Delusion In The Cognitive And Psychodynamic Perspectives

Delusion in the Cognitive and Psychodynamic Perspectives

According to the Glossary of the Diagnostic and Statistical Manual of Mental Disorders, Delusion can be described as false views based on incorrect information about reality despite having proof of the actual events. (Bortolotti, 2013) The false belief has nothing to do with the person’s religion or cultural background, or even how intelligent they are. (Kiran & Chaudhury, 2009) The key element of a delusion depends on how much the person is convinced that the belief is true. A person with a delusion will hold confidently to their belief regardless of evidence to the contrary. (Kiran & Chaudhury, 2009)

Delusions are symptoms of some mental conditions,

one of them being Delusional Disorder. Delusion disorder, previously called paranoid disorder, is a mental illness where cannot identify the difference from reality and imagination. (Delusional Disorder, 2013) The main issue of this disorder is the occurrence of delusions, which is the absolute belief of something that isn’t true. (Delusional Disorder, 2013) People with delusional disorder are able to continue their lives normally aside from their delusions. They do not behave in any outrageous manner because of these delusions. There are some people with this disorder who become so preoccupied with their delusions that their lives do become disrupted. (Delusional Disorder, 2013) Although delusions can be symptoms form more serious illnesses such as schizophrenia, the actual disorder is rare. Delusional Disorder is commonly found more in women in their middle ages. (Delusional Disorder, 2013)
There are different types of Delusional Disorders; one of them is Persecutory type. Persecution is a classic symptom of delusional disorder. (Sadock & Sadock, 2008) People with this type convince themselves that they are always being wronged or harmed. It is associated with irritability and anger, and the individual acts this out aggressively or even destructively. (Sadock & Sadock, 2008) Another type of Delusional disorder is the Jealous Type. These types of delusions have been called conjugal paranoia which usually deals with infidelity. (Sadock & Sadock, 2008) The delusion usually distresses men and it may come out of nowhere.
Another type of delusional disorder is the Erotomanic Type.

These delusions usually occur in people with a low opinion of themselves. They tend to believe that people of a higher status are in love with them. (Sadock & Sadock, 2008) Patients tend to be very private, depended sexually self-conscious, and have poor social skills. People with erotomania have been women who are single and have low-leveled job and are secluded. (Sadock & Sadock, 2008) They incline to creating “secret lovers for themselves.” They show what’s called paradoxical conduct, which is “the delusional phenomenon of interpreting all denials of love, no matter how clear, as secret of affirmations of love.” (Sadock & Sadock, 2008) Although it is most commonly found in women, men do shows signs of erotomania however, they tend to act out aggressively and use violence. These cases could a long period of time or sometimes very

