Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How can I tell if I’m delusional? Advice from a therapist

By Jessica Migala

Oct 24, 202310 min read minute read

Reviewed byApril Kilduff, MA, LCPC

I can’t believe he’d think that. He’s so delusional.

I know, I’m being delusional.

These days, you have to be delusional to be happy.

There are so many ways that the word “delusion” is used in casual conversations. Typically, it’s formed as an insult—whether to someone else or said to yourself for thinking something “dumb” or unusual. 

It has even been a trending term on TikTok: Being “delulu” is sometimes spun as being positive—as in you’ve got to be delusional to get through the day or that deluding yourself is the answer to living a life stress-free.

But delusion actually has a particular meaning that refers to legitimate mental health concerns. If you’re worried that you are truly delusional, read on to learn what the term really means, the mental health conditions that are connected to delusions, and how to find help if you’re having delusions or worried that you are.

What does it mean to be “Delusional”?

When we use delusional so casually in everyday speech, it loses a lot of its meaning. Officially, delusion is defined as: “an often highly personal idea or belief system, not endorsed by one’s culture or subculture, that is maintained with conviction in spite of irrationality or evidence to the contrary,” according to the American Psychological Association (APA). 

Boiled down into simpler terms, “delusions are untrue beliefs that are not supported by evidence,” says Melanie Dideriksen, LPC, CAADC, licensed therapist at NOCD. These beliefs can also be described as irrational. In other words: Delusions are not based on what is happening in reality.

So many different types of delusions exist, and can be centered on themes such as romance, grandeur, and persecution, says Dideriksen. As StatPearls points out, some common delusions include:

What conditions cause Delusions?

Delusions can be present in a variety of conditions that involve psychosis, which describes times when you lose touch with reality, according to the National Library of Medicine. Specifically, delusions can appear in:

  • Bipolar disorder: People who have this brain disorder experience intense moods called mania or depression. About half of people with bipolar disorder develop psychotic symptoms, which include delusions or hallucinations (a false sensory perception that something is real but isn’t).
  • Schizophrenia: The brain disorder that affects less than 1% of people in the U.S., schizophrenia can involve delusions, hallucinations, and disorganized speech, according to the American Psychiatric Association
  • Drug and alcohol abuse
  • Brain tumors and infection: Brain tumors can cause a range of psychiatric symptoms, including delusions, hallucinations, mania, and paranoia, among others, according to the American Brain Tumor Association.
  • Stroke: Delusional disorder can be a rare consequence of stroke; one study says it’s about 5% of those who experience a stroke, according to a review in the Journal of Neurology, Neurosurgery, and Psychiatry.
  • Alzheimer’s disease: In this common form of dementia, people with mid-to late-stage Alzheimer’s may develop delusions that people—including loved ones—are plotting against them or stealing from them, according to the Alzheimer’s Association. Delusion is a facet of the brain degeneration that occurs in the disease.
  • Psychotic depression: This describes having depression and losing touch with reality. You can have both delusions and hallucinations linked to your depression, explains Mount Sinai.

What experiences might you interpret as “Delusional”?

What sets apart clear delusions in a condition like schizophrenia or bipolar disorder from delusions in the context of other conditions like obsessive compulsive disorder (OCD) is the lack of insight, says Dideriksen. “People experiencing true delusions don’t think that the beliefs they have could be delusional,” she says. “Someone who is delusional is living in the delusion, not wondering ‘What if this is a delusion?’” 

The bottom line: If you have a disorder that features delusions, you truly believe those delusions—you do not question them or poke fun at them for being “so delusional.” You have the self-awareness to know that what you’re saying to yourself or others isn’t actually true. 

And yet, these gray areas—the thoughts and beliefs that feel real or bothersome, even though you know they’re not—can still pose a problem for your mental health. Here’s a deeper look into delusion as it relates to a couple other experiences: OCD and intentional dishonesty.

OCD

OCD is a chronic mental health disorder involving the existence of two types of symptoms: obsessions and compulsions. 

Obsessions are defined as unwanted thoughts, images, feelings, sensations, and urges that cause distress. 

Compulsions are the physical and/or mental repetitive behaviors, such as thought stopping, checking, or reassurance-seeking, done to neutralize the distress of obsessions. 

Among the many subtypes of OCD is one that’s focused on fears about having schizophrenia—and it’s surprisingly common among people with OCD. How do you know if you might have it? You have intrusive thoughts that you may actually be psychotic or have a distinct fear of developing schizophrenia. To decrease the anxiety that results from these distressing thoughts, you may perform compulsions, such as:

Here’s how this might play out: let’s say you have persistent intrusive thoughts that you’re being controlled by the government. These are thoughts that can be present in both schizophrenia and OCD. However, says Dideriksen, if you have OCD, your thought process would go like this: I know that this is one sign of schizophrenia because I saw that documentary, read that book, or have a coworker who has it. I’m really worried that I have schizophrenia, too, or that I’m developing it. 

That right there is the sign that your anxieties are based in OCD: You know you have this fear. And many subtypes of OCD feature similar themes as delusions, yet are not actual delusions.

