We have been talking a lot about psychotic disorders, childhood onset-schizophrenia, delusions, and hallucinations,so lets discuss the differences between the psychotic disorders and ways to cope as a family member, parent, friend, companion, or caregiver to someone who is suffering.
Families, friends, and caregivers are often uninformed about the type of psychotic symptoms their loved one may be experiencing. For many therapists, including myself, observing and correctly identifying symptoms can be extremely complex and require months if not years of psychological evaluation. Before a correct diagnosis can be made, therapists must do a comprehensive assessment using informal tools (information from family, friends, and caretakers) and formal tools (tests, questionnaires, observations) to get clarity and direction. So it is no wonder families, friends, caregivers, and parents often struggle to understand some of the psychotic symptoms their loved one is experiencing.
Psychotic disorders include a profound disturbance in perception and thought. They can entail a host of symptoms. Here is a listing of psychotic disorders listed in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders:
- Schizophrenia (hallucinations, delusions, flat affect, lack of motivation, social isolation)
- Schizo-affective disorder (major depressive disorder and symptoms of schizophrenia)
- Delusional disorder (non-bizarre delusions)
- Brief psychotic disorder (delusions, hallucinations, incoherent speech): onset =less than 1month
- Shared psychotic disorder (a delusion develops in an individual in a close relationship with another individual who has delusions). See my website, Anchored In Knowledge, for more information.
- Substance-induced psychotic disorder (psychotic-like symptoms due to substance abuse)
For those living with an individual experiencing some of the above disorders and accompanying symptoms, life can be very disturbing and emotionally draining. What is even more draining is not having a complete understanding of what you are observing. As a result, you must educate yourself and others around you. It’s very important to know the difference between delusions and hallucinations:
- Delusions: A delusion has to do with our belief system. It is a belief strongly held to be true despite evidence that the belief is not true. It is a firmly held belief that cannot be undone by facts or reasoning. This is one of the reasons why a delusion is of a psychotic nature because no reason, no fact, no evidence can change it.Delusions come in many forms such as:
- Persecutory: this includes an individual believing that everyone is out to get them, that they are being persecuted. The belief is so strong that the individual might begin to isolate or withdraw from others for fear of being persecuted.
- Grandeur: These delusions often include thoughts of great importance such as feeling like God or feeling like a beautiful celebrity. Think of the movie Hush Hush Sweet Charlette. Actress Bette Davis, played the role of a caretaker of a family member who needed care. Throughout the movie, Charlette dressed, spoke, and behaved as if she was a beautiful star on stage. She was psychotic to say the least.
- Jealousy: This type of jealousy is sometimes called morbid or pathological jealousy because it takes on a very psychotic and unnatural nature. It’s the kind of jealousy that occurs between two lovers. One person might begin to believe that their spouse is cheating on them or being unfaithful without any concrete proof or reason to worry. This person might contemplate murder just to end their feelings of jealousy. This is not love or obsession, it is a delusional belief that borders obsession.
- Erotomania: this type of delusion is the strong belief that someone of a higher status (celebrity, television personality, supervisor, professor, famous researcher, etc) is in love with the person. This is not a fantasy or strong desire. It is an unshakable belief that the person has some sort of personal connection with the person and feels true feelings of love for them. Erotomania has led to incidents of stalking and even murder.
- Hallucinations: Has to do with our senses (hearing, seeing, feeling, smelling, tasting). Hallucinations include a profound disturbance in perception which can affect a person’s connection to reality and even behavior. Extreme aggression can result from an individual who is either frustrated by their hallucinations or cannot distinguish between reality and fiction. For example, command hallucinations, which includes a person hearing voices telling them to harm others, can greatly impact a person’s behavior and lead to aggression or even death. There are also a variety of hallucinations as well:
- Visual: These type of hallucinations often entail seeing shadows, seeing silhouettes of people, seeing demons or other frightening images.
- Auditory: Auditory hallucinations are the most common. When a patient or client comes into a psychiatric healthcare facility for evaluation, the most disturbing symptoms are often auditory hallucinations. These types of hallucinations may entail the person’s name being called, dogs barking, doors slamming, one or more talking voices, or even white noise.
