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 non-psychiatric conditions that cause psychoses, including:

  • Certain drugs and medications
  • Head injuries
  • Huntington's disease
  • Sleep deprivation
  • Temporal lobe epilepsy
  • Thyroid disorders
  • Vitamin B12 deficiency

In bipolar disorder, psychotic events usually occur during manic episodes, but they can develop during a depressive state as well. Either way, if psychotic episodes are part of your bipolar disorder, your official diagnosis will likely be a bipolar disorder with psychotic features (sometimes referred to as bipolar psychosis).

If you are diagnosed with bipolar psychosis it doesn't mean that your illness is more severe than that of someone who has bipolar without psychosis. One study found that people with bipolar psychosis tend to be more likely to experience more rapid cycling, as well as more chronic mood disturbances, than those who have bipolar without psychosis.

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:

  • A decrease in performance at work or at school
  • A sudden decline in self-care or personal hygiene
  • Being unable to do things you normally can
  • Confused speech or trouble communicating, such as changing topics rapidly or speaking incoherently
  • Difficulty telling reality from fantasy
  • Extreme changes in sleeping or eating patterns
  • Having trouble focusing and concentrating
  • Saying or doing bizarre things that don't reflect reality 
  • Spending a lot more time alone than usual
  • Strong, inappropriate emotions or having no feelings at all
  • Suddenly losing interest in the things you used to enjoy
  • Suspiciousness or uneasiness with others

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

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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  1. Cleveland Clinic. Delusional disorder. Updated January 23, 2018.

  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