Somatic Delusions

Somatic delusions are not the most common type of delusion, but they can be among the most persistent. People with somatic delusions are completely convinced there is something medically, physically, or biologically wrong with them, and their belief is so strong and sincere they will experience a range of “symptoms” that verify their worst fears.

Somatic symptom disorder is one of six delusional disorders recognized by medical authorities, and it is one of the primary causes of somatic delusions. But somatic delusions can also appear during episodes of psychosis, which can manifest in connection with a wide range of psychiatric disorders.

To those who have them, somatic delusions are as real as any other type of injury or illness.

For reasons that remain obscure, people with somatic delusions become convinced their organs are damaged or malfunctioning, or that they are suffering from some type of hidden malady, or that their physical appearance has somehow been altered or distorted. Over time, their concern may grow to the point that they will develop aches, pains, and other sensations that seem to verify their worst fears.

Somatic delusions are usually classified as either bizarre or non-bizarre. The latter refer to imagined conditions that bear a resemblance to real-world maladies experienced by real people, while the former involve impossible scenarios that have no grounding in science. Many somatic delusions skirt the line between bizarre and non-bizarre, however, limiting the value of this formal classification scheme.

Some examples of common somatic delusions include:

• Fears of infestation or infection. People with somatic delusions often believe they’ve been infected by parasites that have taken over their internal organs, or by tiny insects that have burrowed under their skin to lay their eggs.
• Distorted body image. Men and women with somatic conditions often have unrealistic beliefs about their physical characteristics. Despite evidence to the contrary, they may become convinced that their bodies are deformed, misshapen, or unattractive.
• Imagining unpleasant odors. Suffering from accompanying hallucinations, people with somatic delusions may detect foul odors coming from their own bodies, and they won’t be dissuaded by others who insist everything is fine.

People with somatic delusions may spend months or even years going from physician to physician, from specialist to specialist, searching for confirmation of the reality of their conditions—confirmation that never comes.

What they really need is an accurate diagnosis that identifies the mental health disorder responsible for their delusions, but it can take a long time for loved ones to convince them that their problems may be psychological rather than physical.

When someone is diagnosed with somatic symptom disorder, it means two things:

1. Delusions are the primary—and likely the only—symptom that indicates a mental health problem has developed.
2. Physicians could find no underlying physical or mental health condition that better explains the delusions.

Besides their absolute conviction that something is medically wrong with them, men and women with somatic symptom disorder will usually appear normal. They may seem reasonable and rational when conversing about other topics, be involved in happy relationships, have healthy living habits, be productive in the workplace, and function successfully as parents.

But despite their seeming normality, their delusions will remain firmly rooted and impervious to logic. Neither loved ones nor medical professionals will be able to convince them they are well, and as time passes their somatic delusions may expand to include additional bizarre elements (i.e., that aliens are responsible for their illness, or that their internal organs have stopped working entirely or have gone missing, which somehow has not proven fatal).

While it is not frequently diagnosed, estimates are that up to seven percent of the population might have some form of somatic symptom disorder. Other research indicates that 20-25 percent of medical patients who report somatic symptoms will eventually develop a chronic somatic disorder, and it is these individuals who could benefit from intensive mental health treatment.

Delusions are a central determinant in the diagnosis of psychotic disorders, and they can be experienced as psychotic manifestations of other mental and behavioral health conditions as well.

The lists of disorders or medical conditions capable of producing somatic symptoms includes:

• Schizophrenia (delusions are a core symptom)
• Schizoaffective disorder
• Schizophreniform disorder
• Shared psychotic disorder
• Brief psychotic disorder
• Substance-induced psychotic disorder
• Bipolar disorder (usually during manic states)
• Major depression with psychotic features
• Dementia

With these conditions, delusions are just one of what could be an extensive menu of harrowing or debilitating symptoms. If treatment is provided, it will not focus exclusively on the delusions (as is often the case when a delusional disorder has been diagnosed) but will instead address any and all symptoms that interfere with daily functioning.

Somatic delusions are frightening, unpleasant, and highly stressful. They are also frustrating for loved ones, whose powers of persuasion repeatedly fail them.

Fortunately, mental health professionals know how to get through to people who have been ensnared by somatic delusions.

Long-term therapy that begins in a formal treatment program and extends into aftercare is the most efficacious antidote for somatic symptom disorder and for most other conditions that might cause this type of perceptual illusion. Medication in the form of atypical antipsychotics, such as Zyprexa, Risperdal, and Clorazil, can be also be helpful when a psychotic or delusional disorder has been diagnosed.

Regardless of the cause, somatic delusions are treatable, and with time and patience their pernicious influence can be banished for good.