Delusions are a common symptom of psychosis in bipolar disorder. The type of delusion may depend on the type of mood episode the person is currently experiencing.

Delusions are beliefs that aren’t based on reality. During a delusion, you might believe that you’re close friends with a famous musician you’ve never met or that you’re leading the country’s space program.

Having delusions can be a condition of its own, called delusional disorder. They also can occur during the manic or depressive episodes of bipolar disorder. Sometimes, delusions happen together with hallucinations.

Believing in things that aren’t true can distance you from the real world and leave you feeling distressed. The inability to let go of an untrue belief could affect your work, relationships, and other parts of your life. However, there are effective treatments available.

Types of delusions that may occur in bipolar disorder include:

Grandiose

People with grandiose delusions believe that they’re more powerful, rich, smart, or talented than they really are. They think that they have accomplished greater things than they have done. Sometimes, grandiose delusions involve religious beliefs.

Examples of delusions of grandeur include:

  • “I’ve discovered the cure for cancer.”
  • “I have millions of dollars in the bank.”
  • “I’m the new Pope.”

Paranoid or persecutory

Someone with paranoid or persecutory delusions thinks that other people are trying to hurt them despite having no proof that this is happening. They may feel so threatened that they repeatedly call the police seeking help.

People with persecutory delusions may have thoughts like:

  • “The government has planted a chip in my brain, and now they’re monitoring my every move.”
  • “The person in the car parked outside my home has been following me and is trying to kidnap me.”
  • “My co-worker puts poison in my coffee every morning. They want to kill me.”

Jealousy

A person with this type of delusion believes that their romantic partner is cheating on them. In reality, there’s no evidence that their partner is being unfaithful.

Delusions of jealousy may present as the following:

  • “I need to check my partner’s emails every day to see who they’ve been talking to.”
  • “My spouse was 5 minutes late tonight. They must be cheating on me.”
  • “I waited outside my partner’s office for 2 hours to see where they went and who they were with.”

Guilt

This is when someone believes they’re responsible for committing a crime or causing a terrible event, such as a natural disaster. Again, there’s no evidence that they were involved in the event.

Examples of delusions of guilt include:

  • “I gave my roommate a cup of tea, and she died of cancer. I’m responsible for her death, and I must be punished.”
  • “I wished for rain so that I wouldn’t have to go to work. The hurricane that blew through my city was my fault.”

Erotomanic

This type of delusion causes a person to believe that someone is in love with them who isn’t. Often, the object of their affection is someone famous.

People with erotomanic delusions may say or think things like:

  • “The anchor on the evening news is sending secret messages straight into my brain.”
  • “I’ve written hundreds of letters to J. Lo. I wait for her in her hotel lobby after every concert.”
  • “My congressman is in love with me. The restraining order he filed against me is proof of his love.”

Somatic

Someone with a somatic delusion believes that there’s something wrong with their body. For example, they believe that they have cancer or another disease when they’re actually healthy.

Somatic delusions may cause a person to say or think:

  • “Parasites have crawled into my skin and are laying their eggs inside my intestines.”
  • “The left side of my face looks different than the right side. I’m disfigured and ugly.”
  • “I’ve been to 20 different doctors, but none of them will admit that something is wrong with me.”

Mixed

A person with mixed delusions has two or more of the delusions listed above.

Delusion type and bipolar symptoms

Research suggests that certain types of delusions are more common depending on your current bipolar symptoms.

Doctors don’t know exactly why some people develop delusions. These false beliefs are a feature of episodes of psychosis in some people with bipolar disorder.

Genetics may be at least partly responsible for delusions. You’re more likely to have them if one or more of your family members do, too.

Delusions may involve brain chemicals called neurotransmitters, which send messages from one nerve cell to another. An imbalance in these chemicals can prevent the correct messages from getting through.

Other factors that may cause people with bipolar disorder to have delusions include substance use and childhood stress.

A doctor will evaluate your symptoms to figure out which treatment might work best for you. If a doctor determines that you’re a danger to yourself or others, you may need to stay in a hospital for some time.

Treatment for bipolar delusions often combines medication with talk therapy.

Talk therapy can help you identify and work through the thoughts that have become distorted. You can meet one-on-one with a therapist or together with your partner or other family members.

Antipsychotic drugs are the most common medications used to treat delusions. These drugs block the effects of the chemical dopamine in your brain. Dopamine is involved in triggering delusions.

When someone is having delusions, your instinct may be to reason with them or challenge the false belief. But the more you try to talk them out of it, the more difficult it will become to dissuade them.

Instead, try these strategies:

  • Listen calmly as your loved one talks about their concern.
  • Assure them that they’re safe and that you’ll help protect them from any harm.
  • Offer other possible reasons for what’s happening. For example, you might say, “I understand that you think the car parked outside your home is the CIA monitoring your movements. Why are they following you? Is it possible that the person who owns the car is simply visiting one of your neighbors?”
  • Try to distract the person or direct them to another activity.

If your friends and family often tell you that your beliefs are untrue, see a mental health professional. An exam can help pinpoint the reasons for your delusions. Your doctor will suggest treatments to help you manage false beliefs.

Delusions can be a symptom of both manic and depressive episodes in people with bipolar disorder. These false beliefs can be very distressing to anyone who experiences them.

If you’re concerned about delusions in yourself or a loved one, seek help from a primary care physician, psychologist, or psychiatrist. They can help you diagnose the condition and set up a treatment plan.