Delusion vs over-valued belief?

[vanfanal]

Trying to be vague here but also get the point across....saw someone who thinks he discovered a concept in physics that proves Einstein wrong...even though the value for this constant is the same. has multiple articles illustrating his scientific theories online; of course nothing published in a peer-reviewed journal and he has contempt for professors and academic institutions because they do not accepts his work or ideas. Also claims he has a really high IQ. Otherwise no other features of mania or schizophrenia, no religious preoccupation, other special powers; otherwise "functional" and spends most of his time reading and writing about science at home. When I spoke with his ex, she too believes in his intellect and his theories.

Thoughts? Is this really delusional disorder, grandiose type or more like over-valued beliefs similar to online conspiracy theories and sub-cultures?

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[comp1]

Well, it's only a disorder if it's impairing functioning in some way. The only thing you vaguely mentioned that might be considered an impairment is an "ex," but then you said she shared his beliefs...so I'm guessing his beliefs were not what ended the relationship? Anyways, we'd need more info to call it a disorder. MUCH more importantly, why do you care?

 

[littlefred]

Is it similar to this guy?

 

[Jules A]

Sounds like he might meet criteria for delusional disorder.

 

[Sushirolls]

We don't care unless it has negatives, and functionally impacting a person's life. What you typed in OP shows no negatives other than a grumpy person.

Sounds like a fish story. Guy says he caught the state record, but doesn't trust the game department to record his record fish, or want to be bothered by filing the 1 page form, and going to an appropriate weigh station. Cool. You got a good story. Next!

 

[mistafab]

Just to kind of clear the air - an overvalued belief vs a delusion is really just a point for the MSE thought content section and has nothing to do with if it is impairing or not.

An overvalued belief is a shared belief between someone and their culture or subculture. It is often amplified by its holder as well as others in the subgroup. It tends to be logical if you are within that subgroup (i.e. lizard people, pizzagate).

A delusion is not shared with others. It's firm, fixed, and often idiosyncratic. Someone out of nowhere believes The Rock is in love with them. Others find it often bizarre.

This smells more like an overvalued belief given the partner's response and potentially people online who may be supportive of this (think flat earthers). I wouldn't be surprised if this person was part of some somegroup of people regarding credible theorists like einstien into a broader 'false science' overvalued belief.

Either way, it isn't a disorder unless it is impairing. For an overvalued belief, it could become an extreme overvalued belief (EOB), and if its delusional in nature - a delusional disorder. Someone with schizotypal personality would be more likely to flag with EOBs in a clinic, for example, but not necessarily delusions. EOBs would be important to spot in cases of threat assessment or if someone shows up "leaking" prior to a violent attack.

 

[Crayola227]

Sounds like he might meet criteria for delusional disorder.

If I'm not wrong, people can sometimes start with just one of these, that is not really impairing, but depending on what underlying/emerging disorder they have, they can go on to "collect" more, which can become more and more bizarre and clearly delusional and not shared, and eventually maybe impairing.

Like initially they think they are smarter than Einstein and their online nerd friends agree, but then they start to think there is a government conspiracy to hide these "facts," now the government is surveilling them and putting drugs in their food, now it impacts functioning and causes distress because they won't leave the house and lose their job. Then it turns out they have some schizophreniform disorder and later...

But my understanding as well, is that some folks just have one or a couple of these things (overvalued belief or full blown delusions) but then that's the end of it, it's otherwise stable and they go about their business.

This was how it was explained to me on inpatient but input from experts here is always nice. I think this is what @mistafab Is describing?

 

[Ceke2002]

Just to kind of clear the air - an overvalued belief vs a delusion is really just a point for the MSE thought content section and has nothing to do with if it is impairing or not.

An overvalued belief is a shared belief between someone and their culture or subculture. It is often amplified by its holder as well as others in the subgroup. It tends to be logical if you are within that subgroup (i.e. lizard people, pizzagate).

A delusion is not shared with others. It's firm, fixed, and often idiosyncratic. Someone out of nowhere believes The Rock is in love with them. Others find it often bizarre.

This smells more like an overvalued belief given the partner's response and potentially people online who may be supportive of this (think flat earthers). I wouldn't be surprised if this person was part of some somegroup of people regarding credible theorists like einstien into a broader 'false science' overvalued belief.

Either way, it isn't a disorder unless it is impairing. For an overvalued belief, it could become an extreme overvalued belief (EOB), and if its delusional in nature - a delusional disorder. Someone with schizotypal personality would be more likely to flag with EOBs in a clinic, for example, but not necessarily delusions. EOBs would be important to spot in cases of threat assessment or if someone shows up "leaking" prior to a violent attack.

Speaking from personal experience I'm gonna have to heavily agree with this summation.

My Dad was a white supremacist (yeah I'm just gonna go ahead and lead with that), who firmly believed that people of colour were a separate, non human, sub species. That of course is a loathsome idea, but sadly one that at least a portion of the population also held to varying degrees. So as much as I hated and vehemently rejected my Dad's concept of race, I also can't really say his thinking was delusional.

Now when it comes to some of this other greatest mind hits, such as "my infant daughter is made of porcelain, and will shatter if I touch her", "Doctor's have their own mafia and put hits out on patients", or "Let me devote a portion of my weekend towards digging up the yard looking for hidden listening devices", then yeah I'm gonna call delusional on that stuff.

 

[docloufan]

Agree with other. Who cares. Why is he seeing you, anyway?

 

[Candidate2017]

Narcissism as a defense mech should be on the radar. Do you come off as intelligent? Insecure patients sometimes feel threatened when seeing The Doctor, and feel the need to rebalance the interaction by announcing intellectual capability.

