Delusions of reference: what do they consist of?

Psychotic disorders are alterations that modify how we perceive objective reality. When talking about psychosis, we usually think of schizophrenia, but there are many more disorders within this classification. In this sense, Reference delusions are one of the most common symptoms in psychotic conditions.

Although they are often considered a sign of schizophrenia, this is not the only clinical context in which they can appear. In this article, we will further explain the characteristics of these delusions, their possible causes and treatment.

What are delusions of reference?

We all have different belief systems that act as a filter that processes reality. It’s like we see the world through the lens of a camera to get an idea of ​​how it works. Our belief system is not entirely objective, there are factors such as cognitive distortions that influence perception.

Despite this, how we process information is still based on objective reality. Now, when we talk about delusions, we are referring to a series of beliefs that alter perception in a pathological way. Delusions are not based on reality, therefore, they are not shared within the patient’s culture and social group. For example, jealous delusion generates the perception that the partner is unfaithful when there is no evidence of this.

In the case of reference delusions, the focus is the person themselves. The patient believes that external situations, such as the behavior of others, are related to him in some way -Hence it is also known as self-referential delirium. You might think that people are sending you “hidden” messages through body language or even say that an ad on television was made to tell you something.

Referential delusion often appears as a symptom of schizophrenia or other psychotic disorders. But it can also be part of other non-psychotic conditions, and can become a clinical condition in itself. In this situation we are faced with a possible delusional disorder, where other delusions could also appear.

Causes

As with the rest of the psychological disorders, there is no clear or single cause to explain them. Instead, various factors are pointed out that could influence the appearance and maintenance of the symptom. One of these is dysfunction in certain brain regions that modulate self-reference.

A study by Menom et al. (2011) points out that the structures of the cortical midline, subcortical regions, the amygdala and the striatum participate in this. The authors’ work found that in baseline delusions there is increased activation in these brain areas. Furthermore, there is no differentiation in the activity when information that involves the person and contrary information is received.

In other words, These people’s brains have trouble differentiating when something is directed at them and when it isn’t. From there comes their tendency to interpret that certain behaviors of others or everyday situations are related to them. Even when there is evidence to the contrary, they will maintain their conviction as with the rest of the delusions.

Now, we do not know precisely what causes this neurological dysfunction. Different studies suggest that relatives of patients who have suffered psychotic disorders are more likely to develop them. Therefore, it could be hypothesized about genetic factors that are related to neuropsychological problems.

On the other hand, Exposure to stress may increase risk of psychotic symptoms. A work by Turley et al. (2019) found that there is a positive correlation between stress and psychotic experiences.

Intervention in reference delusions

With respect to intervention in baseline delusions, a multidimensional approach is usually chosen to obtain better results. On one side, antipsychotics can be prescribed that help reduce the frequency with which delirium occurs.

In addition, Psychotherapy serves to provide the patient with the necessary psychoeducation about their symptoms and how they affect them. Also, the psychologist or psychotherapist can work with the patient on adherence to pharmacological treatment and use techniques to manage delirium.

In this same sense, it is important to intervene in the patient’s social context. Family members and loved ones need to receive information about the difficulties they present. Likewise, they can be trained with different strategies to deal with episodes in the healthiest way possible.

This triple intervention improves the prognosis for people suffering from psychotic disorders. Over time, it is likely that they will be able to integrate back into their activities such as work or studies. In addition, the risk of experiencing symptom relapse is also reduced.

To end, It is important to highlight that delusions of reference are not the same as delusional ideas.. Although they can become a delirium, they are not delirium in themselves, since it is possible to modify them. Unlike delirium, where the conviction is maintained even though there is no evidence.

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