short.
The Somatic type is a type of delusional disorder where a person believes that they are physically flawed or have medical issues. (Delusional Disorder, 2013) Affected individuals normally complain of invasion, deformity, self-cruelty, exaggerations of their body, and thinking they don’t smell good or have bad breath. Hence, they are also more likely to turn to a dermatologist rather than a psychiatrist. (Kepska, Hawro, Kun-Krupinska, & Zawelska, 2010) Patients with somatic-type delusional disorder typically take very good care of their physical appearance and do not show clear evidence of any weakness. Their speech, psychomotor activity and use of eye contact can be affected by their emotional state and attitude. Feelings and affect are consistent with the nature of the delusions. (Kepska, Hawro, Kun-Krupinska, & Zawelska, 2010) Patients do not have hallucinations other than physical ones, which are related to the subject of the delusion. Their thoughts are bothered, although thought processes are not usually diminished. While orientation, memory and cognition are complete, impulse control may be decreased and patients lack both judgment and awareness. (Kepska, Hawro, Kun-Krupinska, & Zawelska, 2010) Having high levels of stress, hyper attentiveness and a hypersensitive and argumentative personality are also distinguishing traits. Although delusional disorder patients may perform well professionally and in areas aloof from their delusions, they tend to be socially remote as a result of infamy, the fear of “transmitting” their imagined impurity or their personality traits. (Kepska, Hawro, Kun-Krupinska, & Zawelska, 2010)
There is also an unspecified type of delusional disorder. These delusions cannot be categorized with the other types, and often the delusions people have are of misidentification. (Sadock & Sadock, 2008) This type can also be similar to Capgras Syndrome, which is the belief that a familiar face has been substituted by an impostor. (Sadock & Sadock, 2008)
Even though Delusions are part of psychology, it can describe in different ways in different psychological perspectives. One perception is Cognitive. In Cognitive psychology, psychologists try to make sense of people by looking at their environment and the meaning of things they encounter. (The Cognitive Apporach: The Basics) Cognitive descriptions of behavior are based on the ways people establish and process information significant to particular ways of acting. Cognitive psychologists try to use information they have processed and create cognitive models that go on inside people’s minds. (The Cognitive Apporach: The Basics)
A cognitive model of the memory system has two main components, Working Memory, which deals with the information that we process now, and Long Term Memory, which stores all the information we have developed in the past and might need again in the future. (The Cognitive Apporach: The Basics) These modules are assumed to be consistent, because current information processing may need to draw on past experience and because the result of current information processing might need to be stored for future reference. The memory system would be linked to other information processing methods, for example those for making sense of incoming information and design dialogue and conduct. (The Cognitive Apporach: The Basics) Cognitive psychologists’ stress on scientific methods is strength of their approach, although some would question the significance of their experimental research, which often makes use of very artificial and unrealistic tasks and measures which may not effectively replicate real-world psychological and behavioral processes. (The Cognitive Apporach: The Basics)
In clinical psychiatry, delusions are usually measured to be ‘pathological beliefs’, although current cognitive approaches differ in their inclination to explain delusions within a model of impairment to normal belief formation. (Bell, Halligan, & Ellis, 2006) Belief-positive models have originally developed in cognitive neuropsychiatry where “the study of psychopathology is used to infer normal function, and normal models provide the framework for understanding the phenomena.” (Bell, Halligan, & Ellis, 2006) Therefore, many belief-positive models describe delusions in extensive models of the neuropsychology of normal belief development. Traditionally, research in this area has concentrated on brain-injury related ‘monothematic’ delusions that characteristically have difficult material. (Bell, Halligan, & Ellis, 2006) Belief-negative models mainly emphasize on the more common, idiopathic or ‘functional’ insanities, rather than delusions following brain injury. Typically, they try to describe the pathological process only and do not make clear relations to theories of normal belief development. (Bell, Halligan, & Ellis, 2006)
Delusion can also be seen in the Psychodynamic perspective. Psychodynamic psychologists see behavior as the result of cooperation between three parts of the mind. Each person has biological drives from their id. (Psychodymanic Approach: the basics) These need to be satisfied but this is prevented by the superego, which is the moral part of the psyche, which uses apprehension and guilt to stop us from acting on the id’s impulses. (Psychodymanic Approach: the basics) Between the two is the ego, which tries to find ways of sustaining the id in a way that the superego will receive and that is coherent with reality. This often involves the use of defense mechanisms which renovates unconscious impulses into more adequate procedures. (Psychodymanic Approach: the basics)
Psychodynamic psychologists study human behavior by trying to find hidden meanings in the things that people think, do or say. (Psychodymanic Approach: the basics) In order to do this, they must collect a great amount of qualitative data about people, which is usually done by conducting individual case-studies. (Psychodymanic Approach: the basics) The subjects of the case studies are often a person who suffers from a psychological disorder and who is being treated with psychoanalysis. The researcher gathers material from the things the person says or does in therapy. (Psychodymanic Approach: the basics)
Psychologists believe that, many patients with delusional disorder have socially secluded themselves and have reached low levels of achievement. (Sadock & Sadock, 2008) Explicit psychodynamic theories about the origin and development of delusional symptoms involve possibilities regarding hypersensitive people and specific ego mechanisms, such as, reaction formation, projecting and denial. (Sadock & Sadock, 2008)
Clinical observations specify that many, if not all, fearful patients have a lack of trust in their relationships. A suggestion relates this mistrust to a consistently unsafe family environment, often with over controlling mother and having an unstable relationship with their father. (Sadock & Sadock, 2008) Erik Erikson’s concept of trust versus mistrust in early development is a beneficial model to explain the suspiciousness of the paranoid who never went through the healthy experience of having his or her needs fulfilled by what Erikson termed the “outer-providers.” (Sadock & Sadock, 2008) Thus, they have a general suspicion of their environment. Delusions have been connected to a variety of additional factors such as social and sensory remoteness, socioeconomic deficiency, and personality disturbance. People with disparities such as, being deaf, visually impaired, or even being an immigrant with limited skills in a new language may be more susceptible to delusion formation than the normal population. (Sadock & Sadock, 2008) Vulnerability is intensified with aging. Delusional disturbance and other paranoid features are seen more in the elderly. To sum up, multiple factors are supplementary with the construction of delusions, and the source and pathogenesis of delusional disorders per se have yet to be defined. (Sadock & Sadock, 2008)
Patients with delusional disorder mainly use the defense mechanisms of reaction formation, denial, and projection. They use reaction formation as a battle against aggression, dependence needs, and feelings of affection and transmute the want for dependence into constant independence. (Sadock & Sadock, 2008) Patients use denial to divert from not thinking about their painful reality. “Consumed with anger and hostility and unable to face responsibility for the rage, they project their resentment and anger onto others and use projection to protect themselves from recognizing unacceptable impulses in themselves.” (Sadock & Sadock, 2008)
Delusional disorder was generally viewed as people just being resistant to treatment, and interventions often focused on handling the illness of the disorder by reducing the influence of the delusion on the patient’s life.

