The American Psychiatric Association’s DSM-IV specifies seven subtypes of delusional disorder based on the principle delusional theme. The most common subtype of delusional disorder is the Paranoid or Persecutory type characterized by the belief that someone (usually someone close to the person) is striving to harm them (American Psychiatric Association, 2000).
The Erotomanic type is based on the belief that another person is in love with this individual, mostly a celebrity or a boss at work (American Psychiatric Association, 2000). This delusional disorder is more widespread in women than men (Appelbaum, Robbins, & Roth, 1999). It may also prompt violence or even stalking those viewed as probable romantic rivals. The Grandiose type is characterized by the inflation of one’s worth, power, identity or knowledge (American Psychiatric Association, 2000). The patient believes that he or she is in a special relationship with a powerful person or a deity. The disorder mostly associated with violence, usually between romantic partners, is the Jealous delusional disorder. Patients firmly believe that their loved one or sexual partner is unfaithful. Somatic type patients believe that they have some physical defects or a medical condition, which may include worries of infestation with insects or parasites or imagined physical deformity (American Psychiatric Association, 2000). Mixed type delusional disorder is, however, characterized by more than one of the above behaviors with no single theme predominating. The unspecified type, on the other hand, does not fit the explanation of any of the above types of delusional disorders.
Jeff’s behavior fits the description of the Grandiose delusional disorder. He seems convinced of his connections with the President of The United States of America. He goes ahead to tell Dr. Foster that he is the President’s guest of honor.
Delusional disorder is distinguished from schizophrenia largely by the understanding that the delusions of schizophrenia usually are bizarre, whereas those of delusional disorder are non-bizarre (Double, 1992). To aid further this dissimilarity, DSM-IV defines a bizarre delusion as that which involves a phenomenon that the individual’s culture would regard as totally implausible. Diagnosticians are left, in this case, to assume that the non-bizarre delusions of delusional disorder must be delusions that the individual’s culture does find plausible (Double, 1992). For example, the Jealous type delusional disorder involves a supposedly non-bizarre symptom that the central theme of the patient’s delusion is that his or her partner or lover is unfaithful. The main question, however, is how the diagnosing psychiatrist could possibly know with certainty whether the patient’s suspicions are the truth or a delusion.
I believe Jeff fits the diagnosis for delusional disorder. The diagnosis of delusional disorder is done partially by elimination as the symptoms expressed may be part of a serious problem like bipolar disorder or schizophrenia, or reactions to drug metabolism, medical or physical condition. The DSM IV and psychologist agree that if the person expresses an idea with unusual persistency or force, the idea or belief exerts undue influence on the person’s life. The individual may thus tend to be humorless or oversensitive about the idea triggering the arousal of a strong emotional reaction with irritability and hostility with an attempt to contradict the belief; a clear indication of delusional disorder (Appelbaum, Robbins, & Roth, 1999).
It is particularly essential, however, to make a clear distinction between an overvalued idea and a delusion. For instance, the intricacy of cultural and religious differences should be emphasized with respect to evaluating personal beliefs as some cultures widely accept the belief that would otherwise be considered delusional in others.