Ideas on How to Handle

Delusions

Delusions

Delusions Are Difficult to Handle     

     Like hallucinations, delusions are difficult for both the caregiver and the family member to handle because they seem real. The person experiencing the delusion believes the story they tell about a situation. If your family member tells you she had dinner last night in Paris with your dead Aunt who works for the CIA, understand that in her mind, it happened. If you ask her questions about how she got there and returned home before morning, she will have an answer that makes sense to her. 

Exists in an Alternate Reality

     That’s the nature of a delusion. The person with the delusion exists in a different reality from everyone around them. They strongly believe in what they know to be true within this complex alternate reality even though no evidence or facts supports their belief. When confronted with something they cannot prove, they create a rational explanation based on their created facts or divert attention to another subject. Unless they are self-aware of their medical condition, they will deny they are delusional.  

Types of Delusions Disorders

an example of a bizarre delusion--a clown as a dentist using a chain saw to extract teeth.Delusional Disorders     

     Delusions can be either bizarre or non-bizarre by nature.  Bizarre themes are based could never happen or are unrealistic (ex: aliens cloned the person as a child and their watch sends signals to the mothership daily regarding their activities). The classification for delusions based on themes that could happen or be real but have no evidence to support them is non-bizarre.

Non-Bizarre Delusions

     When a person sustains a delusional episode for a month or longer, they have a delusional disorder. Most delusional disorders have non-bizarre themes, and apart from this unrealistic belief, the person functions normally in everyday life. Some of the types of delusional disorders are:

  • Erotomanic: The person thinks someone higher in social standing than they are is in love with them. Usually, that person does not know them.
  • Grandiose: The individual believes he has some greater but unappreciated or unrecognized talent, power, insight, knowledge, self-worth, or relationship with someone famous or with God.
  • Jealous: The person thinks his partner has been unfaithful.
  • Persecutory: He believes that he is the victim of cheating, spying; was drugged, followed, slandered, or somehow mistreated.
  • Somatic: The individual believes he is experiencing physical sensations or bodily dysfunctions, such as foul odors or crawling insects under his skin, or is suffering from a disease.
  • Mixed: The person has delusions characterized by more than one of the above delusional types with one theme dominating.
  • Unspecified: An individual’s delusions do not fall into the described categories or cannot be clearly determined.
In this delusion, she feels as if everyone is spying on her every move and blaming her for not meeting expectations.
In this delusion, she feels as if everyone is spying on her every move and blaming her for not meeting expectations.

Ideas on How to Handle Situations Involving Delusions

Try not to argue

     Interacting with someone having a delusion who insists you believe in what they are experiencing takes a lot of patience. Your first reaction is often to correct them. If their reaction to their delusion may cause them harm, you need to intervene.  However, do so in a way that removes the risk of danger but does not provoke them further if you can.

     Using some of the following techniques can help you do meet that challenge.

  • Do not reason, argue, or challenge the delusion. Attempting to disprove the delusion is not helpful and will create distrust.
  • Assure the person they are safe and no harm will occur. Do not leave them alone if they are afraid; always use openness and honesty.
  • Please encourage them to talk about their feelings of anxiety, fear, or insecurity; offer your concern and protection to prevent injury to them or others.
  • Convey acceptance of the need for their false belief.
  • Focus on building a trusting relationship rather than needing to correct their false belief.

Wife attempting to convenience husband that his delusion isn't real. but getting nowhere.

Attempt to calm them, listen to understand their concern, and determine why the delusion is occurring.

     Many times fear causes delusions.  Your family member may have overheard a conversation, misinterpreted a sound as a threat, or seen a shadow figure believing it to be an intruder.  When you actively listen, not just to the words but to the emotion associated with the words, you can often get to the root of their distress and help eliminate the need for the delusion.  In supporting their emotions, you build trust with your family member.

     To show you understand and to help resolve the problem, consider saying something like, “I can see that hat rack is throwing a shadow. I certainly could appear to be a man in your room. It’s no wonder you were frightened.  What if we move it away from the light so that the shadow is no longer there?” 

