Signs of Delusional Disorder: Abnormal Behavior in Young Adults

Q: Signs of Delusional Disorder: Abnormal Behavior in Young Adults

Hello： Your uncle's condition seems to have significantly impacted his normal daily functioning, and he indeed needs treatment. <br>The challenge is how to get him into the healthcare system. <br>1. <br>Persuading him to seek medical attention may be difficult, especially since h

A 23-year-old family member, my younger brother, is exhibiting abnormal behavior and showing signs of delusions?

Hello, doctor! I apologize for the difficulty in describing the situation.
My husband's brother has been exhibiting some strange behaviors, and I suspect it might be a case of delusional disorder or something similar.
Their father mentioned taking him to see a doctor yesterday, but he is unwilling to go.
My brother-in-law has been studying philosophy at a university (extending from his fifth to sixth year) and has been living a seemingly normal life for the past few years.
He doesn't work and doesn't attend school very often, and I personally don't see any significant stress in his life.
Recently, he worked as a dishwasher at a restaurant he opened at home for six months, where he had issues with an important employee that everyone disliked.
He wanted to get rid of this employee but ultimately failed, which seemed to affect him.
He told his family he wanted to focus on studying and stopped working.
After that, he started to become idle and rarely went to school.
Occasionally, he would meet friends for coffee or study, but he has started acting strangely over the past month.
It seems he has been having arguments with friends or experiencing issues in his friendships.
During our conversations, he mentions (names of friends I often hear) that he went out with a girl and feels that one of his friends is backstabbing him or that he thinks another friend is useless and doesn't want to contact them anymore.
Recently, he even argued with some close friends and arranged to meet in a park to negotiate, unsure if he might get beaten up.
He mentioned blocking several friends and said he doesn't answer calls from those he considers useless.
He has also expressed that he thinks his brother is useless for not studying while serving in the military and only going out to drink and play mahjong during his time off.
When chatting with him, he often seems incoherent.
He also mentioned that he believes he is perfect and questioned why no girls like him, displaying a somewhat unfounded sense of superiority.
One day, I overheard him calling a friend, asking, "Did you say bad things about me to Yazu (a girl he has no connection with and doesn't like)?" When the friend denied it, he asked, "Then why doesn't she reply to my messages?" He then abruptly said, "Forget it, we don't need to contact each other anymore!" and blocked the friend.
He also called his brother to ask, "Did you tell my friend that I scored over 400 on the TOEIC?" and when his brother denied it, he hung up the phone (the brother has no contact with the friend's brother, so this is impossible).
One day, he came out of his room, feeling the house was messy, and started tidying up.
I felt he was being unreasonable, and when I sat on the couch with a displeased expression, he suddenly got angry and said, "Why are you sitting there? Can't you see I'm cleaning the house?" I replied, "XXX! I usually keep the house tidy! You just help take out the trash; what else have you done?" He said, "Okay, you're right," but he seemed to be looking for trouble.
This month, during summer vacation, he said he wanted to move back to Taoyuan because he didn't want to stay in Taipei, and that's when his strange behaviors officially began.
His father works for an airline and travels frequently, so he can't be home every day to take care of him (their mother passed away when the brothers were young).
Initially, their father thought the brother was acting strangely and wondered if he might be depressed, but later felt it didn't seem like that.
I'm really not sure how to clearly explain the whole situation; I'm currently very worried and confused.
To summarize: 1.
His father said he doesn't eat when he's home alone.
2.
He seems to have cut off all contact with his friends.
3.
He aimlessly wanders around the house in Taoyuan.
4.
Last week, my husband went back to Taoyuan to see him, and he was looking for something at home.
My husband asked, "What are you looking for?" and he replied, "I'm looking for the 'Xi Jinping' qipao that an uncle gave me when we visited his house???" My husband responded, "That thing doesn't exist; what are you talking about?" The brother then exploded in anger, saying, "You all keep moving my things!" 5.
He has blocked his brother's phone number.
6.
He has blocked me and his brother on Facebook.
7.
He mentioned that one of his friends is a lesbian and claimed that this friend was actually a boy when they were younger and had their genitalia removed to become who they are now (I've met this friend; she is just a girl who is a lesbian, not as he described, and they used to be very close, but for some reason, he cut off contact).
8.
He asked his brother (my husband) if he thinks there are surveillance cameras in the house, as he feels there are many cameras watching them.

