Reference delusion: what it is, how it affects us and the disorders that cause it

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

Reference delusions are a type of psychotic manifestation, although they can occur in other disorders beyond the spectrum of schizophrenia. Patients who suffer from it believe that what happens in the world accompanies them, that what others say and do has something to do with it.

In this article, we will delve into reference delusion, 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 distorting filter. Our belief systems prevent us from being totally objective, making us victims of multiple cognitive distortions and biases that explain why two people are able to see different things from the same stimulus. It’s not pathological, but it’s part of the human condition.

    However, there are some limitations. Despite an interpretation of the world from a personal angle that changes everything, the most normal thing is that it does not stray too far from reality itself. The opposite is true of having a delusional perception of things. When we speak of delusions, we are referring to a series of beliefs that modify perception in a pathological way. Because they are not based in reality, delusions are not shared within the patient’s culture and social group, which makes him stand out, and not for good.

    In referential or self-referential delirium, the focus is on the patient himself. The person who manifests this distortion of reality he believes that external situations, such as the behavior of others, are related to him. You may come to think that people are sending you hidden messages through body language, that people are whispering in front of you. There are instances where people think billboards, TV ads, or newspapers are meant to send you a message.

    In fgeneral delusions are a symptom of mental disorders on the schizophrenia spectrum, although they can also occur in other disorders with or without psychotic symptoms. In the case of reference delirium, it can worsen and become a full-fledged disorder, delusional disorder.

      Manifestations of delusional reference

      Reference delirium shares with the rest of the delusions the following manifestations:

      • Hallucinations of delusional content
      • Affective state according to the delusional theme
      • Absence of judgment of psychological problem
      • Different vital areas affected depending on the content of the delirium

      Although delusions are considered pathological, they can be presented as an isolated symptom. That is, they do not necessarily have to be accompanied by a mental disorder in their extent, so there may be no other psychotic symptoms or impairment of the individual’s psychosocial activity. However, if aggravated, they could end up with a serious disorder like schizophrenia or other psychotics.

      In the particular case of delusion of reference, the manifestation that would differentiate it from the rest is, as we have seen, the delusional idea that everything that happens in the subject’s life is linked to it. That is, the delusional theme of this problem is the mistaken personal attribution to the person himself, that everything that happens goes with him.

      Like other types of delusions, in the event of non-early detection and early treatment, its evolution is chronic. It starts with the suspicion that everything around him has to do with him, and over time it becomes an illusion with ideas such as they try to communicate with the patient via television, radio or even products of supermarket.

      Reference delirium has little prevalence. The data indicate that it would be between 0.03 and 1% of the population, being more frequent in women than in men. As with other delusions, and this is a useful feature in the differential diagnosis with other psychotic spectrum disorders, its onset is delayed. It usually appears after the age of 40.

        Causes of this madness

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

        However, the fact that the exact cause is not known does not mean that no risk factor is known to manifest this delirium. Among these factors is considered drug and substance use, history of delusional episodes, and family history of mental disorders, especially if they are psychotic disorders or if they 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 to this delusion is that conducted by the group of Mahesh Menon and colleagues in 2011. In their research, it was concluded that the structures of the cortical midline, subcortical regions, the amygdala and striatum are implicated in the onset of self-referential delirium. In his work, it was found that people with this delirium show greater activation in these brain areas.

          Moreover, these same authors saw that patients with reference delirium they did not show a differential activation pattern when given information about themselves and contrary information. That is to say, his brain had difficulty in differentiating between the information that was addressed to these patients and what was not. This served as a neurological explanation for the tendency of patients with this delirium to interpret the behaviors of others or everyday situations as something going there.


            When the reference delirium is a symptom of another disorder or caused by a medical condition, the treatment aims to intervene on the pathology that caused it. That is, if, for example, the patient has delusions associated with schizophrenia, the main treatment will be focused on treating this disorder.

            The main therapeutic route is pharmacological, especially with the help of antipsychotics. Additionally, psychological therapy is also used, with cognitive-behavioral treatments being most effective in treating delusions and other psychotic symptoms.

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

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