Delusions Occurring in Bipolar Disorder

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A delusion is a false belief that a person firmly holds to be true, regardless of whether it actually is true or even possible. Someone who's delusional will hang on tight to such a belief even if other people are able to logically explain why it's false.

There is a recognized mental illness called delusional disorder in which delusions are the dominant symptom. In a type of bipolar disorder that includes psychosis, however, delusions are a psychotic symptom of the mood disorder. They often appear along with hallucinations—sensory perceptions aren't actually there. In order to understand delusions as a symptom of bipolar disorder, it is helpful to also become familiar with psychosis.

Psychosis in Bipolar Disorder

In the simplest terms, psychosis is the loss of touch with reality. When someone is having a psychotic event, their thoughts and beliefs become distorted. Sometimes the delusions and hallucinations that accompany bipolar symptoms are in keeping with a person's current mood state, in which case they're called mood-congruent symptoms, and sometimes the opposite is the case—a person's delusion doesn't match up with their mood, which is known as mood-incongruent symptoms.

Psychosis is not an illness in and of itself, but a symptom of an underlying disorder. Roughly 3% of the U.S. population will experience psychosis during their lifetime, according to the National Institute of Mental Health, whether they have a mental disorder or not. In fact, there's an array of causes of psychoses other than psychiatric illness, including:

  • Being sleep-deprived
  • Drug use
  • Head injury
  • Temporal lobe epilepsy
  • Thyroid disorders
  • Bad reactions to medications
  • Vitamin B12 deficiency
  • Huntington's disease

In bipolar disorder, psychotic events usually occur during periods of mania, but they can develop while a depressive state is prominent as well. Either way, if psychotic episodes are part of your bipolar disorder, your official diagnosis will likely reflect that and you will be said to have bipolar disorder with psychotic features.

If you are diagnosed this way, it doesn't necessarily mean your illness is more severe or your prognosis is bleaker than that of someone with bipolar disorder without psychotic episodes, research shows. One study found that in bipolar disorder with psychosis there tends to be more rapid cycling between mania and depression, as well as more chronic mood disturbances, than in bipolar disorder that doesn't have psychotic symptoms.

Warning Signs of Psychosis

Psychosis doesn't normally happen suddenly. There are often warning signs that can let you know that it's coming, including:

  • Suddenly losing interest in the things you used to enjoy
  • Strong, unreasonable emotions or feeling no emotion at all
  • Extreme changes in your sleeping patterns
  • Being unable to do things you normally can
  • Isolating yourself more than normal
  • Your grades or work performance suddenly dropping
  • Becoming suspicious of others
  • Saying or doing bizarre things that don't reflect reality 
  • Losing interest in maintaining personal hygiene
  • Having trouble focusing and concentrating
  • Problems communicating, such as changing topics rapidly or speaking incoherently
  • Beginning to be unable to tell what's real and what's not

Types of Delusions

There are many different types of delusions. These are the ones most commonly associated with mental disorders.

  • Delusions of grandeur: Believing that you're famous or publicly important or that you're a god.
  • Delusional jealousy: Believing that your spouse or partner is being unfaithful when they are not.
  • Persecutory or paranoid delusions: Suspecting that you are being followed, spied on, secretly listened to, or the like.
  • Somatic delusions: Believing that you have a certain medical condition or physical defect.
  • Delusions of reference: Thinking that random events contain a special meaning for you alone.
  • Bizarre delusions: Believing in things that are impossible, such as thinking you're a werewolf, or your sister is an octopus, or that giant worms make subway tunnels.

Treatment Options

Psychosis—and therefore the delusions and/or hallucinations that comprise it—is treatable, especially if treatment is focused and prompt. Early intervention makes a big difference in recovery. Treatment may include antipsychotic medications and psychotherapy, such as cognitive-behavioral therapy (CBT) and supportive psychotherapy.

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  2. Early Assessment & Support Alliance. What is psychosis? 2016.

  3. National Institute of Mental Health. RAISE questions and answers.

  4. Burton CZ, Ryan KA, Kamali M, et al. Psychosis in bipolar disorder: Does it represent a more "severe" illness? Bipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527

  5. Skelton M, Khokhar WA, Thacker SP. Treatments for delusional disorder. Cochrane Database Syst Rev. 2015;(5):CD009785. doi:10.1002/14651858.CD009785.pub2