Delusional Disorder in Children and Adolescents

ICD-10 code: F22

Delusional disorder is part of a cluster of diagnoses called the schizophrenia spectrum and other psychotic disorders. Schizophrenia spectrum and other psychotic disorders are a group of psychiatric conditions that include:

  • Schizotypal (personality) disorders
  • Delusional Disorder
  • Brief Psychotic Disorder
  • Schizophreniform Disorder
  • Schizophrenia
  • Schizoaffective Disorder
  • Substance/Medication-Induced Psychotic Disorder
  • Psychotic Disorder Due to Another Medical Condition
  • Catatonia

These disorders are characterized by symptoms that can be divided into two groups: positive and negative.

Positive symptoms are those which are in addition to normal experiences and which youth without schizophrenia will rarely experience. Positive symptoms include delusions, hallucinations, disorganized thinking (speech), and grossly disorganized or abnormal motor behavior (including catatonia). Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Hallucinations are perception-like experiences that occur without external stimulus. Disorganized thinking/speech is characterized by a derailment or loose associations in an individual’s speech pattern. Grossly disorganized or abnormal motor behavior is a difficulty in sustaining goal-oriented behavior. This may manifest itself in a variety of ways, ranging from childlike “silliness” to unpredictable agitation.

Negative symptoms include diminished emotional expression, avolition, alogia and anhedonia. Negative symptoms are those that involve a loss of normal function or experience. Diminished emotional expression is the reductions in the expression of emotions in the face, eye contact, intonation of speech, and movement of hand, head, and face that normally give an emotional emphasis to speech. Avolition is a decrease in motivated self-initiated purposeful movement. Alogia is manifested by diminished speech output. Anhedoia is the decreased ability to experience pleasure from positive stimuli.


What is delusional disorder?

Delusional disorder is one of the less common psychotic disorders, in which patients have delusions but not the other classical symptoms of schizophrenia (thought disorder, hallucinations, mood disturbance or flat affect). Unlike most other psychotic disorders, the person with delusional disorder typically does not appear obviously odd, strange or peculiar during periods of active illness. Yet, the person might make unusual choices in day-to-day life because of the delusional beliefs. The delusion will not always include bizarre content.

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Understanding Delusional Disorder

Delusional disorder is infrequently seen in practice. This is possibly attributed to the often intact daily living skills and ability to function seen in people with the disorder, despite their delusions. Those who believe implicitly in their delusions may not feel the need for treatment and may resist the suggestions of others that they seek psychiatric attention. 

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How is delusional disorder treated?

There is currently insufficient research to make evidence-based recommendations for treatments for individuals with delusional disorder. Until further research is conducted in this area, the following treatments are recommended based on efficacy in other psychotic disorders in the pediatric population.

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