  • Show empathy and try to understand the purpose behind the delusion.
  • Paraphrase what they said, try to clarify any confusion about what they describe.
  • Without agreeing or arguing with them, question the logic or reason behind the delusion. Keep the tone of your voice calm and your inflections non-condescending.
  • Avoid, however, arguing your point or arguing over the reality of a situation. Rather, focus on the emotions of the person rather than the “facts” they present. If you argue facts with them, they will shut down.
  • Identify the theme of the delusion, the main feeling behind it, and its tone.

Look around the immediate environment for the possible cause.

    Between changes in eyesight, poor lighting, impaired hearing, and altered mental status, it’s no wonder normal sounds and sights get misinterpreted when they occur unexpectedly around someone with dementia or facing mental health challenges. If they see a person in Halloween attire or theatre costume, they may believe they are the character or the defender against the character.  After considering your family member’s statement, you may identify the trigger behind the event somewhere in the environment. If you can remove the trigger for future events or reduce the number of occurrences by removing or altering the trigger, do so.  The solution may be as simple as adding light, changing a diet, or encouraging a nap.

Use distraction.

     Since objects, sounds, and other activities in the environment can cause delusions, diverting your family member’s attention away from the trigger precipitating the event may help put a stop to the delusion.  For example:  If your father says that he’s Major Smith and Gomer Pyle reports to him at a Marine Corp base, check to see if he was watching that show recently.  If he has developed a pattern of watching the program regularly, maybe changing the channel to the Cooking Channel instead might stop the delusions. Other activities such as exercise, playing cards, doing puzzles, looking at pictures, talking to friends, etc., can also be helpful.

     If the person talks to you about the delusional theme, redirect them back to what is going on around them. Ask them if they recall what activity everyone is performing and suggest both of you return to that. If they continue to talk, sit, and listen quietly but not engage in discussion.

Consider whether there could be an underlying medical problem.

     A change in how someone behaves, loss of memory, confusion, hallucinations, and delusions can all be signs of declining health. 

  • Many medical conditions affect the brain by accumulating toxins in the blood that enter the brain and affect mental status.
  • Other conditions affect oxygen intake. As the body’s ability to take in oxygen decreases, mental clarity decreases as well.
  • Infections, especially urinary tract infections, trigger changes in mental status in many individuals.
  • High fevers, pain medications, and dehydration also alter mental clarity.

Investigate how the delusion is affecting a person’s life.

  • Determine if and how the delusion affects a person’s life. For example, are they able to function the same as before, or have changes occurred?
  • What about relationships? Have any changes occurred in how they relate to family members or close friends as a whole or related to a specific individual?
  • Determine if your family member has made any specific change based on the delusion.
  • Identify how often the delusions are occurring, how long they last, and how intense the episode becomes. Regarding intensity – Are they immersed in the delusion to the exclusion of their former life, or is the delusion just on the fringe of their activities.
  • Do the delusions have a pattern? Do they occur on a particular day, at a certain time of day, after a particular activity? How many times per day, per week? What triggers them?
  • Are the delusions always the same, or do they change?

     If you believe any of the above may be causing a change in your family member’s mental status, discuss it with their doctor for prompt attention.

Express concern and the need for possible assistance.

Doctor explaining how to deal with the delusions once they get home.

     The time may come, especially if your family member has a delusional disorder, that you need to persuade them to see a therapist. Since they believe their delusion is true, suggesting they need help may lead to conflict unless the conversation is nonconfrontational. Usually, it’s best not to focus on the delusion but instead to address their emotions or another physical/mental status. Express that you have observed that they appear to be more anxious, or exhausted, or “fill in the blank with the emotion you see,” and you’re concerned that they might be feeling overwhelmed or need more support than you’ve been able to provide.

     Suppose an occasional clash occurred related to a delusion episode. In that case, you might reference that event and use it to say that you feel you could use some assistance on how to help your family member in those situations and you would like them to go with you. Truth-be-told, you probably could use the support on how to deal with them, and it’s a good way often to lead them to help by saying you need it first and they’re helping you.

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