Delusions Occurring in Bipolar Disorder

A delusion is a false belief that a person firmly holds to be true, regardless of whether it is actually true or even possible. Someone who is delusional will hold on tight to such a belief even if other people are able to logically explain why it's false.

There is a recognized mental illness called delusional disorder in which delusions are the dominant symptom. In a type of bipolar disorder that includes psychosis, however, delusions are a psychotic symptom of the mood disorder. They often appear along with hallucinations—sensory perceptions aren't actually there.

Types of Delusions in Bipolar Disorder

There are many different types of delusions. These are the ones most commonly associated with mental disorders such as bipolar disorder:

• Delusions of grandeur: Believing that you're famous or publicly important or that you're a god.
• Delusional jealousy: Believing that your spouse or partner is being unfaithful when they are not.
• Persecutory or paranoid delusions: Suspecting that you are being followed, spied on, secretly listened to, or the like.
• Somatic delusions: Believing that you have a certain medical condition or physical defect.
• Delusions of reference: Thinking that random events contain a special meaning for you alone.
• Bizarre delusions: Believing in things that are impossible, such as thinking you're a werewolf, your sister is an octopus, or that giant worms make subway tunnels.
  

Psychosis and Delusions in Bipolar Disorder

In the simplest terms, psychosis is the loss of touch with reality. When someone is having a psychotic event, their thoughts and beliefs become distorted.

Sometimes the delusions and hallucinations that accompany bipolar symptoms are in keeping with a person's current mood state, in which case they're called mood-congruent symptoms, and sometimes the opposite is the case—a person's delusion doesn't match up with their mood, which is known as mood-incongruent symptoms.

In fact, there's an array of non-psychiatric conditions that cause psychoses, including:

• Certain drugs and medications
• Head injuries
• Huntington's disease
• Sleep deprivation
• Temporal lobe epilepsy
• Thyroid disorders
• Vitamin B12 deficiency

Bipolar Psychosis

In bipolar disorder, psychotic events usually occur during manic episodes, but they can develop during a depressive state as well. Either way, if psychotic episodes are part of your bipolar disorder, your official diagnosis will likely be a bipolar disorder with psychotic features (sometimes referred to as bipolar psychosis).

One study found that people with bipolar psychosis tend to be more likely to experience more rapid cycling, as well as more chronic mood disturbances, than those who have bipolar without psychosis.

Warning Signs of Psychosis

Psychosis doesn't normally happen suddenly. There are often warning signs that can let you know that it's coming, including:

• A decrease in performance at work or at school
• A sudden decline in self-care or personal hygiene
• Being unable to do things you normally can
• Confused speech or trouble communicating, such as changing topics rapidly or speaking incoherently
• Difficulty telling reality from fantasy
• Extreme changes in sleeping or eating patterns
• Having trouble focusing and concentrating
• Saying or doing bizarre things that don't reflect reality 
• Spending a lot more time alone than usual
• Strong, inappropriate emotions or having no feelings at all
• Suddenly losing interest in the things you used to enjoy
• Suspiciousness or uneasiness with others
  

Treatment for Delusions in Bipolar Disorder

Psychosis—and therefore the delusions and/or hallucinations that comprise it—is treatable, especially if treatment is focused and prompt. Early intervention makes a big difference in recovery. Treatment may include antipsychotic medications and psychotherapy, such as cognitive-behavioral therapy (CBT) and supportive psychotherapy.

Medications

Medications can help reduce delusions and the behaviors that result. Typical antipsychotics block dopamine in the brain, while atypical antipsychotics can be used to block both dopamine and serotonin. Antidepressants may be prescribed if a person is also experiencing mood symptoms in addition to delusions. Mood stabilizers may also be prescribed to treat symptoms of bipolar disorder.

Psychotherapy

Cognitive-behavioral therapy (CBT) is often used to treat delusions that may occur in bipolar disorder. This type of therapy works by helping people learn to recognize their delusional beliefs and challenge these ways of thinking with more realistic thought patterns.

Coping With Delusions in Bipolar Disorder

If you have bipolar disorder and experience delusions, it is important to take steps to manage your symptoms. Strategies that can help include:

• Tracking your symptoms: Use a mood tracker or daily journal to record your thoughts, moods, and other symptoms. Note things that might trigger delusions, like stress or environmental changes.
• Avoid triggers: Do your best to limit your exposure to things that might trigger symptoms, such as stress, alcohol, or poor sleep.
• Seek support: Talk to close friends or family about your condition and ask them to help watch for signs of mood changes. Have a plan in place for the steps your loved ones can take if you begin to experience a psychotic episode.
• Stick to your treatment plan: Be sure to follow your doctor's treatment recommendations, including taking your medication and attending therapy appointments.