Internet Mental Health

DELUSIONAL DISORDER




Diagnostic Features of Delusional Disorder

SYMPTOM DEFINITION SELF-DESCRIPTION
DELUSIONS
Unusual Beliefs Firmly believing a false belief (delusion) despite all evidence to the contrary "I often have thoughts that make sense to me but that other people say are strange."

Onset:

In the developed world, the lifetime prevalence of Delusional Disorder is 0.2%. Individuals with this disorder have one (or more) delusions with a duration of 1 month or longer. (Delusions are false beliefs that are firmly held despite what almost everyone else believes and despite incontrovertable obvious evidence to the contrary.) These persistent, well organized delusions are defended with a great deal of emotion and sharp argument. These individuals appear quite convincing, especially because they otherwise behave rationally. Apart from their delusion(s), their mental functioning is not markedly impaired, and their behavior is not obviously bizarre or odd. This disorder is unlike Schizophrenia in that the individual has never had: (1) prominent hallucinations, (2) disorganized speech, (3) grossly disorganized or catatonic behavior, (4) negative symptoms (i.e., diminished emotional expression or marked apathy). If there are manic or depressive episodes, the total duration of all mood episodes must be brief relative to the total duration of the delusions. This disorder is not due to the effects of a substance, medication, or other medical condition. The most common delusion is paranoid.

Warning: When initially interviewed, people with this disorder may appear normal until the topic of their delusion is discussed or acted on. Thus they can often fool people into believing that they are normal and harmless. However, serious anger and violent behavior can occur with persecutory, jealous, and erotomanic types of Delusional Disorder. A high percentage of shooters who commit mass murders or kill celebrities are diagnosed as having this disorder.

Treatment:

There is currently insufficient evidence to make evidence-based recommendations for treatment of Delusional Disorder. A review of 385 individuals with this disorder found that treatment with oral antipsychotic medication achieved a good response in 33.6% of the patients.

Prognosis:

Delusional Disorder usually is a chronic condition with some individuals eventually developing Schizophrenia.

Problems

    Occupational-Economic :

    • Functioning is not markedly impaired and behavior is not obviously odd or bizarre.

    Antagonistic (Antagonism):

    • Majority are nonviolent, but overall, like any psychotic disorder, there is an above average risk of physical violence.

    Psychotic (Impaired Intellect) :

    • Presence of one (or more) delusions with a duration of 1 month or longer.

    • Is unlike schizophrenia in that it has: no prominent hallucinations, no disorganized speech, no grossly disorganized or catatonic behavior, no negative symptoms (i.e., diminished emotional expression or marked apathy), psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre.

    • Delusions are not widely accepted beliefs in the individual's culture.

      • Many religious and political fanatics suffer from this disorder, in that their fanatical delusions are not widely accepted beliefs in the individual's culture.

    • Delusions have lasted longer than any associated depression or mania.

    Emotional Distress (Negative Emotion):

    • Mood disturbances, especially depression, commonly develop.

SAPAS Personality Screening Test

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

Most of the time and in most situations:

      In general, do you have difficulty making and keeping friends?
      Would you normally describe yourself as a loner?
      In general, do you trust other people? ("No")
      Do you normally lose your temper easily?
      Are you normally an impulsive sort of person?
      Are you normally a worrier?
      In general, do you depend on others a lot?
      In general, are you a perfectionist?

Answer "Yes" or "No" to each of these 8 questions.



7-Question Well-Being Screening Test (By P. W. Long MD, 2020

Individuals with this disorder would have a significant impairment in the behaviors that are displayed in red :

      Agreeableness: I was kind and honest.
      Conscientiousness: I was diligent and self-disciplined.
      Openness/Intellect: I showed good problem-solving and curiosity. (Instead had delusions [but no disorganized speech, grossly disorganized or catatonic behavior; and no/very brief hallucinations]; not disoriented for person, place or time).
      Sociality: I was gregarious, enthusiastic, and assertive.
      Emotional Stability: I was emotionally stable and calm.
      Physical Health: I was physically healthy.
      Role Functioning: I functioned well socially and at school/work.