But practically (i.e., disposition), safety first. Disposition may vary upon whether inpatient vs. outpatient, as well as how they got to you. In the end, if no danger or organic psychiatric issue treatable with pills, then it's basically, "Cool story bro, bye."

Also, we can't discount the vast number of people who are just weird with weird thoughts. Patients often feel entitled to our ears, so they will take a verbal dump on us knowing we won't mock them like their family and friends do for their idiosyncratic ideas.

Trying to be vague here but also get the point across....saw someone who thinks he discovered a concept in physics that proves Einstein wrong...even though the value for this constant is the same. has multiple articles illustrating his scientific theories online; of course nothing published in a peer-reviewed journal and he has contempt for professors and academic institutions because they do not accepts his work or ideas. Also claims he has a really high IQ. Otherwise no other features of mania or schizophrenia, no religious preoccupation, other special powers; otherwise "functional" and spends most of his time reading and writing about science at home. When I spoke with his ex, she too believes in his intellect and his theories.

Swap out physics for psychology and psychiatry, and your post sounds like your patient is the Scientology founder.

 

[vanfanal]

Thanks for the replies.
Several people have mentioned that it's no delusional disorder unless it's impairing; criteria C for delusional disorder is rather nebulous but says that apart from the ramifications of the delusions itself, function is not markedly impaired.
To answer another reply, I care because attaching a diagnosis of delusional disorder to this guy's chart will have ramifications for him in the healthcare system...and then I think it's also then my responsibility to try and explore a tx plan with CBT and maybe medications.
In the end I went with over-valued beliefs because he had some patents and other forms of evidence that tangentially corroborate some of his claims, no significant distress or impairment, and I did add narcissistic traits.

Attaching and article I read if anyone else finds it helpful.

 

[comp1]

Omph, criterion C definitely needs to be rewritten. What the heck is that phrasing?

 

[clausewitz2]

Omph, criterion C definitely needs to be rewritten. What the heck is that phrasing?

Criterion C seems . . . kind of unremarkable. What is the aspect of the phrasing you object to?

EDIT: at least of the paper the previous poster linked, maybe you mean in the DSM?

 

[Crayola227]

Intuitively it makes sense to say that marked impairment isn't necessary. Just because the delusional belief isn't causing problems in and of itself, doesn't make it any less whacky, and as we've all said it's worth noting officially and medically any time you have a significant break with reality, even if nothing bad is coming of it at the time.

If I believe Sandra Bullock is an alien who can shoot red laser beams out of her eyes... it might never lead to some kind of impairing or dangerous action on my part, but it's so bizarre as to be worth noting. As for criteria C, it's suggested that for an overvalued belief, someone is going to agree with you. The delusion on the other hand, may not actually be causing social issues if it doesn't come up, but almost universally if almost anyone who finds out about it they're going to think you're unwell.

 

[clausewitz2]

Intuitively it makes sense to say that marked impairment isn't necessary. Just because the delusional belief isn't causing problems in and of itself, doesn't make it any less whacky, and as we've all said it's worth noting officially and medically any time you have a significant break with reality, even if nothing bad is coming of it at the time.

If I believe Sandra Bullock is an alien who can shoot red laser beams out of her eyes... it might never lead to some kind of impairing or dangerous action on my part, but it's so bizarre as to be worth noting. As for criteria C, it's suggested that for an overvalued belief, someone is going to agree with you. The delusion on the other hand, may not actually be causing social issues if it doesn't come up, but almost universally if almost anyone who finds out about it they're going to think you're unwell.

The trouble is you do find these online TI/gangstalking communities that do serve as validating echo chambers for what are very clearly delusions.

For what it is worth philosophers of psychiatry have tended to conclude that there isn't actually a principled way to distinguish reliably between delusions and overvalued beliefs/ideas. It's not clear to me that very much hangs on this question to be honest unless you think that we need to be the epistemology police enforcing consensus reality.

 

[comp1]

Criterion C is remarkable here because it does not explicitly demand impairment for the diagnosis. It appears to only sort of imply that such an impairment might come from this "disorder," but that if the impairment comes from something else, they definitely don't have the disorder. It's a very weird exclusionary criteria instead of the typical inclusion criteria we see with most diagnoses.

 

[clausewitz2]

Criterion C is remarkable here because it does not explicitly demand impairment for the diagnosis. It appears to only sort of imply that such an impairment might come from this "disorder," but that if the impairment comes from something else, they definitely don't have the disorder. It's a very weird exclusionary criteria instead of the typical inclusion criteria we see with most diagnoses.

Surely the idea is to make sure that people with more classical psychosis not quite rising to the level of diagnosable schizophrenia do not immediately qualify for a delusional disorder diagnosis? Delusional disorder is really in the DSM to capture the picture that Kraepelin was originally describing when he discussed paranoia (as opposed to the incredibly sloppy way the term is used in psychiatry today).

 

[comp1]

I hope it is, but the phrasing of Criterion C seems to imply that you could just have some odd, non-impairing beliefs, that would qualify you for a frank delusional disorder diagnosis as long as you didn't also something else like schizophrenia or delirium.

 

[splik]

Surely the idea is to make sure that people with more classical psychosis not quite rising to the level of diagnosable schizophrenia do not immediately qualify for a delusional disorder diagnosis? Delusional disorder is really in the DSM to capture the picture that Kraepelin was originally describing when he discussed paranoia (as opposed to the incredibly sloppy way the term is used in psychiatry today).

You mean American psychiatry. In European psychiatry (and even psychoanalysis), paranoia has always referred to what is now called delusional disorder.