Psychology Today~ Delusional disorder refers to a condition associated with one or more nonbizarre delusions of thinking—such as expressing beliefs that occur in real life such as being poisoned, being stalked, being loved or deceived, or having an illness, provided no other symptoms of schizophrenia are exhibited.
Delusions may seem believable at face value, and patients may appear normal as long as an outsider does not touch upon their delusional themes. Mood episodes are relatively brief compared with the total duration of the delusional periods. Also, these delusions are not due to a medical condition or substance abuse.
Themes of delusions may fall into the following types: erotomanic type (patient believes that a person, usually of higher social standing, is in love with the individual); grandiose type (patient believes that he has some great but unrecognized talent or insight, a special identity, knowledge, power, self-worth, or special relationship with someone famous or with God); jealous type (patient believes his partner has been unfaithful); persecutory type (patient believes he is being cheated, spied on, drugged, followed, slandered, or somehow mistreated); somatic type (patient believes he is experiencing physical sensations or bodily dysfunctions—such as foul odors or insects crawling on or under the skin—or is suffering from a general medical condition or defect); mixed type (characteristics of more than one of the above types, but no one theme dominates); or unspecified type (patient's delusions do not fall in described categories).
ABC News~ Black Swan, a new psycho-drama anchored in the competitive world of ballet, is getting as much analysis on the psychiatrist's couch as it is Oscar buzz.
The Golden-Globe nominated film takes viewers deep into a ballerina's descent into madness in a frightening portrait of psychosis that doctors say resonates realism.
Nina Sayers, a fragile and repressed ballerina, played by Natalie Portman, strives for the lead in Tchaikovsky's "Swan Lake," a role that will require her to play both the gentle white and the seductive black swans.
But in the process, she will have to shed her "sweet girl" persona and embrace her darker side to fully embrace the role and to please her demanding and sexually aggressive director.
Her metamorphosis is so complete, that Nina eventually develops webbed feet, bird-like legs and sprouts feathers and wings to actually become the black swan.
"It was intense and disturbing and fascinating and mysterious," said Nadine Kaslow, vice-chair of the department of psychiatry at Emory University and psychologist to the Atlanta Ballet. "What was a hallucination and what was real? When people are psychotic, it's difficult, even as a therapist, to know what's real and what's not."
Nina, who constantly strives for perfection, lives with her controlling mother Erica, played by Barbara Hershey, who gave up dance to have her daughter. They live in a tiny New York City apartment, cluttered with her mother's narcissistic paintings.
When the ballet's artistic director decides to replace the aging prima ballerina for the new season production of "Swan Lake," Nina is his first choice. But she has competition in new sexually open dancer Lily, played by Mila Kunis.
After securing the role, Nina is asked to "lose herself" to play the black swan, and so she does.
In visual hallucinations, she sees a black-clad version of herself across the subway platform and again in the maze of hallways at Lincoln Center. Even the pink stuffed animals that adorn the bedroom she shares with her neurotic mother seem to come alive and mock her.
She conjures up an array of fantasies and delusions, including a lesbian love scene with Lily.
"As a movie fan, it held my attention," said Dr. Steve Lamberti, professor of psychiatry at University of Rochester Medical Center. "It was poetic in a way, showing this transformation gone wrong."
But speaking as a psychiatrist, Lamberti said the film did not accurately depict schizophrenia, as has been widely speculated, but "does present a reasonable portrait of psychosis."
"People tend to be scared of things they don't understand," he said. "If you have never treated or observed a person with psychosis, it's upsetting."
Psychosis is a loss of contact with reality that usually includes false beliefs or delusions, and seeing or hearing things that are not there.
Like a fever, psychosis is a symptom rather than a disease, and can be caused by a variety of triggers: exposure to mercury (the hats of the Mad Hatter were impregnated with the heavy metal), drugs like amphetamines, epilepsy, a brain tumor, dementia or psychiatric disorders like schizophrenia.
Psychosis Usually Involves Auditory Hallucinations
But unless psychosis is due to neurological causes, patients normally have auditory, rather than visual hallucinations.
"In terms of cinematography, it's much easier to portray the visual," he said. "Whispers are not nearly as dramatic as seeing something."