How often in the past week did you do each of these 7 behaviors:



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Diagnose Delusional Disorder

Diagnose Psychotic Disorders

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment

Delusional Disorder 297.1

This diagnosis is based on the following findings:
  • Psychotic symptoms were not due to a general medical condition
  • Psychotic symptoms were not due to substance use or other treatment
  • Delusion of reference (still present)
  • No auditory hallucinations
  • No visual hallucinations
  • No tactile hallucinations
  • No olfactory or gustatory hallucinations
  • No negative symptoms (affective flattening, alogia, or avolition)
  • No disorganized speech
  • No obviously odd, bizarre, or grossly disorganized behavior
  • No catatonic behavior
  • Functioning is not markedly impaired by these delusions
  • Not due to Schizoaffective or Mood Disorder
  • Delusional belief not learned from a close relationship with another delusional person

TREATMENT GOALS:

  • Goal: prevent delusion of reference.
    If this problem persists: She will continue to have a false belief that people were staring at her or talking about her, or there were strange messages meant only for her on signs, newspapers, radio or television.


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Diagnostic Features

Delusional Disorder is diagnosed when prominent delusions are present for at least one month. Hallucinations, if present, are not prominent and are related to the delusional theme. This disorder is unlike Schizophrenia in that the individual has never had: (1) prominent hallucinations, (2) disorganized speech, (3) grossly disorganized or catatonic behavior, (4) negative symptoms (i.e., diminished emotional expression or marked apathy). If there are manic or depressive episodes, the total duration of all mood episodes must be brief relative to the total duration of the delusions. This disorder is not due to the effects of a drug, medication, or other medical condition. This disorder's delusions are not widely accepted beliefs in the individual's culture. WARNING: When initially interviewed, people with this disorder may appear normal until the topic of their delusion is discussed or acted on. Then they can become very angry or violent.

Course

Most fanatical religious and political cults are started by someone who successfully teaches his delusional beliefs to others. Tragically, sometimes these fanatical cult delusions become widely accepted. Like all delusions, these fanatical beliefs are firmly held despite all evidence to the contrary.

Complications

Overall functioning in Delusional Disorder usually is not markedly impaired, and behavior is not obviously bizarre or odd. Many individuals develop irritable, anxious or depressed mood. Anger and violent behavior can occur with persecutory, jealous, and erotomanic types of Delusional Disorder.

Associated Laboratory Findings

No laboratory or psychometric test is diagnostic of this disorder.

Prevalence

The lifetime prevalence of Delusional Disorder is 0.2%, and the most frequent subtype is persecutory. The male to female ratio is 1:1. This disorder is more prevalent in older individuals, but it can occur in younger age groups.

Controlled Clinical Trials Of Therapy

Click here for a list of all the controlled clinical trials of therapy for this disorder.

Course

Delusional Disorder usually remains stable, but a minority go on to develop Schizophrenia.

Familial Pattern

There is a significant familial relationship with Schizophrenia and Schizotypal Personality Disorder.

Effective Therapies

There is currently insufficient evidence to make evidence-based recommendations for treatments of any type for people with delusional disorder. Current treatment usually includes a combination of antipsychotic medication with cognitive therapy or supportive psychotherapy.

Ineffective therapies

Vitamins [1, 2], dietary supplements, cognitive training and cognitive rehabilitation have all proven to be ineffective in the treatment of psychotic disorders.

Trustworthy Research (PubMed.gov)


A Dangerous Cult


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What Is Delusional Disorder?


The Pattern Behind Self-Deception (How Delusions Are Formed)

Stories

Rating Scales


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Diagnostic Features of Delusional Disorder

ABNORMAL BIG-6 DIMENSION OF MENTAL ILLNESS DELUSIONAL DISORDER
IMPAIRED INTELLECT: Being intellectually impaired or psychotic.
Unusual Beliefs or Experiences

(Note: Recovery = symptomatic remission + full-time gainful employment + weekly contact with friends)


Delusional Disorder F22.0 - ICD10 Description, World Health Organization
A disorder characterized by the development either of a single delusion or of a set of related delusions that are usually persistent and sometimes lifelong. The content of the delusion or delusions is very variable. Clear and persistent auditory hallucinations (voices), schizophrenic symptoms such as delusions of control and marked blunting of affect, and definite evidence of brain disease are all incompatible with this diagnosis. However, the presence of occasional or transitory auditory hallucinations, particularly in elderly patients, does not rule out this diagnosis, provided that they are not typically schizophrenic and form only a small part of the overall clinical picture.
Delusional Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with delusional disorder needs to meet all of the following criteria:

  • The presence of one (or more) delusions with a duration of 1 month or longer.

