed delusion is when the affected individual has a combination of several types of delusions.

7- What Is an Unspecified Delusion?

This type of delusion cannot be classified according to the different types of delusions.

8- What Are the Signs of Delusions?

A delusional individual may manifest the following signs:

• Fixed and non-changeable belief in the delusion
• The individual is emotionally invested in the delusion
• The delusional individual is suspicious when questioned about the delusion
• Irritability and hostility if contradicted about the delusion
• Impact of the delusion on everyday life of the delusional individual

9- What Medical Conditions Can Cause Delusions?

Although the mechanisms are not known, they are several biological causes that may contribute to the development of a delusional disorder:

• Head injury
• Seizures
• Dementia
• Basal ganglia disorder (rare disease affecting the brain and other parts of the nervous system)
• Temporal lobe Disease (resulting in seizures)
• Unbalance in neurotransmission due to anomalies in the function of tyrosine hydroxylase involved in the synthesis of dopamine, epinephrine, and norepinephrine [2].

10- What Genetic Factors Cause Delusions?

Delusions appear to be more common in individuals with family members diagnosed with a delusion disorder or paranoid personality characteristics [3].

11-What Environmental Factors Cause Delusions?

Stress, drug, and alcohol abuse, and individuals’ social isolation, such as immigrants, appear to be contributing factors of delusions.

12- What Psychological Conditions Cause Delusions?

Although delusions have fewer symptoms and functional disability, they have been classified on the same spectrum as schizophrenia, and therefore, the neuropsychological models that are applied to schizophrenia are also applied to delusions [4].

• A cognitive bias model measures emotional and affective states of an individual in response to the individual perception and response to received information.
• A cognitive deficit model evaluates the impact of cognitive impairments on the formation of a delusion.

13- How Are Delusions Diagnosed?

The diagnosis of delusion may involve the use of the Peters et al. Delusions Inventory (PDI) that measures the delusional disorder of the individual through evaluating the ideas and concepts (ideation) behind the delusion using the Present State Examination [5].

Other tools that are used for the diagnosis of delusions involve questionnaires and interviews of the patient and immediate family about the everyday life of the patients and the potential existence of a history of mental health disorders, such as schizophrenia or mood disorders [6].

The assessment of the potential existence of physical disorders such as dementia, metabolic disorders, infections, and endocrine disorders (e.g., hormonal unbalance) is also performed through checking the patient medical record.

The questionnaires, interviews, and medical history records can help in eliminating potential psychological and physical disorders that might be involved in the etiology (cause) of the delusions.

14- How Are Delusions Treated?

The treatment of delusions may involve pharmacotherapy, cognitive-behavioral therapy (CBT), psychosocial interventions, and supportive psychotherapy. However, building a good doctor-patient relationship is the key to the success of the treatment [1].

• Pharmacotherapy

This treatment involves the use of psychotic medications, and antidepressants are used for somatic delusions.

• Cognitive Behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) focuses on identifying biases, worries, interpersonal sensitivity, reasoning style, and any factor that may have influenced the formation of the delusion (ideation) and what the delusional individual consider as evidence for the delusion.

The discussion and analysis that are performed during CBT therapeutic can help deconstruct the ideation that is at the heart of the delusional disorder [7].

• Supportive Therapy

Supportive Therapy aims at reducing the discomfort of the delusional individual through gaining insights about the individual experiences with the delusion and providing suggestions.

This therapeutic approach can also help the acceptance of the treatment process through educating the delusional individual about the illness [8].

Conclusion

Psychotic disorders are associated with individuals that have different perceptions of reality than those of most people around them. Delusions are also psychotic disorders characterized by a fixed and non-changeable interpretation of the reality which other people around them do not perceive.

The delusion is also a process that relies on building fixed ideas and concepts which explain the difficulty in treating delusional individuals. Therefore, achieving a successful treatment of a particular delusion would involve deconstructing those exact same ideas and concepts that make the delusion. However, building a good doctor-patient relationship is the key to the success of the treatment.

The post What Are the Most Common Delusions? appeared first on .

The prevalence of BPD is estimated to be 1.6% in the general population and 20% in the inpatient psychiatric population [1]. It is estimated that 10% of BPD patients commit suicide, which is 50% higher than that of the total population [2].

What causes borderline personality disorder?

The causes of BPD are complex and involve genetic factors and adverse childhood experiences that alter emotions and cause impulsivity leading to behavioral alterations and psychosocial struggles and deficits.

Studies using neuroimaging technologies identified differences in certain parts of the brain of BPD patients, including the amygdala, hippocampus, and medial temporal lobes. Neurobiological studies suggested the potential implication of serotonin in the pathogenesis of BPD [1].

1- Genetic Factors

Evidence of the involvement of genetics in BPD was provided by the study of identical and non-identical twins. A study showed that the rate of BPD in Identical twins is 70%, while it was only 7% for non-identical twins [3]. These results were confirmed by other twin studies that reported a genetic heritability of 50% [4].

