Understanding Delusions in Schizophrenia

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Delusional thinking refers to a combination of:

  1. Rigid ideas and thoughts that are
  2. Not supported by evidence (or not reality-based)
  3. Not shared by other people with similar cultural backgrounds and values

These three characteristics — rigidity in beliefs, lack of evidence supporting the belief (“poor reality testing”), and identification of the beliefs as strange and at odds with reality by people within the same culture — are all essential parts of the definition.

While paranoid beliefs are the most frequent type of delusional thinking seen in schizophrenia, people with schizophrenia also report other types of delusional experiences.

Delusions (Ideas) of Reference

Ideas of reference are manifested as a feeling that neutral events or circumstances are meaningful or significant. Songs on the radio are meant to convey coded messages; the news anchor on TV is talking directly to you; the three cars in the intersection signal to you that there are three days before the Coming.

Delusions of Grandeur (Grandiose Delusions)

You feel you have special powers such as the power of reading other people minds (telepathy), the power of foretelling the future, the power of changing other people’s destiny. Or you might feel you have amazing talents in science and art, at a level that will certainly bring you the next Nobel Prize. Or you might feel you are an extremely important figure: a political leader, a prophet, or even the incarnation of a famous historical figure such as Jesus Christ or past kings or emperors. Alternatively, you might feel that you have a personal relationship with an important or famous person (e.g. personal adviser to the President; personal friend of a celebrity).

In common parlor delusions of grandeur are called “megalomania” even though this would be a more appropriate term for the grandiose ideation that can be seen in a manic-depressive (bipolar) disorder.

Delusions of Control

You feel that your thoughts, moods, or actions are controlled by an outside force. Your thoughts feel as if they are not your own but instead have been implanted in your mind: “They make me think these thoughts”. “I feel excitement but it is not me; they force this feeling on me”. “You see my hand moving but I don’t control it; it is remotely controlled from the outside.”

Somatic Delusion

You feel that something is clearly wrong with your body. The feelings coming from your body tend to be strange: “My body is rotting” or “I have a tumor that I feel growing inside” or “There are rats eating my brain.” The belief that something must be wrong with your body is very strong and are usually maintained regardless of doctors’ opinions and negative medical tests.

Religious Delusions

You feel that you have a special communication with God to the point that you are chosen as one of His special messengers or prophets. Alternatively, you might feel possessed by the Devil or evil spiritual entities. In practice, religious delusional beliefs overlap with grandiose ideation such as “I am chosen” or “I am the Savior” and hallucinatory experiences such as hearing God’s voice directly talking to you or experiencing physical sensations from spiritual entities taking over your body.

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