  • Absence of the following active-phase symptoms of schizophrenia (which last for a significant portion of time during a 1-month period, or less if successfully treated):

    • Hallucinations. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).

    • Disorganized speech (e.g. frequent derailment or incoherence).

    • Grossly disorganized or catatonic behavior.

    • Negative symptoms (i.e., diminished emotional expression or avolition).

  • Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.

  • If manic or depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.

  • The disturbance is not attributable to the physiological effects of a substance or a another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

  • Specify whether:

    • Erotomanic type: This subtype applies when the central theme of the delusion is that another person is in love with the individual.

    • Grandiose type: This subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery.

    • Jealous type: This subtype applies when the central theme of the individual's delusion is that his or her spouse or lover is unfaithful.

    • Persecutory type: This subtype applies when the central theme of the delusion involves the individual's belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligneed, harassed, or obstructed in the pursuit of long-term goals.

    • Somatic type: This subtype applies when the central theme of the delusion involves bodily functions or sensations.

    • Mixed type: This subtype applies when no one delusional theme predominates.

    • Unspecified type: This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types (e.g., referential delusions without a prominent persecutory or grandiose component).

  • Specify if:

    • With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., an individual's belief that a stranger has removed his or her internal organs and replaced them with someone else's organs without leaving any wounds or scars).

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World Health Organization Psychosis Treatment Guidelines
(Note: WHO realizes that most of the world can't afford over-priced atypical antipsychotic medication.)














World Health Organization Suicide Treatment Guidelines

Treatment Guidelines

Treatment



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Self-Help Resources For

Monitoring Your Progress

NOTE: When each of the following presentations finish; you must exit by manually closing its window in order to return to this webpage.

The Healthy Social Behavior Scale lists social behaviors that research has found to be associated with healthy social relationships. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



The Mental Health Scale lists behaviors and symptoms that research has found to be associated with mental health (or disorder). You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



The Life Satisfaction Scale lists the survey questions often used to measure overall satisfaction with life. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



Life Satisfaction Scale (5-Minute Video)

The "Big 6" Dimensions of Mental Health

Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders.

This website uses these 5 major dimensions of human behavior (i.e., Agreeableness, Conscientiousness, Openness/Intellect, Extraversion/Sociability, and Emotional Stability) to describe all mental disorders. This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.

The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].



Desiderata (5-Minute Video)



The following "Morning Meditation" allows you to plan your day using these "Big 6" dimensions of mental health.



The following "Evening Meditation" allows you to review your progress on these "Big 6" dimensions of mental health.




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    "In physical science a first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about and express it in numbers you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind: it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be."

    Lord Kelvin (1824 – 1907)


  • The best summary on bad research is given by Laura Arnold in this TEDx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!

  • Economist in grim battle against deceptive scholarship

  • List of Predatory Journals and Publishers

  • The power of asking "what if?"

  • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

  • Criteria For High Quality Research Studies

  • It is troubling that a recent study found that two-thirds of important psychological research studies couldn't be replicated. High quality research must meet the following criteria:

    • Randomized Controlled Trial:
      Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).

    • Representative Sample:
      Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).

    • Single Blind Trial:
      Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).

    • Double Blind Trial (Better Than Single Blind Trial):
      Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.

    • Baseline Comparability:
      Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.

    • Confounding Factors:
      Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.

    • Intervention Integrity:
      Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).

    • Statistical analysis:
      Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.

      Ask: Are the results both statistically significant and clinically significant? Many medical research findings are statistically significant (with a p-value <0.05), but they are not clinically significant because the difference between the experimental and control groups is too small to be clinically relevant.

      For example, the effect of a new drug may be found to be 2% better than placebo. Statistically (if the sample size was large enough) this 2% difference could be statistically significant (with a p-value <0.05). However, clinicians would say that this 2% difference is not clinically significant (i.e., that it was too small to really make any difference).

