What are Delusions of Reference?

Delusions of reference are sometimes observed in people affected by erotomania, wherein the affected individual believes that a stranger, usually a highly influential or famous person, is in love with them. For instance, they might believe that the stranger is communicating his/her affection through media.

A delusion is an erroneous, misguided belief that the affected individual holds with a great deal of conviction. It must be noted that the belief is not associated with the religious or cultural beliefs of that individual, and has nothing to do with the level of intelligence of that person.

It is indicative of an abnormality in the content of thought, or might be a result of disordered thinking in the affected individual, as the person maintains this belief, despite the presence of contradictory evidence. His/her faith is unshakable, however implausible the belief may be.

A delusion of reference is a type of delusion wherein the individual perceives unrelated events or objects in his/her surroundings to be of significance for himself/herself. It can be differentiated from an idea of reference on the basis of the degree of conviction.

In case of the latter, the affected individual might understand that he/she might just be imagining things. In case of the former, the person is convinced that his/her belief is true. A person affected by delusions is unable to understand what is real and what is unreal. Delusions may or may not be bizarre.

For instance, being imprisoned by aliens is a bizarre delusion, whereas believing that one is being followed by cops isn't bizarre. Delusions are often observed in individuals affected by a medical, neurological, or mental disorder, and can have an adverse effect on the quality of life.

Delusions could be a symptom of certain neurological or mental disorders as:
✦ Schizophrenia
✦ Schizoaffective disorder
✦ Delusional disorder
✦ Schizophreniform disorder
✦ Shared psychotic disorder
✦ Brief psychotic disorder
✦ Substance-induced psychotic disorder
✦ Bipolar disorder
✦ Major depressive disorder with psychotic features
✦ Delirium
✦ Dementia

Schizophrenia is a psychotic mental illness that is characterized by an altered perception of reality. The affected individual loses touch with reality, and sees the world differently. He/she might hallucinate, which means that he/she sees or hears things that don't really exist. He/she might become delusional or develop certain misguided beliefs.

For instance, the patient might believe that he/she is being watched, or his thoughts are being read out aloud by someone. Paranoid delusions can have adverse effect on the person's ability to lead a normal life. Mostly, people affected by delusions behave in irrational ways due to fear and suspicion, and might become averse to maintain contact with others.

Here are some examples of delusions of reference:

✦ An affected individual might believe that secret messages about him are being broadcast on a television show.

✦ A delusional person who considers himself to be a spy might record and watch TV programs, as he believes that cues or secret messages have been left for him on the shows.

✦ A delusional patient might believe that messages on billboards hold meaning, and are aimed directly at him/her.

✦ A delusional patient might believe that each time a dog barks, one day gets reduced from his/her life.

✦ A person affected by schizophrenia or any condition that is characterized by delusions might believe that a song playing on the radio is meant for them.

✦ An affected person might believe that all the people walking on a crowded street are talking about him/her.

✦ On seeing a group of people laughing, a delusional individual might think that they are mocking him/her.

✦ Such individuals might find the gestures, dressing style, etc., of a TV anchorperson to be of significance to them.

✦ They might believe that electronic devices are sending secret messages that are only meant for them.

The main difference between ideas of reference and delusions of reference is that in case of the former, in the presence of contradictory evidence, the subject is able to realize that what he feels is a figment of his imagination. On the other hand, a delusional subject will continue to believe that the irrelevant occurrences are personally significant.

Since delusions of reference are observed in individuals affected by psychotic or mental disorders such as schizophrenia, it is extremely essential to identify and treat the underlying cause.

As per the DSM-V, to be diagnosed with schizophrenia, just one of the five symptoms of psychotic disorders listed in Criterion A (delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms) is required. 

Besides these two symptoms, at least one symptom must be one of the first three (delusions, hallucinations, disorganized speech) symptoms. Therefore, psychiatric evaluation is done, keeping this requirement in mind. The psychiatrist analyzes the patient's symptoms, psychiatric history, and family history of mental health problems.

Also, a physical examination is conducted for other underlying medical conditions. Besides routine tests, imaging studies are done to analyze the brain's structure, and look for abnormalities linked with psychotic disorders. Psychotherapy coupled with the use of antipsychotic medication has been known to be beneficial in the treatment of delusions.

Besides delusion of reference, other types, responsible for distorted sense of reality are:

• persecutory delusions (believing one is under surveillance or being followed)
• grandiose delusions (believing one is famous, influential, or has extraordinary powers)
• delusion of control (belief that others are controlling one's thoughts, feelings, impulses, behavior)

• nihilistic delusion (belief in the non-existence of self, parts of self, others)
• delusion of infidelity (false belief that one's spouse/lover is having an affair)
• delusion of guilt (belief that one has committed a crime or is responsible for a disaster)

• somatic delusion (belief that one's body is diseased, abnormal, or changing)
• delusion that one's mind is being read, thoughts are being heard aloud, or thoughts are being inserted or removed

Such delusions can adversely affect the patient's ability to lead a normal life. Therefore, medical assistance must be sought at the earliest for treating delusions.

Disclaimer: The information provided here is solely for educating the reader. It is not intended to be a substitute for the advice of a mental health professional.