How can I tell if I’m delusional?

Mental health terms are often misused in casual conversation, and “delusional” is no exception. Typically, it’s used as an insult to describe someone who is acting unusual or has unrealistic expectations. 

This mischaracterization even made its way to TikTok when “delulu” started trending as short-hand for delusional. The slang term is sometimes spun in a positive direction—as in you’ve got to be delusional to get through the day or that deluding yourself is the answer to living a life stress-free.

But the clinical definition of being delusional, or having delusions, is connected to a number of legitimate mental health concerns. If you’re worried that you are experiencing real delusions, read on to get a better understanding of the term’s actual meaning. In this article, we’ll look at mental health conditions connected to delusions, as well as how to find help if you think you’re experiencing them.

What does it mean to actually be delusional?

Since we use “delusional” so casually in everyday speech, it has lost a lot of its actual meaning in the collective lexicon. The American Psychological Association (APA) officially defines delusion as “an often highly personal idea or belief system, not endorsed by one’s culture or subculture, that is maintained with conviction in spite of irrationality or evidence to the contrary.” 

Boiled down into simpler terms, “Delusions are untrue beliefs that are not supported by evidence,” says Melanie Dideriksen, LPC, CAADC. These beliefs can also be described as irrational. In other words, delusions are not based on what is happening in reality. 

Types of delusions

Many different types of delusions exist and they can be centered on various themes. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official reference guide the APA uses for classifying mental health conditions, lists nine distinct common delusions:

• Jealous delusions involve the belief that a person’s romantic partner is cheating on them, despite any evidence.
• Erotomanic delusions is where someone believes another person, such as a celebrity, is in love with them.
• Grandiose delusions are when a person’s sense of importance is elevated. Someone with grandiose delusions may believe they are much more wealthy or famous than they actually are, or that they have some type of special power.
• Persecutory delusions revolve around themes of being conspired against. Someone with persecutory delusions may feel like they’re being surveilled or that someone is out to get them. 
• Somatic delusions are when people have false beliefs about their bodily functions and sensations. 
• Bizarre delusions involve subjects outside of the realm of normal life and are often impossible. 
• Thought broadcasting is when a person believes that other people can read their thoughts.
• Thought insertion is when a person thinks other people (or entities) are infiltrating their mind.

What conditions cause delusions?

Delusions can be present in a variety of conditions that involve psychosis. Psychosis is a mental state where a person experiences disruptions to their thoughts, which can impact how they perceive the world around them. A person with psychosis may have delusions and/or hallucinations that make it difficult to distinguish what is real from what’s not. 

Here’s some instances when delusions may be present:

Mental health conditions

• Schizophrenia is a psychotic disorder that affects how a person thinks, feels, and behaves. It’s characterized by a combination of delusions, hallucinations, and disorganized speech. 
• Delusional disorder is a psychotic condition marked by experiencing one or more delusions that last for at least a month. While this may sound like schizophrenia, it’s actually a distinct diagnosis because hallucinations and cognitive symptoms are not present.
• Psychotic depression is a severe form of depression where a person experiences psychosis and loses touch with reality. 
• Bipolar disorder is a mental health condition characterized by intense mood swings. About half of people with bipolar disorder develop psychotic symptoms, which include delusions or hallucinations.

Medical conditions

• Brain tumors and infection can cause a range of psychiatric symptoms, including delusions, hallucinations, mania, and paranoia.
• Delusions may appear in the latter stages of dementia. For example, those living with Alzheimer’s disease may believe that people—including loved ones—are plotting against them or stealing from them.
• Delusional disorder may be a rare consequence of a stroke. One study found that about 5% of those who have a stroke also experienced delusions.

Even if there’s not a diagnosable health issue, environmental and psychological factors like stress, social isolation, and prior trauma can lead to delusions. It’s also important to know that drug and alcohol use can sometimes trigger substance-induced psychosis, which may include delusions.

Things that might seem like delusions but aren’t

What sets apart clear delusions in a condition like schizophrenia from other symptoms that you might interpret as delusions is the lack of insight, says Dideriksen. “People experiencing true delusions don’t think that the beliefs they have could be delusional,” she says.

If you have a disorder that features delusions, you truly believe them. You do not question delusions or poke fun at yourself for being “so delusional.” If you have enough self-awareness to know that what you’re saying to yourself or others isn’t actually true, then it’s not a delusion. 

And yet, it can be distressing to experience thoughts and beliefs that feel real or bothersome, even when you know they’re not. Plus, they too can pose problems for your mental health. Let’s take a deeper look at some issues and experiences that might be misidentified as delusions.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a chronic mental health disorder involving the existence of two types of symptoms: obsessions and compulsions. Obsessions are defined as unwanted thoughts, images, feelings, sensations, and urges that cause distress. Compulsions are the physical and/or mental repetitive behaviors done to neutralize the distress of obsessions or prevent a feared thing from happening. 

Among the many subtypes of OCD is one that’s focused on fears about having schizophrenia—and it’s surprisingly common among people with OCD. How do you know if you might have it? You have intrusive thoughts that you may actually be psychotic or have a distinct fear of developing schizophrenia. To decrease the anxiety that results from these distressing thoughts, you may perform compulsions, such as:

• Seeking reassurance from others that you’re not “losing your mind.”
• Excessively researching the symptoms of schizophrenia.
• Mentally reviewing your thoughts or actions to see if they are indications that you have schizophrenia. 

Let’s say you have persistent intrusive thoughts that you’re being controlled by the government. These are thoughts that can be present in both schizophrenia and OCD. However, says Dideriksen, if you have OCD, your thought process would go like this: “I know that this is one sign of schizophrenia because I saw that documentary, read that book, or know someone who has it. I’m really worried that I have schizophrenia, too, or that I’m developing it.” 

