Delusions of guilt: what it is, characteristics, causes and treatment

The delusion of guilt shows the characteristics of other delusions, but presenting as its central theme the unrealistic belief that we are the one to blame for a negative event.

This type of delirium is usually associated with depression, but the treatment used will depend on the main condition causing this problem.

In this article you will know better what is meant by delirium and specifically by delusion of guilt, what are its main symptoms, the causes that generate it and how to treat it.

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What is a delusion?

Delusions are considered a psychological alteration associated with mental disorders that affect the content of thought; are defined as false judgments that are maintained by the subject with full conviction even when evidence and experiences incompatible with that idea are presented. Thus, it is a symptom of the psychotic pathology although it can occur in patients with other disorders than those typically psychotic: for example, in the Bipolar disorder, depressive disorders, delirium or dementias.

They are unmodified and incorrigible beliefs, that is, they remain stable over time. They show themselves with great conviction and intensity: the subject is fully convinced that they reflect reality and there is nothing that can make him change his mind; his thinking is not supported by his culture, and his environment does not have this same belief.

Similarly, the delusional idea generates great concern in the subject; much of his day, if not all, revolves around this belief. On some occasions, especially in patients with schizophrenia, the delusional idea is implausible, which means that it makes no sense and cannot occur in reality; for example he may believe that he has lost his internal organs and that he is empty inside.

Delusions are usually personal in nature, and given the patient's full belief in these ideas, does nothing to avoid them or fight for them to disappear.

Delusions are a psychotic symptom; by themselves they do not involve a disorder, it is necessary to meet other criteria such as the presence of other symptoms or a minimum duration of the affectation.

On the other hand, it is important to differentiate it from the other characteristic psychotic symptom: hallucinations. These are considered an alteration of perception, and in them the five senses are affected, that is, That is, the subject can see, hear, smell, feel, touch, or taste a stimulus that is not really exists.

Now that we know what a delusional idea is and what its main characteristics are, we will focus on the delusion of guilt.

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What is delusions of guilt?

In the delirium of guilt we observe a full conviction of the idea that one is guilty of something and that his current negative state is his fault. This type of delusion is shown mainly in subjects with major depressive disorder, who apart from have symptoms typical of a depressive state also have psychotic symptoms, in this case an idea delirious.

It will be important that we make sure that the idea of ​​guilt is presented intensely, persistently and with high conviction; These characteristics must be shown to be able to differentiate from simple guilt for an event that has happened and of which we believe we could have done more.

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Main symptoms

The symptoms presented by patients with this type of delirium are those of delusional ideas but focused on the issue of being guilty and responsible for an act. The subject may have hallucinations linked to the delusion, that is, they are consistent with the theme of the delusion; but normally in subjects with depression and delusions of guilt, other psychotic symptoms are not usually observed. The state of mind is consistent with delirium, for this reason it is common for it to appear in depressive individuals.

Too we observe anosognosia, term that refers that the patient is not aware of having any pathology, he perceives it as something real. The affectation that the individual shows will depend on what other symptoms they have; for example, schizophrenia disorder is more disturbed than delusional disorder. However, in the delusion of guilt, a special affectation of the psychosocial sphere is not perceived.

The least affected cases imply that only the environment linked to the topic of the delusional idea will be affected, the patient being able to remain functional in other contexts. Likewise, if the delirium is not intervened, it tends to become chronic, integrating itself more and more into the subject's life. Despite treating it, the subject persists in a greater vulnerability to develop it again in the face of a stimulus that triggers it.

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Causes

There are different causes that can lead to the appearance of a delusion of guilt; As in most disorders, some of these triggers are due to biological or genetic factors, such as a viral infection or neurodevelopmental problems, and another part is influenced by environmental causes, learned, such as the environment of upbringing, or the family.

Factors associated with the onset of delusions are thought to include: brain dysfunction, personality type (depending on the personality there is a greater predisposition to present a delusion and also influences its theme), the maintenance of self-esteem (this factor is usually present in self-referential delusions), and affect (the guilt delusion is shown mainly in the depression; therefore, affect will have great influence in this case).

Other factors related to the appearance of delusions are unusual experiences (before experiences that the subject has and cannot explain it is believed that the tendency to use delusions to give them sense) cognitive overload (such as excessive activation) or hypervigilance (linked to a change in brain function that could lead to the formation of delusions).

In addition, interpersonal variables influence the manifestation of delusions (a deficit in social skills is observed that would lead to difficulties in social interactions), social isolation (as a consequence the subject would not have social validation of his beliefs), and situational variables (such as sensory isolation or lack of stimulation).

The inertia to maintain the belief is observed in all subjects, not only in those who have developed a pathology; if the idea is accepted by the patient and he believes it to be true, it will be difficult for him to abandon or change it. Another relevant phenomenon is self-fulfilling prophecy: the delusional idea influences and affects behavior causing the environment to end up acting confirming the delusion.

Biases in attributions are also important: As strange perceptions or experiences continue to occur, they verify the delusion.

Treatment

When we start the treatment of delirium, it will be necessary to assess what is the main affectation that the delirium has. patient, that is, it is observed if apart from delirium there is a mental disorder, such as the aforementioned disorder depressant. If so, psychotherapy professionals focus on intervening in the primary problem using treatment techniques specific to that pathology.

However, to reduce delusions the treatments that have been proposed are very similar to those used with schizophrenia. When we face the delusional idea, it is important to do it progressively to gain the patient's trust. In most cases, the subject does not attend therapy voluntarily but referred by a doctor or by family recommendation.

The use of psychoactive drugs is also useful, especially when the patient is agitated or upset, in the acute phase. Psychological intervention, as we have said, is similar to that used for the treatment of schizophrenia, with cognitive-behavioral therapy being the most used to deal with delusions.

One of the most proven interventions is Chadwick, Birchwood and Trower's cognitive therapy based on cognitive restructuring. The two main techniques are the verbal challenge, which presents the final intention of questioning the delusional beliefs, and reality testing that is based on empirical verification of the belief delirious.