      Statistically, the best way to test for clinical significance is to test for effect size (i.e., the size of the difference between two groups rather than confounding this with statistical probability).

      When the outcome of interest is a dichotomous variable, the commonly used measures of effect size include the odds ratio (OR), the relative risk (RR), and the risk difference (RD).

      When the outcome is a continuous variable, then the effect size is commonly represented as either the mean difference (MD) or the standardised mean difference (SMD) .

      The MD is the difference in the means of the treatment group and the control group, while the SMD is the MD divided by the standard deviation (SD), derived from either or both of the groups. Depending on how this SD is calculated, the SMD has several versions such, as Cohen's d, Glass's Δ, and Hedges' g.

        Clinical Significance: With Standard Mean Difference, the general rule of thumb is that a score of 0 to 0.25 indicates small to no effect, 0.25-0.50 a mild benefit, 0.5-1 a moderate to large benefit, and above 1.0 a huge benefit. It is a convention that a SMD of 0.5 or larger is a standard threshold for clinically meaningful benefit.

      The statistical summary should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention).

      In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).

        Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.

        Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)

        Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”

      Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.

    • Completeness of follow-up data:
      Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.

    • Handling of missing data:
      Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.

    • Replication of Findings:
      Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).

    • Fraud:
      Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size ( n ), mean ( M ) and standard deviation ( SD ) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:

      • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean ( M ) is defined as "the sum ( Sum ) of the values of each observation divided by the total number ( n ) of observations". So: M = Sum / n . Thus: ( Sum ) = ( M ) multiplied by ( n ). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate ( M ) multiplied by ( n ). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean ( M ) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value , and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)

      • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible.

      • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).

      • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).

      • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).

      • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.

      • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.

      • If the research study's data contradicts the study's own conclusions - surprisingly, this often occurs.

  • Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!

  • Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999

  • Not All Scientific Studies Are Created Equal - video

  • The efficacy of psychological, educational, and behavioral treatment

  • Estimating the reproducibility of psychological science

  • Psychologists grapple with validity of research

  • Industry sponsorship and research outcome (RevDisiew) - Cochrane Library

  • 'We've been deceived': Many clinical trial results are never published - (text and video)

  • Junk science misleading doctors and researchers

  • Junk science under spotlight after controversial firm buys Canadian journals

  • Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?

  • When Evidence Says No, But Doctors Say Yes


  • Cochrane Collaboration - the best evidence-based, standardized reviews available

Research Topics

Delusional Disorder - Core Clinical Journals

Delusional Disorder - All Journals

Delusional Disorder - Review Articles - Core Clinical Journals

Delusional Disorder - Review Articles - All Journals

Delusional Disorder - Treatment - Core Clinical Journals

Delusional Disorder - Treatment - All Journals

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Normal Distribution Of Human Attributes

Regression to the Mean (Or Why Scientific Experiments Require A Control Group)

The "Big 6" Dimensions of Mental Health

Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Five Factor Model of Personality". Although not computerized online, the Big Five Inventory (BFI) is a 44-item test often used in personality research.

This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.)

The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].

    Which "Big 6" Dimensions of Mental Health are Impaired in Delusional Disorder?

    THE POSITIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THE NEGATIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH THIS DISORDER
    Agreeableness
    Being kind and honest.
    Antagonism
    Being unkind or dishonest.
    Conscientiousness
    Being diligent and self-disciplined.
    Disinhibition
    Being distractible, impulsive, or undisciplined.
    Openness/Intellect
    Showing good creativity, problem-solving, and learning ability
    Impaired Intellect
    Showing decreased creativity, problem-solving, or learning ability.
          Psychosis
    Extraversion
    Being gregarious, assertive and enthusiastic.
    Detachment
    Being detached, unassertive, and unenthusiastic.
    Emotional Stability
    Being emotionally stable and calm.
    Emotional Distress
    Being emotionally unstable/distressed.
    Physical Health
    Being physically fit and healthy.
    Physical Symptoms
    Being physically unfit or ill.





The Following Will Only Discuss The Dimensions of Mental Illness That Are Abnormal In This Disorder

The problems that are characteristic of this disorder are highlighted with this pink background color.


