See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/44682016 Delusions with Religious Content in Patients with Psychosis: How They Interact with Spiritual Coping Article in Psychiatry Interpersonal & Biological Processes · June 2010 DOI: 10.1521/psyc.2010.73.2.158 · Source: PubMed CITATIONS READS 46 1,169 6 authors, including: Sylvia Mohr Carine Bétrisey Hôpitaux Universitaires de Genève Laval University 54 PUBLICATIONS 1,207 CITATIONS 11 PUBLICATIONS 104 CITATIONS SEE PROFILE SEE PROFILE Pierre-Yves Brandt Christiane Gillieron University of Lausanne University of Geneva 54 PUBLICATIONS 823 CITATIONS 39 PUBLICATIONS 782 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Genetic epistemology View project Expérimentation d'une approche communicationnelle adaptée au contexte de l'immigration afin d'optimiser le développement des enfants View project All content following this page was uploaded by Sylvia Mohr on 21 May 2014. The user has requested enhancement of the downloaded file. Psychiatry 73(2) Summer 2010 158 Delusions with Religious Content Mohr et al. Delusions with Religious Content in Patients with Psychosis: How They Interact with Spiritual Coping Sylvia Mohr, Laurence Borras, Carine Betrisey, Brandt Pierre-Yves, Christiane Gilliéron, and Philippe Huguelet Delusions with religious content have been associated with a poorer prognosis in schizophrenia. Nevertheless, positive religious coping is frequent among this popu- lation and is associated with a better outcome. The aim of this study was to com- pared patients with delusions with religious content (n = 38), patients with other sorts of delusions (n = 85) and patients without persistent positive symptoms (n = 113) clinically and spiritually. Outpatients (n = 236) were randomly selected for a quantitative and qualitative evaluation of religious coping. Patients presenting de- lusions with religious content were not associated with a more severe clinical status compared to other deluded patients, but they were less likely to adhere to psychi- atric treatment. For almost half of the group (45%), spirituality and religiousness helped patients cope with their illness. Delusional themes consisted of: persecution (by malevolent spiritual entities), influence (being controlled by spiritual entities), and self-significance (delusions of sin/guilt or grandiose delusions). Both groups of deluded patients valued religion more than other patients, but patients presenting delusions with religious content received less support from religious communities. In treating patients with such symptoms, clinicians should go beyond the label of “religious delusion,” likely to involve stigmatization, by considering how delu- sions interact with patients’ clinical and psychosocial context. According to the DSM-IV-TR (Ameri- The diagnostic approach sets up quali- can Psychiatric Association, 2000), a delu- tative differences between delusions and sion is a false belief based on incorrect in- other beliefs. The belief is not one ordinarily ference about external reality that is firmly accepted by other members of the person’s sustained despite what almost everyone else culture or subculture (e.g., it is not an ar- believes and despite what constitutes incon- ticle of religious faith). When a false belief trovertible and obvious proof of evidence to involves a value judgment, it is regarded the contrary. Yet, defining a delusion is not as a delusion only when the judgment is so always an easy task. extreme as to defy credibility. Delusional Sylvia Mohr, Ph.D., Laurence Borras, M.D., Carine Betrisey, M.A., and Philippe Huguelet, M.D., are affiliated with University Hospital of Geneva and University of Geneva, Division of Adult Psychiatry. Pierre-Yves Brandt, Ph.D. is on the Faculty of Theology at Lausanne University in Lausanne, Switzerland. Christiane Gillieron, Ph.D., is on the Psychology and Education Sciences Faculty at Geneva University. This study was supported by Grant 325100-114136 from the Swiss National Science Foundation. Address correspondence to Sylvia Mohr, Ph.D., Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland. E-mail: [email protected]. Mohr et al. 159 conviction occurs on a continuum and can delusion on its own, considering these ele- sometimes be inferred from an individual’s ments together can consolidate agreement. behavior. It is often difficult to distinguish For instance, the more a belief is implau- between a delusion and an overvalued idea sible, unfounded, strongly held, not shared (in which case the individual has an unrea- by others, distressing, and preoccupying, the sonable belief or idea but does not hold it as more likely it is to be considered a delusion firmly