(Sadock & Sadock, 2008) In recent years, however, the viewpoint has become less doubtful or constrained in planning effective treatment. The goals of treatment are to establish the diagnosis, decide on suitable interventions, and manage difficulties. (Sadock & Sadock, 2008) The success of these goals depends on an effective and therapeutic doctor–patient relationship, which is initially, not easy to create. The patients do not complain about psychiatric symptoms and often enter treatment against their will; even the psychiatrist may be drawn into their delusional nets. (Sadock & Sadock,

2008)
The principal treatment for delusional disorder has been psychotherapy. This includes psychosocial treatment which can facilitate with the social and psychological problems connected with delusional disorder. (Delusional Disorder, 2013) The vital element in operative psychotherapy is to build a relationship in which patients are able to trust their therapist. Individual therapy seems to be the most effective for delusions; however there are also group therapies such as, insight-oriented, supportive, cognitive, and behavioral therapies which can be very helpful as well. (Sadock & Sadock, 2008) Initially, a therapist should neither agree with nor confront a patient’s delusions. Although therapists must ask about a delusion to see the measure of the illness, tenacious questioning regarding it should probably be avoided. (Sadock & Sadock, 2008) Physicians may encourage the motivation to receive help by emphasizing an enthusiasm to help patients with their apprehension or irritability, without signifying that the delusions be treated, but therapists should not keenly support the concept that the delusions are real. (Sadock & Sadock, 2008) In order to gain a good therapeutic outcome, it must really depend on a psychiatrist’s ability to respond to the patient’s mistrust of others and the resulting interpersonal differences, frustrations, and malfunctions. The mark of successful treatment may be a satisfactory social adjustment rather than abatement of the patient’s delusions. (Sadock & Sadock, 2008)
Ina case of an emergency, sternly restless patient should be given an antipsychotic drug intramuscularly. (Sadock & Sadock, 2008) Although there has been no sufficient clinical trials with large numbers of patients have been directed, most clinicians view antipsychotic drugs the treatment of choice for delusional disorder. (Sadock & Sadock, 2008) Patients are likely to decline medication because they can easily integrate the direction of drugs into their delusional systems; physicians should not provide medication immediately after hospitalization but, reasonably, should spend a few days establishing an understanding with the patient. Physicians should explain potential opposing effects to patients, so that they do not later question that the physician lied to them. (Sadock & Sadock, 2008)