2- Adverse Childhood Experiences

Many patients with BPD reported experiences of traumatic neglect and abuse during their childhood, including childhood sexual abuse that represented 40-70% of the reported cases of BPD and difficulties reaching stable attachments or losing attachments figures (e.g., parents) [5][6].

Borderline Personality Disorder Symptoms

The symptoms of BPD are complex and involve affective, cognitive, behavioral, and interpersonal symptoms [7]:

1- Affective Symptoms

These symptoms include intense and frequent episodes of uncontrolled and constant anger with repeated fights, chronic feelings of emptiness, and affective instability associated with anxiety and irritability.

1- Cognitive Symptoms

These symptoms are characterized by temporary stress-related feelings of being persecuted or harassed, or the presence of severe dissociative symptoms such as the feeling as if one is outside, one’s body, and loss of memory.

2- Behavioral Symptoms

These symptoms are associated with impulsivity and frequent suicidal behavior, gestures, or threats, or self-mutilating behavior.

3- Interpersonal Symptoms

These symptoms are associated with hysterical efforts to prevent real or imaginary abandonment but also the existence of unstable and intense interpersonal relationships that are characterized by a switch between extreme acts of devaluation and overestimation of an admired aspect of another person.

Diagnosis of Borderline Personality Disorder

Before performing a comprehensive psychiatric assessment, a careful history and physical examination are performed. Diagnostic screening tools for BPD are also used such as the Zanarini Rating Scale for borderline personality disorder [1]. It has also been shown that patients with BPD have high rates of comorbid disorders:

• Mood disorders 80% to 96%
• Anxiety disorders 88%
• Substance abuse disorders 64%
• Eating disorders 53%
• Attention deficit hyperactivity disorder (ADHD) 10%-30%
• Bipolar disorder 15%
• Somatoform disorders 10%

Borderline personality disorder treatment

1- Psychosocial Interventions

These interventions involve mentalizing-based therapy (MBT) to help the emotional aspect of the patients, dialectical behavior therapy (DBT) that combines mindfulness practices with tangible interpersonal and emotion regulation skills, and transference-focused psychotherapy (TFP) to help make the patients aware of problems associated with interpersonal interactions.

2- Pharmacotherapy

So far, there are no medications that are approved to specifically treat BPD; however, medications such as SSRIs, mood stabilizers, and antipsychotics are used for the control of anxiety, depression, sleep disturbance, or psychotic symptoms [7].

Prognosis of Borderline Personality Disorder

Compared to other mental disorders such as bipolar disorder, BPD seems to have a better prognosis. A study has reported a remission of 75% of hospitalized patients who were included at the start of the study followed up was for 6 years.

The study also reported that only 6% of those who achieved remission had a later recurrence and only 4% of the patients committed suicide within the 6-year study period [8]. Another study that included 290 patients with BPD, reported a remission of 35% after 2 years, 91% after 10 years, and 99% after 16 years.

Conclusion

Although borderline personality disorder is a severe mental disorder characterized by high rates of suicide, psychosocial interventions combined with pharmacotherapy to relieve symptoms such as anxiety, depression, and psychosis, have led to high rates of remission. However, while waiting for better and more cost-effective treatments, early intervention and prevention strategies during childhood or adolescence can certainly help the development of this disorder.

References

[1] Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2021 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.

[2] Swartz, M., Blazer, D., George, L. and Winfield, I., 1990. Estimating the prevalence of borderline personality disorder in the community. Journal of personality disorders, 4(3), pp.257-272.

[3] Torgersen, S., Lygren, S., Øien, P.A., Skre, I., Onstad, S., Edvardsen, J., Tambs, K. and Kringlen, E., 2000. A twin study of personality disorders. Comprehensive psychiatry, 41(6), pp.416-425.

[4] Amad, A., Ramoz, N., Thomas, P., Jardri, R. and Gorwood, P., 2014. Genetics of borderline personality disorder: systematic review and proposal of an integrative model. Neuroscience & Biobehavioral Reviews, 40, pp.6-19.

[5] Zanarini, M.C., Yong, L., Frankenburg, F.R., Hennen, J., Reich, D.B., Marino, M.F. and Vujanovic, A.A., 2002. Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. The Journal of nervous and mental disease, 190(6), pp.381-387.

[6] West, M., Keller, A., Links, P.S. and Patrick, J., 1993. Borderline disorder and attachment pathology. The Canadian Journal of Psychiatry/La Revue canadienne de psychiatrie.

[7] Lieb, K., Zanarini, M.C., Schmahl, C., Linehan, M.M. and Bohus, M., 2004. Borderline personality disorder. The Lancet, 364(9432), pp.453-461.

[8] Zanarini, M.C., Frankenburg, F.R., Hennen, J. and Silk, K.R., 2003. The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. American Journal of Psychiatry, 160(2), pp.274-283.

[9] Gunderson, J.G., Stout, R.L., McGlashan, T.H., Shea, M.T., Morey, L.C., Grilo, C.M., Zanarini, M.C., Yen, S., Markowitz, J.C., Sanislow, C. and Ansell, E., 2011. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Archives of general psychiatry, 68(8), pp.827-837.

The post Emotionally Unstable Personality Disorder appeared first on .