Is It Reasonable to Consider Delusions as Mainly a Thought Disorder?

Abstract

This review reflects on the question whether delusions are predominantly a thought disorder, characterized by defective cognitive processes. As background, a general model describing the aetiology of delusions is presented. Research in the positivist epistemology, especially the cognitive approach, focuses on defects in reasoning processes, but increasingly recognizes the relevance of emotions, and attempts to integrate them into explanatory models. First person accounts point to the high level of emotionality in delusional experiences. It will be argued that emotions exert an influence in multiple and pervasive ways. Theory and evidence regarding direct reflection of emotions in delusional content and for delusions as defence against unwanted feelings is considered. Research in the interactionist tradition suggests that delusions can develop in response to severe affective disturbances, for example through traumatising experiences, and that adverse social factors contribute to development and maintenance of delusions via their impact on feelings about self and others. A social account of delusions explains delusions as a relational problem, characterized by disturbed affective relations to others. Considering the pervasive presence of emotions in the development and maintenance of delusions, this leads to the conclusion that it would be too narrow to understand delusions as a purely cognitive disorder.

Keywords: delusions