Definition of 'delusion' updated in DSM

Pete Tar

Senior Member.
Now apparently delusion as a technical term in psychiatry has been refined so it is not the belief itself but the *way* it is believed that makes it 'delusional'.


Delusions, in the medical sense, are not simply a case of being mistaken, as the everyday use of the term suggests. They are profound and intensely held beliefs that seem barely swayed by evidence to the contrary – even to the point of believing in the bizarre. My heart has been replaced by steam. My thoughts are being stolen by satellites. The government communicates with me through birdsong.

But many delusions are not outlandishly eccentric, they are simply implausible. Consider the scenario where people believe that their neighbours are conspiring against them or that they are the subject of a film star's secret affections. Occasionally, these beliefs turn out to be true, but this is not a reliable guide to whether someone is delusional or not. This was memorably illustrated by the psychiatrist Andrew Sims, who warned in his psychopathology textbook Symptoms in the Mind that spouses of people with delusions of infidelity may occasionally be driven to infidelity. This romantic betrayal does not suddenly cure their partner of their mental illness.

The general idea is that delusions represent a problem with how you believe – that is, a problem with forming and changing beliefs – not a problem with what you believe. In other words, simply believing something strange or unusual should not be considered a problem but having "stuck" beliefs that are completely impervious to reality suggests something is mentally awry.

On the ground, mental health professionals are often required to decide if someone's thinking indicates a disturbance in their understanding of the world, and this is where the new DSM-5 definition of a delusion may usher in a quiet revolution in psychiatry. No longer are psychiatrists asked to decide whether the patient has "a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary". A wordy and unhelpful definition that has so many logical holes you could drive a herd of unicorns through it.

Instead, the new definition of delusions describes them as fixed beliefs that are unswayed by clear or reasonable contradictory evidence, which are held with great conviction and are likely to share the common themes of psychosis: paranoia, grandiosity, bodily changes and so on. The belief being false is no longer central and this step forward makes it less likely that uncomfortable claims can be dismissed as signs of madness.
Content from External Source
http://www.theguardian.com/science/2013/aug/04/truly-madly-deeply-delusional
 

JRBids

Senior Member.
Sounds like paranoia and delusion are the same thing. Although I suppose someone who thinks their heart is replaced by steam is a totally different pathology than someone who thinks their neighbors are beaming electromagnetic pulses at them.
 

Pete Tar

Senior Member.
I think it means that plausible paranoia isn't immediately a sign of mental disorder - it depends if the paranoia is open to, and can be altered by, evidence to show it's unfounded, where that is possible.
 

David Fraser

Senior Member.
I am not a fan of the DSM mainly due to fixed diagnoses and the apolitical way in which it us written. Anyway I digress. I often talk to people of delusional thinking and it is something we all do. It is a defence mechanism in some cases. Many of us may have continued in crap relationships deluding ourselves we are happy. But at the end of the day in mental health a delusion is often a symptom of a wider problem.
 

Mick West

Administrator
Staff member
Being paranoid is just being very suspicious. Paranoid delusions often follow. You could think that the government might be reading your emails, or you could be convinced that the government sends agents into your house at night to move things around.

You have to remember there's a huge spectrum in these classifications. Someone who is just concerned that when they take their phone in to be repaired that the the technicians will read their emails are very different from people who are concerned that if they say something subversive they will be hauled off to a FEMA camp.
 

JRBids

Senior Member.
I think it means that plausible paranoia isn't immediately a sign of mental disorder - it depends if the paranoia is open to, and can be altered by, evidence to show it's unfounded, where that is possible.

So it it can be altered it's "plausible" paranoia? Of is it if it's physically possible it's "plausible" like the neighbors are watching me is plausible, the neighbors are beaming electro magnetism at me is implausible.
 

Mick West

Administrator
Staff member
So it it can be altered it's "plausible" paranoia? Of is it if it's physically possible it's "plausible" like the neighbors are watching me is plausible, the neighbors are beaming electro magnetism at me is implausible.

Unlikely but not totally implausible. "My wife has been replaced by a robot" is implausible.

There's a sliding scale on all these things. You can point at things at either end of the scale, but it gets a bit fuzzy in the middle.
 

Pete Tar

Senior Member.
It's possible to have totally implausible ideas due to mis-education or exposure to bad ideas, so the 'far-outness' of the idea should not be the measure of ill-health - but reasonable people can have their implausible beliefs altered with evidence.
eg, even if they have somehow aquired the fantastic idea their internal organs have been replaced a simple x-ray of their internal organs compared to a trusted colleague for comparison should convince a reasonable person.
 
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