- Olfactory: Every human being has what is known as the Olfactory bulb, which is located in the fore-brain (the area of the brain behind the forehead) that entails our perception of odors and controls our sense of smell. In cases where psychotic disorders are present, olfactory hallucinations are typical such as smelling smoke or something burning. Some individuals claim they can randomly smell the scent of flowers or cologne.
- Tactile: This type of hallucination has to deal with touch. It often entails feeling pressure on the skin or feeling things crawling on the body.
- Gustatory: These hallucinations have to do with taste. Some individuals state that they can taste poison in their food.
Delusions and hallucinations can be dangerous for the individual experiencing them and those around the individual. Hallucinations can cause people to act on their emotions. Delusions can turn into rooted beliefs that cause the individual to act. For example, a woman who writes letters to Alex Baldwin begins to believe he is sending her messages that he is in love with her, may attempt to buy tickets to all of his shows and cyber stalk him. A strong delusion such as this can lead to emotional (and maybe even) financial distress.
Delusions, hallucinations, and thinking errors are not easy to cope with. But here are a few things to try:
- Do not argue facts: I always encourage families to refrain from arguing with their loved one about their delusions or hallucinations. The key is to be mindful that the delusion or hallucination is very real to them. So if you go against the delusion or hallucination, you are “going against them.” Although not true, this is often the experience of people in these shoes. Your goal is not to be right but to be safe. There are cases in which a person is so convinced that their delusion is correct that anyone who goes against the delusion is the enemy. Verbal and physical aggression is often likely. You want to aim for safety and take the higher road, even if that means temporarily going along with the delusion until you can safely challenge or question the person. “Going along” might simply include silence or nodding while the person speaks.
- Understand their emotions: Hallucinations and delusions often have an emotional component of some sort. The woman attracted to and writing Alex Baldwin may feel “emotionally connected” to the point of behaving as if she “knows” him on a personal level. If you find there is a strong emotional connection with the delusion or hallucination, try to talk with your loved one and calmly discuss your concerns.
- Get inside their head: Individuals experiencing delusions or hallucinations may be difficult to talk to, especially if they do not believe they are impaired/ill. So wait until the individual brings up their experience and discuss it without judgment. Try not to ask questions that would make your loved one feel condemned or “crazy.” You want to try to understand, no matter how unstable their reasoning is and their thought processes. This is good “data” for if you ever have to discuss your case with a psychiatrist. It also shows you just how ill the person is becoming.
- Do not tell them they are “crazy:” using terms such as “crazy,” “lunatic,” “neurotic,” or “out of your mind” are all what I call fighting words. They are words that are most likely to trigger an angry response and cause the person to shut-down.” When a loved one is experiencing psychotic symptoms, our job is not to harm or offend but reel them in so that we can help them seek help.
- Reduce stimulation and audience: Through experience with extreme verbal and physical aggression, I have learned to reduce the amount of audience around the person who is acting out and the stimulation (lights, sounds, noise, movement, etc). When someone is losing control and appearing delusional, the first thing you want to do is reduce noise and movement around the person to lessen the chances of the person becoming further agitated. Even if someone is simply being aggressive with words, you still want to reduce all external stimulation. Having an “audience” (neighbors, siblings, police, etc) can trigger more of an angry response or cause the person to feel outnumbered.
The most important thing to do in such cases is to be compassionate and understand that your loved one is going through something quite serious. Reaching out for help is important, but so too is showing love and understanding, even if the delusions or hallucinations are unrealistic.
I always enjoy hearing your thoughts, post below.
All the best
Editor’s note: This article was originally published May 8, 2013 but has been updated to reflect comprehensiveness and accuracy.
Healthline. (2014). Psychosis. Retrieved November 23, 2014 from http://www.healthline.com/health/psychosis#Overview1.
MedPlus. (2014). Hallucinations. Retrieved November 1. 2014, from http://www.nlm.nih.gov/medlineplus/ency/article/003258.htm.