“For someone who has OCD and is concerned that they are delusional, they still know that it’s not really true—but they still worry about what if it is actually happening to them,” says Dideriksen. Despite the extreme fear that they may have or be developing psychosis, there is still a level of awareness that they are not delusional. On the other hand, someone who is experiencing psychosis, which includes delusions and hallucinations, lacks this insight: they would simply believe that the government is controlling them, and feel fear or other emotions in response to this belief.

It’s also important to point out that a phenomenon called depersonalization, or its close cousin derealization, can present in OCD. With depersonalization, you feel as if you’re outside of your own body or disconnected from reality, and this can occur with another type of OCD called existential OCD, where your fears are centered around your existence and identity. This is not the same as a delusion, but it can certainly feel that way. This type of OCD would be treated with the same type of treatment as any other theme of OCD. 

Intentionally being dishonest with yourself or ignoring reality

Even though being “delulu” is far from an official mental health term—and the way it’s used is not in line with the real definition of delusion—it’s still important to acknowledge if it’s happening to you. For example, maybe you are intentionally ignoring the reality of a relationship that’s detrimental to your mental health, pursuing relationships that aren’t being reciprocated, or spending money you don’t have. While this is not the definition of a break from reality, it is still something that can greatly impact your life. 

In short, while popular, casual ideas of what it means to be delusional aren’t in line with how the mental health community talks, they can certainly be worth talking about with a trained professional—especially if they’re impacting the way you live your life.

Do you need help for Delusions or being “Delusional”?

If you have a mental health condition that’s causing a break from reality, you absolutely need to seek help. Delusions can cause harm to yourself or others, affect your relationship, lead to legal issues, or contribute to depression, according to the Cleveland Clinic.

At the same time, if your delusions are not part of a mental health condition, and you feel as if you have delusional thinking (such as the aforementioned relationship challenges or financial problems), consider seeking mental health help with a therapist who can help you work on reframing your thinking and changing your behaviors to those that serve you better. Everyone deserves qualified help for their mental health struggles, whether they fit into certain diagnostic groups or not.

If, on the other hand, you’re on the fence, wondering if your thinking, beliefs, or actions could be considered delusional or out of touch with reality—or if you find yourself highly anxious about the possibility that you could be delusional—this may be a sign of a condition like OCD. Fortunately, this is a condition that has been shown to be highly treatable.

What kind of treatment will help me?

For everyone who is worried that they are making poor life choices (and being “delusional” about their own life), psychotherapy with a licensed mental health counselor can help you unravel unhelpful patterns of thinking and behavior.

When it comes to diagnosable mental health conditions, it’s important to be properly diagnosed. Depending on the underlying mental health condition, your treatment could be dramatically different. 

This is critical because receiving the wrong treatment for mental health conditions can be very harmful. “If someone fears that their thinking is becoming delusional and they have insight into their symptoms, we might have them face that head on through exposure to their fears. If you have actual delusions because you have psychosis, we would not encourage doing that at all,” says Dideriksen. 

For instance, schizophrenia is treated with antipsychotic medication, psychotherapy, and psychosocial treatments (in which you work with a professional to address barriers and live successfully), according to the National Alliance on Mental Illness (NAMI).

That is very different from how fears about psychosis or schizophrenia in OCD would be treated, which is through exposure and response prevention therapy, also known as ERP. ERP is the optimal treatment for reducing OCD symptoms compared to other types of psychotherapy, medication, or no treatment, according to a review of 24 studies on nearly 1,200 people with OCD published in 2021 in the Journal of Obsessive-Compulsive and Related Disorders

During therapy, ERP will trigger an obsession (this is the exposure part), which will increase your discomfort, just as your triggers have in the past. However, you will be encouraged to sit with that anxiety and purposefully not perform any compulsions (this is the response prevention part). Over time, this type of treatment allows you to manage your triggers and accept uncertainty, reducing the impact of OCD in your life, and leading to less fear about being or becoming delusional.

Here are a couple of examples of how Dideriksen might use ERP to treat someone with obsessive fears about being delusional:

  • Read articles about someone who has schizophrenia.
  • Watch videos of people with schizophrenia talking about their experience with the condition.
  • Watch videos of people with schizophrenia talking about their beliefs or thoughts. “In people who have OCD and have a fear of having delusions or schizophrenia, it’s highly distressing even watching someone be interviewed about their delusions,” says Dideriksen.
  • Watching videos that feature pretty “trippy” visuals that make you feel disoriented. While watching them, you might say to yourself, I may or may not lose control and start to believe things that aren’t real. 
  • Saying to yourself: “I’m not always rational. Sometimes, people might even think I’m being delusional!”

Keep in mind that the exposures will be geared toward what’s best for you depending on your individual fears. No matter what type of stimulus you use to trigger your obsession, you will be asked to sit with that feeling of not knowing what will happen, which is a reality that all people have to accept and live with. 

What you can do today to seek help

It can be scary to lean into your fears and uncertainties, but having a qualified mental health counselor by your side is a time-tested way to help you gain greater comfort in your life and your thoughts, imperfect as they can be.

If you think that your worries about being delusional could be related to OCD or anxiety, please know that there’s hope for you to feel better. I encourage you to learn more about NOCD’s evidence-based, accessible approach to ERP therapy for OCD and anxiety.

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