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. In order to understand delusions as a symptom of bipolar disorder, it is helpful to also become familiar with psychosis.
Psychosis 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. Psychosis is not an illness in and of itself, but a symptom of an underlying disorder. Roughly 3% of the U.S. population will experience psychosis during their lifetime, according to the National Institute of Mental Health, whether they have a mental disorder or not. In fact, there’s an array of non-psychiatric conditions that cause psychoses, including:
Certain drugs and medicationsHead injuriesHuntington’s diseaseSleep deprivationTemporal lobe epilepsyThyroid disordersVitamin B12 deficiency
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). If you are diagnosed with bipolar psychosis it doesn’t mean that your illness is more severe than that of someone who has bipolar without 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 schoolA sudden decline in self-care or personal hygieneBeing unable to do things you normally canConfused speech or trouble communicating, such as changing topics rapidly or speaking incoherentlyDifficulty telling reality from fantasyExtreme changes in sleeping or eating patternsHaving trouble focusing and concentratingSaying or doing bizarre things that don’t reflect reality Spending a lot more time alone than usualStrong, inappropriate emotions or having no feelings at allSuddenly losing interest in the things you used to enjoySuspiciousness or uneasiness with others
Types of Delusions
There are many different types of delusions. These are the ones most commonly associated with mental disorders.
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, or your sister is an octopus, or that giant worms make subway tunnels.
Treatment
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.
