Delusions
Like hallucinations, delusions are difficult for both the caregiver and the family member to handle because they seem real. The person experiencing the delusion believes the story they tell about a situation. For example, if your family member tells you she had dinner last night in Paris with your dead Aunt who works for the CIA, understand that in her mind, it happened. If you ask her questions about how she got there and returned home before morning, she will have an answer that makes sense to her.
Believe Without Proof
That’s the nature of a delusion. The person with the delusion exists in a different reality from everyone around them. They strongly believe in what they know to be true even though no evidence or facts supports their belief. When confronted with something they cannot prove, they create a reasonable explanation based on facts they create or divert attention to another subject. Unless a person knows they have a medical condition causing them to have a delusion, they usually refuse to believe that what they think is happening is not real.
Person Seems Normal
Although some delusions are bizarre (i.e., based on events that could never happen or are unrealistic, like an alien abduction into a wristwatch), most themes could happen and be real; however, no evidence supports that it’s true. Individuals with delusions disorders often maintain the delusion for a month or longer and carry on their daily activities without difficulty. Apart from the delusion, nothing about the individual seems unusual.
Types of Delusions
Some of the types of delusional disorders include the following:
- Erotomanic: The person thinks someone higher in social standing than they are is in love with them. Usually, that person does not know them.
- Grandiose: The individual believes he has some greater but unappreciated or unrecognized talent, power, insight, knowledge, self-worth, or relationship with someone famous or with God.
- Jealous: The person thinks his partner has been unfaithful.
- Persecutory: He believes that he is the victim of cheating, spying, was drugged, followed, slandered, or somehow mistreated.
- Somatic: The individual believes he is experiencing physical sensations or bodily dysfunctions, such as foul odors or crawling insects under his skin, or is suffering from a disease.
- Mixed: The person has delusions characterized by more than one of the above delusional types with one theme dominating.
- Unspecified: An individual’s delusions do not fall into the described categories or cannot be determined.
Helping Someone Having Delusions
Try not to Argue.
Dealing with someone trying to convince you to believe something that you know is not true without losing your patience. As they attempt to persuade you that what they believe is true, you naturally want to correct their way of thinking. However, to do so will only lead to an argument or a breakdown in communication. Unless the person is at risk of danger, it’s best to go along with them. Try the following techniques if they are potentially at risk and need to move in another direction.
- Do not try to talk them out of what they believe. If you do, your family member will stop trusting you, and it will only start an argument.
- Reassure them that they are safe and not in danger. Do not leave the person experiencing the delusion alone if they are afraid. Try to maintain an open and honest behavior with them during all your interactions.
- Try to get them to talk about how they are feeling or whatever is bothering them at that time; offer to help keep them safe and explain what you can do to protect or help them.
- Accept that they feel the need to believe what they believe, for example. If the person with the delusion believes someone is out to harm them, they probably feel the need to find safety. Therefore, they have a sincere need to find a safe haven.
- Focus on building a trusting relationship rather than correcting their false belief.
Attempt to calm them, listen to understand their concern, and determine why the delusion occurs.
Many times, fear is the cause of delusion. Your family member may have overheard a conversation, misinterpreted a sound as a threat, or seen a shadow figure believing it to be an intruder. When you actively listen, not just to the words but to the emotion associated with them, you can often get to the root of their distress and help eliminate the need for the delusion. By listening and supporting them, you build trust.
To show you understand and to help resolve the problem, consider saying something like, “I can see that hat rack is throwing a shadow. It certainly could appear to be a man in your room. It’s no wonder you were frightened. What if we move it away from the light so that the shadow is no longer there?”
- Show empathy and try to understand the purpose behind the delusion.
- Paraphrase what they said; clarify any confusion about what they describe.
- Without agreeing or arguing with them, question the logic or reason behind the delusion. Keep the tone of your voice calm and your inflections non-condescending. For example, I checked the locks on the doors, and the house is locked uptight. No one can get in the doors, and all the windows are locked. So, if you see something that you think looks like someone, let’s check it out together because it’s likely to be a shadow.
- Avoid, however, arguing your point or arguing over the reality of a situation. Rather, focus on the person’s emotions rather than the “facts” they present. If you argue facts with them, they will shut down. For example: “It’s very scary to think that someone has entered your home without permission and that your life might be in danger. You must have been very frightened. Tell me about it.”
- Identify the theme of the delusion, the main feeling behind it, and its tone.
Look around the immediate environment for the possible cause.
Between changes in eyesight, poor lighting, impaired hearing, and altered mental status, it’s no wonder normal sounds and sights get misinterpreted when they occur unexpectedly around someone with dementia or facing mental health challenges. If you consider statements made within the delusion context, you may identify the trigger behind the event within the environment. If you can, you may remove the trigger for future events or reduce the number of occurrences by removing or altering the trigger. The solution may be as simple as adding light, changing a diet, or encouraging a nap.
Use distraction.
Since objects, sounds, and other activities in the environment can cause delusions, diverting your family member’s attention away from the trigger precipitating the event may help put a stop to the delusion. For example, if your father says that he’s Major Smith and Gomer Pyle reports to him at a Marine Corp base, check to see if he was recently watching that show. If he has developed a pattern of watching the program regularly, maybe changing the channel to the Cooking Channel instead might stop the delusions. Other activities such as exercise, playing cards, doing puzzles, looking at pictures, talking to friends, etc., can also be helpful.
If the person talks to you about the delusional theme, redirect them back to what is happening around them. Ask them if they recall what activity everyone is performing and suggest both of you return to that. If they continue to talk, sit, and listen quietly but not engage in discussion.
Consider whether there could be an underlying medical problem.
A change in how someone behaves, memory loss, confusion, hallucinations, and delusions can all be signs of declining health.
- Many medical conditions affect the brain by accumulating toxins in the blood entering the brain and affecting mental status.
- Other conditions affect oxygen intake. For example, as the body’s ability to take in oxygen decreases, mental clarity decreases as well.
- Infections, especially urinary tract infections, trigger changes in mental status in many individuals.
- High fevers, pain medications, and dehydration also add to the confusion and sometimes cause delusions.
Investigate how the delusion is affecting a person’s life.
- Determine if and how the delusion affects a person’s life. For example, can they function the same as before, or have changes occurred?
- What about relationships? Have any changes occurred in how they relate to family members or close friends as a whole or related to a specific individual?
- Determine if your family member has made any specific change based on the delusion.
- Identify how often the delusions occur, how long they last, and how intense the episode becomes. Regarding intensity – Do they always live their life within the delusion, making it a part of how they react to everything that occurs?
- Do the delusions have a pattern? Do they occur on a particular day, at a certain time of day, after a particular activity? How many times per day, per week? What triggers them?
- Are the delusions always the same, or do they change?
Express concern and the need for possible assistance.
The time may come that you need to persuade them to see a therapist. Since they believe their delusion is true, suggesting they need help may lead to conflict unless the conversation is nonconfrontational. Usually, it’s best not to focus on the delusion but instead address their emotions or physical/mental status. Express that you have observed that they appear to be more anxious, or exhausted, or “fill in the blank with the emotion you see,” and you’re concerned that they might be feeling overwhelmed or need more support than you’ve been able to provide.
Suppose an occasional clash occurred related to a delusion episode. In that case, you might reference that event and use it to say that you feel you could use some assistance on how to help your family member in those situations and you would like them to go with you. You probably could use the support on how to deal with them, and it’s a good way to lead them to help by saying you need it first and they’re helping you.
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