Delusions of reference: what they are, how they affect us and disorders that cause them.

Delusions of reference are among the symptoms of schizophrenia and other mental disorders.

Psychotic disorders are mental problems that alter how we perceive reality. Schizophrenia and other such disorders can manifest delusions, symptoms that are very common in psychotic conditions.

Delusions of reference are a type of psychotic manifestation, although they can occur in other more common disorders.Although they can occur in other disorders beyond the schizophrenia spectrum, delusions of reference are a type of psychotic manifestation. Patients who suffer from it believe that what happens in the world goes with them, that what others say and do is related to them.

In this article we are going to deepen on the delirium of reference, what are its characteristics, possible causes and treatment.

What are delusions of reference?

No one perceives reality as it is. We all have belief systems that make us interpret the world through a filter that distorts it. Our belief systems prevent us from being completely objective, making us victims of multiple distortions and cognitive biases that explain the world as it is.Our belief systems prevent us from being completely objective, making us victims of multiple distortions and cognitive biases that explain why two people are able to see different things from the same stimulus. This is not pathological, but part of the human condition.

However, there are limits. In spite of interpreting the world through a personal lens that changes everything, it is normal that it does not stray too far from reality itself. The opposite is the case of having a delusional perception of things. When we speak of delusions we refer to a series of beliefs that alter perception in a pathological way. As they are not based on reality, delusions are not shared within the patient's culture and social group.which makes it stand out, and not for the better.

In the delirium of reference or self-referential delirium, the focus is the patient himself. The person who manifests this distortion of reality believes that external situations, such as the behavior of others, are related to the patient's own reality. believes that external situations, such as the behavior of others, are related to him/her.. He may even think that people send him hidden messages through body language, that people whisper in his presence. There are cases of people who think that billboards, television commercials or newspaper news are meant to send them a message.

Generally delusions are a symptom of mental disorders belonging to the schizophrenia spectrum, although they can also occur in other disorders.although they can also occur in other disorders with or without psychotic symptomatology. In the case of the delirium of reference, this can aggravate and become a disorder in itself, the delusional disorder.

Manifestations of delirium of reference

The delirium of reference shares with the rest of delusions the following manifestations:

• Hallucinations of delusional content
• Affective state in consonance with the delirious theme.
• Absence of judgment of psychological problem
• Several vital areas affected depending on the content of the delirium.

Although delusions are considered pathological, they may occur as an isolated symptom.. That is to say, they do not necessarily have to be accompanied by a mental disorder in its extension, so there may be absence of other psychotic symptoms or deterioration in the psychosocial activity of the individual. However, if aggravated, a serious disorder such as schizophrenia or other psychotic disorders could develop.

In the specific case of delirium of reference, the manifestation that would differentiate it from the rest is, as we have mentioned, the delusional idea that everything that happens in the subject's life has to do with him or her. That is to say, the delusional theme of this problem is the erroneous personal attribution to the person himself, that everything that happens has to do with him or her.

Like other types of delusions, if it is not detected early and treated early, its course is chronic.. It starts with the suspicion that everything that happens around him or her has to do with him or her and, as time goes by, a delirium is formed with ideas such as that they are trying to communicate with the patient through television, radio or even products from the supermarket.

The delirium of reference is not very prevalent. Data suggest that it is found in between 0.03 and 1% of the population, being more common in women than in men. As it happens with the other delusions, and being this a useful feature in the differential diagnosis with other disorders of the psychotic spectrum, its appearance is late. It usually appears after the age of 40 years.

Causes of this delirium

No clear cause is known to explain the appearance of delusions of reference. As with all other delusions, and also mental disorders in general, it is assumed that must be the result of the interaction between hereditary aspects and environment in equal parts..

However, the fact that the exact cause is not known does not mean that there are no known risk factors for manifesting this delirium. Among such factors are considered to be the use of drugs and psychoactive substances, history of delusional episodes and family history of mental disorders.especially if they are psychotic disorders or contain psychotic symptoms, such as the following:

• Schizophrenia
• Schizophreniform disorder
• Schizoaffective disorder
• Delusional disorder
• Brief psychotic disorder
• Shared psychotic disorder (Folie à deux)
• Psychotic disorder due to medical illness
• Psychotic disorder due to substance intoxication
• Bipolar disorder
• Unipolar depression
• Dementia

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An investigation into this psychological phenomenon

A study that draws attention regarding this delirium is the one conducted by the group of Mahesh Menon and colleagues in 2011. Their research concluded that cortical midline structures, subcortical regions, the amygdala and the striatum are involved in the occurrence of self-reference delirium. In their work it was found that people presenting such delirium show increased activation in these brain areas.

In addition, these same authors found that patients with baseline delirium did not show a differential activation pattern when they received information about them and did not show a differential activation pattern when they received information about them and information to the contrary.. That is, their brains had trouble differentiating between information that was directed to these patients and information that was not. This has served as a neurological explanation for the tendency of patients with this delirium to interpret the behaviors of others or everyday situations as something that goes with them.

Treatment

When the delirium of reference is a symptom of another disorder or caused by a medical illness, the treatment is oriented in intervening on the pathology that has provoked it.. That is, if, for example, the patient presents delusions associated with schizophrenia, the main treatment will be focused on treating that disorder.

The main therapeutic route is the pharmacological onespecifically using antipsychotics. In addition, psychological therapy is also used, with cognitive-behavioral treatments being the most effective for the therapeutic approach to delusions and other psychotic symptoms.

In the specific case of the delirium of reference, tools such as cognitive restructuring and confrontation are used, with the aim of increasing the patient's rational judgment of himself and also trying to dismantle the beliefs that have been the basis of his particular delusional idea.