That right there is the sign that your anxieties are based in OCD—you know you have this fear. And many subtypes of OCD feature similar themes as delusions, yet are not actual delusions. “For someone who has OCD and is concerned that they are delusional, they still know that it’s not really true—but they still worry about what if it is actually happening to them,” says Dideriksen. Despite the extreme fear that they may have or be developing psychosis, there is still a level of awareness that they are not delusional. 

On the other hand, someone who is experiencing psychosis lacks this insight. They would simply believe that the government is controlling them, and feel fear or other emotions in response to this belief. “I’ll say this: people who are delusional don’t ask me if they’re delusional, but people who have OCD do ask me if they’re delusional,” says Dr. Patrick McGrath, Chief Clinical Officer at NOCD.

It’s also important to point out that a phenomenon called depersonalization, or its close cousin derealization, can present in OCD. With depersonalization, you feel as if you’re outside of your own body or disconnected from reality. This can occur with another subtype of OCD called existential OCD, where your fears are centered around your existence and identity. That may include obsessions like:

• “What if I’m not really here? How would I know?”
• “What if it’s all a simulation? Would I be able to tell?”
• “If everything around me isn’t real, then is there a point to anything?”

This is not the same as a delusion, but it can certainly feel that way. Especially since existential OCD may lead you to believe you need to figure out an answer to these philosophical questions ASAP, otherwise something bad could happen. Trouble dealing with uncertainty is a distinguishing factor of OCD and these unanswerable questions can lead to compulsions like:

• Endless rumination over what’s real and what’s not.
• Constant reality-testing, where someone performs actions to see if they’re experiencing the real world. For instance, people who are worried that they’re in a dream might count their fingers as a way to test if they’re awake.
• Avoidance of places, situations, people, and media that trigger these types of thoughts.

Intentional self-deception

As mentioned earlier, the “delulu” slang phrase has taken on a different meaning from the actual definition of delusion. When it comes to mental concerns, people sometimes think there’s elements of conditions we can manipulate to our advantage if we so desire, according to Dr. McGrath. That may sound like: ‘I must act delusional about my worth to become famous, it’ll make others perceive me as a star.’ 

For those who actually experience real delusions, these kinds of comments can come off as flippant. “You don’t see people with delusions saying those things,” Dr. McGrath says. “It’s like when people say ‘boy, if I had OCD, I’d always have a clean house. It would be great.’” 

Despite “delulu” not being a legitimate mental health term, it’s still important to acknowledge when you’re intentionally being dishonest with yourself or ignoring reality. For example, maybe you are purposely ignoring the reality of a relationship that’s detrimental to your mental health, pursuing crushes that aren’t being reciprocated, or spending money you don’t have. While this is not the definition of a break from reality, it is still something that can greatly impact your life. 

Do I need to get help for delusions?

If you have a mental health condition that’s causing a break from reality, you absolutely need to seek help. Delusions can cause harm to yourself or others, affect your relationships, lead to legal issues, or contribute to depression.

On the other hand, if you’re intentionally engaging in negative patterns, consider seeking out a therapist who can help reframe your thinking and change your behaviors to those that better serve you. Everyone deserves qualified help for their mental health struggles, whether they fit into certain diagnostic groups or not.

But what if you’re on the fence, wondering if your thoughts, beliefs, or actions could be considered delusional or out of touch with reality? If you find yourself highly anxious about the possibility that you could be delusional, this may be a sign of a condition like OCD. Fortunately, OCD has been shown to be highly treatable.

What kind of treatment will help me?

Treatment can be dramatically different depending on the underlying mental health condition. It’s critical to be properly diagnosed because receiving the wrong care could potentially be harmful. “If someone fears that their thinking is becoming delusional and they have insight into their symptoms, we might have them face that head on through exposure to their fears,” says Dideriksen. “If you have actual delusions because you have psychosis, we would not encourage doing that at all.”

For instance, schizophrenia is treated with antipsychotic medication, psychotherapy, and psychosocial treatments where you work with a professional to address any barriers and learn to live successfully.

That is quite different from how fears about psychosis or schizophrenia in OCD would be treated. Exposure and response prevention therapy (ERP) is the optimal method for reducing OCD symptoms compared to other types of psychotherapy. During ERP, you work with your therapist to intentionally trigger obsessions that increase your discomfort. You’re then encouraged to sit with that anxiety and purposefully not perform any compulsions. 

Here are some exposure exercises Dideriksen might use to treat fears about being delusional:

• Read articles about someone who has schizophrenia.
• Watch videos of people with schizophrenia talking about their beliefs, thoughts, and overall experience with the condition. Dideriksen says it’s “highly distressing” for those with an OCD fear about being schizophrenic to even watch someone be interviewed about their delusions.
• Watching videos that feature pretty “trippy” visuals that make you feel disoriented. While watching them, you might tell yourself: “I may or may not lose control and start to believe things that aren’t real.”
• Saying to yourself: “I’m not always rational. Sometimes, people might even think I’m being delusional!”

Keep in mind that the exposures will be geared toward what’s best for you depending on your individual fears. No matter what type of stimulus you use to trigger your obsession, you will be asked to sit with that feeling of not knowing what will happen, which is a reality that all people have to accept and live with. Over time, ERP teaches you how to handle any triggers and accept uncertainty, which reduces the control that OCD has over your life.

Bottom line

 If you think that your worries about being delusional could be related to a mental health concern, please know that there’s help out there. It can be scary to lean into your fears and uncertainties, but having a qualified counselor by your side is a time-tested way to become more comfortable with your thoughts.