Delusional disorder diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Diagnostic Criteria

Diagnosis of delusional disorder requires fulfillment of the DSM-5 criteria, below. Medical history (including substance use), physical examination, and laboratory testing are used to rule out medical causes of psychosis. No laboratory test can make the diagnosis of delusional disorder, but a detailed psychiatric history and exam can be used to distinguish delusional disorder from other mental disorders. The differential diagnosis is provided below. The differential diagnosis of psychosis is described in greater detail separately. (See "Clinical manifestations, differential diagnosis, and initial management of psychosis in adults", section on 'Differential diagnosis'.)

DSM-5 diagnostic criteria for delusional disorder are as follows:

A. The presence of one (or more) delusions with a duration of one month or longer. B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (eg, the sensation of being infested with insects associated with delusions of infestation). C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd. D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods. E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder. The specific DSM-5 criteria for delusional disorder are as follows:[1]

Presence of one or more delusions with a duration of one month or longer. The criteria for schizophrenia has never been met. Note: Hallucinations, if present are not prominent and are related to the delusional theme (e.g., the sensation of being infected with insects is associated with the delusions of infestation). Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods. The disturbance is not better explained by another mental disorder such as obsessive-compulsive disorder, and is not attributable to the physiological effects of a substance or medication or another medical condition. Subtypes are defined as erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified. The diagnosis is further specified “with bizarre content” when delusions are clearly implausible, not understandable, and not derived from ordinary life experiences.

The following duration specifiers are used only after 1-year duration of the disorder:

First episode, currently in acute episode First episode, currently in partial remission First episode, currently in full remission Multiple episodes, currently in acute episode Multiple episodes, currently in partial remission Multiple episodes, currently in full remission Continuous