OPEN-MINDEDNESS VS. CLOSED-MINDEDNESS
OPEN-MINDEDNESS (Intellect)

Description: Intellect is synonymous with being open to experience and being intellectual. Openness to experience reflects appreciation for art, music, nature, beauty, adventure, and variety of experience. These individuals are willing to learn, be innovative, and be flexible. Intellect reflects one's cognitive capacity (e.g., reasoning, memory, attention, language and learning). Individuals with high Intellect are intellectually curious, quick to learn things, creative, formulate ideas clearly, and have a rich vocabulary. Humans are set apart from all other species by their intellectual curiosity and their need to tell stories as a form of social bonding. The Intellect dimension measures the behaviors that are central to the concept of WISDOM - having curiosity, experience, knowledge, and good judgment. (Science requires openness, intellectual curiosity, experimentation, and the free exchange of information.) High Intellect is associated with better: longevity, school and creative performance.
Descriptors: Intelligent, good problem-solving, open-minded, open to new ideas, creative, innovative.
  • From Between facets and domains: 10 aspects of the Big Five
    • Intellectual:
      • Am quick to understand things
      • Can handle a lot of information
      • Like to solve complex problems
      • Have a rich vocabulary
      • Think quickly
      • Formulate ideas clearly
    • Open to Experience:
      • Original, come up with ideas
      • Value artistic, aesthetic experiences
      • Have an active imagination
      • Enjoy the beauty of nature
      • Believe in the importance of art
      • Love to reflect on things
      • Get deeply immersed in music
      • See beauty in things that others might not notice
      • Need a creative outlet
  • From International Personality Item Pool:
    • Like complex problems
    • Prefer variety to routine
    • Tend to vote for liberals
    • Have a vivid imagination
    • Believe in the importance of art
Chimpanzees: Human babies vs. chimps: who's smarter? Chimps, orangutans, and human toddlers perform about equally well on "physical learning" (e.g., locating hidden objects, figuring out the source of a noise, understanding the concepts of more and less, using a stick to get something that's out of reach). Chimpanzees are far superior to humans in "working memory" (video) (i.e., the brain's ability to temporarily store and use information). Where human toddlers are far superior to these apes is on "social learning" tasks (e.g., understanding how to solve a problem by watching someone else do it, figuring out someone else's state of mind from their actions, or using nonverbal communication to explain or understand how to find something). Thus what makes human intelligence special is our ability to cooperate and communicate to share expertise. This has allowed us to build complex societies, collaborate and learn from each other at a high level, and use symbolic representation (writing, numerals, imagery) to communicate ideas.
Evolution: The brains of intelligent species evolved the ability to detect correlational patterns in their perceptions. Then a few intelligent species evolved the ability to logically detect causal patterns in their perceptions (and later in their abstract or semantic information). [But will the human brain destroy itself?]
Language Characteristics: Many positive emotion words (e.g. happy, good), high meaning elaboration, more perspective, politeness, few self-references, complex sentence constructions, few causation words, many inclusive words (e.g. with, and), few third person pronouns, many tentative words (e.g. maybe, guess), many insight words (e.g. think, see), few filler words and within-utterance pauses, stronger uncommon verbs.
Research: Higher scores on Intellect are associated with greater creativity and general intelligence. *MRI research found that Intellect did not have any significant correlation with the volume of any localized brain structure. However cognitive testing has shown that "dorsolateral prefrontal cortex function as well as both fluid and crystalized cognitive ability was positively related to Intellect but no other personality trait."
Relationship To General Intelligence: The "Big 5" personality dimension of Intellect appears to describe the individual's general intelligence (g). Research has shown that Intellect can be separated into 2 factors: Openness and Intellect. Intellect was independently associated with general intelligence (g) and with verbal and nonverbal intelligence about equally. Openness was independently associated only with verbal intelligence.
Example: This video shows how we see what we want to see. What we pay attention to (or what we believe about the world) blinds us to reality. (Exit YouTube after first video.)