Wenwen, 20~29 year old female. Ask Date: 2018/07/04

Dr. Huang Jiabin reply Psychiatry

Hello: Your uncle's condition seems to have significantly impacted his normal daily functioning, and he indeed needs treatment.
The challenge is how to get him into the healthcare system.
1.
Persuading him to seek medical attention may be difficult, especially since he lacks insight into his condition.
It may help to use certain phrases, such as addressing sleep issues (if he has similar concerns).
2.
Contact the local health department and request assistance from a public health nurse for an evaluation.
Depending on the situation, she may arrange for a physician to conduct a home visit or even initiate involuntary hospitalization, coordinating with emergency services to transport him to the nearest medical facility for treatment.

Reply Date: 2018/07/04

More Info

Delusional disorder is a serious mental health condition characterized by the presence of one or more delusions that persist for at least one month. These delusions are false beliefs that are firmly held despite evidence to the contrary and can significantly impact an individual's behavior and interactions with others. In the case of your brother-in-law, several signs and behaviors suggest he may be experiencing symptoms consistent with delusional disorder.

Firstly, the behaviors you've described indicate a potential break from reality. For instance, his belief that people are conspiring against him, such as thinking friends are speaking ill of him or that his brother is involved in some sort of betrayal, points to paranoid delusions. Additionally, his assertion that there are surveillance devices in the home is another common theme in delusional disorders, where individuals may feel they are being watched or persecuted.

Moreover, his sudden change in social behavior—such as cutting off friendships and expressing disdain for family members—can be indicative of a withdrawal that often accompanies delusional thinking. This isolation can further exacerbate his condition, as social support is crucial for mental health. The fact that he has stopped eating and is aimlessly wandering around suggests a decline in self-care, which is often seen in individuals experiencing severe psychological distress.

It's important to note that delusional disorder can manifest in various forms, including:
1. Persecutory Type: The individual believes they are being targeted or harassed.

2. Grandiose Type: The individual has an exaggerated sense of self-importance or belief in their own exceptional abilities.

3. Jealous Type: The individual believes that their partner is unfaithful.

4. Somatic Type: The individual believes they have a physical defect or medical condition.

5. Mixed Type: The individual has delusions that do not fit into the above categories.

In your brother-in-law's case, elements of both persecutory and grandiose delusions seem to be present. His belief in his own perfection and the idea that others are beneath him, coupled with the paranoia regarding his friends and family, suggests a complex interplay of delusional thinking.

Given the situation, it is crucial to approach this matter with sensitivity. Encouraging him to seek professional help is essential, but it may be challenging since individuals with delusional disorder often resist treatment, believing they do not need it. Here are some steps you might consider:
1. Open Communication: Try to have a calm and non-confrontational conversation with him. Express your concerns without judgment. Use "I" statements to convey how his behavior affects you and others, rather than making accusatory statements.

2. Involve Family: If possible, involve other family members who can express their concerns. A united front may help him feel less isolated and more willing to consider seeking help.

3. Professional Intervention: If he continues to refuse help, you may need to consider contacting a mental health professional for advice on how to proceed. They can provide guidance on interventions that may be necessary.

4. Emergency Situations: If at any point you feel he may be a danger to himself or others, do not hesitate to seek emergency assistance. Safety is the priority.

5. Educate Yourself: Understanding delusional disorder and its symptoms can help you communicate more effectively with him and provide the support he may need.

In conclusion, your brother-in-law's behavior raises significant concerns that warrant professional evaluation. Delusional disorder can be challenging to address, but with the right support and intervention, individuals can receive the help they need to manage their symptoms and improve their quality of life. Encourage him to seek help, and consider reaching out to mental health professionals for guidance on how best to support him during this difficult time.

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