Being Smart Is About Being Adaptive And Open To New Ideas: When facts prove them wrong, successful people are smart enough to admit that they are wrong and change their mind. Multi-billionaire Jeff Bezos said "that the smartest people are constantly revising their understanding, reconsidering a problem they thought they'd already solved." He said that people who are right a lot often change their minds a lot as well. According to Bezos, being truly smart is about being adaptive and open to new perspectives and ways of thinking. Bezos encourages people to "look for new ideas from everywhere."
Our IQs Are Increasing: IQ gains have averaged 0.28 IQ points annually since 1908. That would mean that the average person in 1908 would be borderline retarded by today's standards. Likewise, the average person today would have a higher IQ that 98 percent of people in 1908. This could explain why modern moral judgments differ so dramatically from those of our Bronze Age ancestors. For example, the Bible condoned genocide (Deuteronomy 20:16–18, Joshua 10:40), slavery (Leviticus 25:44, Ephesians 6:5, 1 Timothy 6:1), and insisted on the death penalty for extramarital affairs (Deuteronomy 22:22) and for being a subborn and rebellious son (Deuteronomy 21:18-21).
"I am original, and come up with new ideas."
"I am curious about many different things."
"I am quick to understand things."
"I can handle a lot of information."
"I like to solve complex problems."
"I have a rich vocabulary."
"I think quickly and formulate ideas clearly."
"I Enjoy the beauty of nature"
"I believe in the importance of art."
"I love to reflect on things."
"I get deeply immersed in music."
"I see beauty in things that others might not notice."
"I need a creative outlet."
CLOSED-MINDEDNESS (Impaired Intellect)
Description: Low Intellect is synonymous with being closed to experience and being unintellectual. Individuals that are closed to experience are rather unimpressed by most works of art, prefer routine over variety, stick to what they know, and prefer less abstract arts and entertainment. Individuals with low intellect are not intellectually curious, learn things slowly, have difficulty understanding abstract ideas, avoid creative pursuits, and feel little attraction toward ideas that may seem radical or unconventional.
Descriptors: Unwise, poor problem-solving, closed-minded, not open to new ideas, uncreative, not innovative.
  • From Between facets and domains: 10 aspects of the Big Five
    • Unintellectual:
      • Have difficulty understanding abstract ideas
      • Avoid philosophical discussions
      • Avoid difficult reading material
      • Learn things slowly
    • Closed to Experience:
      • Do not like poetry
      • Seldom get lost in thought
      • Seldom daydream
      • Seldom notice the emotional aspects of paintings and pictures
  • From International Personality Item Pool:
    • Avoid philosophical discussions
    • Dislike changes
    • Believe in one true religion
    • Seldom daydream
    • Do not like poetry
Language Characteristics: Few positive emotion words, low meaning elaboration, less perspective, less politeness, few positive emotion words, many self-references, simple sentence construction, many causation words (e.g. because, hence), many third person pronouns, few tentative words, few insight words, many filler words and within-utterance pauses, milder verbs.
"I prefer work that is routine."
"I have difficulty understanding abstract ideas."
"I think slowly."
"People find it hard to follow my logic or understand my thoughts."
"I avoid philosophical discussions."
"I avoid difficult reading material."
"People find it hard to follow my logic or understand my thoughts."
"I have few artistic interests."
"I seldom notice the emotional aspects of paintings and pictures."
"I do not like poetry."
"I seldom get lost in thought."
"I seldom daydream."
Psychoticism
Description: Psychoticism is the state of being psychotic or of being predisposed to develop psychosis.
Descriptors: Unusual beliefs and experiences, eccentricity, perceptual dysregulation.
Screening Questions:
  • "My thoughts often don’t make sense to others."
  • "I have seen things that weren’t really there."
  • "I often have thoughts that make sense to me but that other people say are strange."
  • "I often “zone out” and then suddenly come to and realize that a lot of time has passed."
  • "Things around me often feel unreal, or more real than usual."
* Unusual Beliefs and Experiences:
"I often have unusual experiences, such as sensing the presence of someone who isn't actually there."
"I've had some really weird experiences that are very difficult to explain."
"I have some unusual abilities, like sometimes knowing exactly what someone is thinking."
"Sometimes I can influence other people just by sending my thoughts to them."
"I often see unusual connections between things that most people miss."
("OPENNESS TO EXPERIENCE vs. BEING CLOSED TO EXPERIENCE" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five) [More Information]
*MRI Research:
Testing predictions from personality neuroscience. Brain structure and the big five.



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Internet Mental Health © 1995-2019 Phillip W. Long, M.D.