as a delusion). The contents of delu- (Freeman, Pugh, Green, Valmaggia, Dunn, sions may include a variety of themes (e.g., & Garety, 2007). The number and the na- persecutory, referential, somatic, religious, or ture of these dimensions varies across stud- grandiose).The aforementioned definition of ies; the most commonly retained dimensions delusions has been widely criticized. The fal- are conviction, preoccupation, pervasive- sity criterion of delusions has been dismissed ness, negative emotionality and action-inac- as impossible to apply, difficult to prove or tion (Combs, Adams, Michael, Penn, Basso, even irrelevant in the sense that a delusion’s & Gouvier, 2006). Peters, Joseph, Day, and content can actually be true (Spitzer, 1990). Garety (2004) retained three dimensions: In particular, delusional religious beliefs distress, preoccupation, and conviction as- lack any clear empirical content (Lesser & sociated with current delusional ideations. O’Donohue, 1999); the level of conviction Members of new religious movements have may change with time (Myin-Germeys, Ni- been shown to endorse as many delusional colson, & Delespaul, 2001); individuals can beliefs as psychotic inpatients, with the same form a community based on the content of level of conviction, but without preoccupa- delusional beliefs (Bell, Maiden, Munoz- tion or distress (Peters, Day, McKenna, & Solomando, & Reddy, 2006); and religious Orbach, 1999). Jones and Watson (1997) beliefs, like delusions, lie outside the realm of compared the characteristics of delusions in objective “falsifiability,” subjective certainty, subjects with schizophrenia to beliefs about and incorrigibility (Pierre, 2001). However, the existence of God in a control group of the categorical nature of the diagnostic ap- highly religious Christians. Their religious proach underlines a core psychopathological beliefs and delusions did not differ with re- feature indicative of a substantial break with gard to conviction, falsity, affect, or influence reality, with widespread clinical acceptance on behavior. They only differed in their de- and demonstrated reliability (Bell, Halligan, gree of preoccupation and the role of percep- & Ellis, 2006). tion in belief. The discontinuity between pathol- These studies indicate that assess- ogy and normality has been challenged by ing the content of beliefs is of little use in epidemiological studies with standardized differentiating religious beliefs from delu- diagnostic instruments which have dem- sions. When Appelbaum, Robbins, and Roth onstrated the presence of delusions in the (1999) compared the non-content dimen- general population without psychiatric dis- sions of delusions (conviction, pervasiveness, orders (Eaton, Romanoski, Anthony, & preoccupation, action, inaction, and nega- Nestadt, 1991; Kendler, Gallagher, Abelson, tive affect) across various types of delusions & Kessler, 1996; Van Os, Hanssen, Bijil, & (persecutory, body/mind control, grandiose, Vollenbergh, 2001). With this in mind, de- thought broadcasting, religious, guilt, somat- lusions can be considered as complex and ic, influence on others, jealousy, and other), multi-dimensional phenomena rather than they found that religious delusions were held as discrete discontinuous entities. Thus, the with more conviction and pervasiveness than most effective way to assess the presence of a other delusions. delusion may be to consider a list of dimen- The prevalence of diagnosed religious sions. While no single dimension is necessary delusions has varied across epochs and cul- or sufficient to establish the presence of a tures. Some studies have compared the prev- 160 Delusions with Religious Content alence of religious delusions across popula- attempt to relieve pain, tension, and distress) tions (Azhar, Varma, & Hakim, 1995; Kim, and a deficit or defect model (delusions as Hwu, Zhang, Lu, Park, & Hwang, 2001; a consequence of fundamental cognitive or Ndetei & Vadher, 1984; Suhail, 2003). The perceptual abnormalities (Garety, Kuipers, prevalence rate for inpatients with psycho- Fowler, Freeman, & Bebbington, 2001)). sis varied from 6% in Pakistan, 7% in Ja- McKay, Langdon, and Coltheart (2007) have pan, 20% in Italy, 21% in Germany, 21% integrated these two models: motivation in Austria to 36% in North America (Appel- plays a role in the formation of delusional baum et al., 1999; Raja, Azzoni, & Lubich, hypotheses to explain anomalous perceptual 2000; Stompe, Friedman, Ortwein, Strobl, experiences. A central psychological function Chaudhry, Najam, 1999; Tateyama, Asai, of spirituality and religion is to give mean- Hashimoto, Bartels, & Kasper, 1998). These ing to life experiences (Park, 2007). Drinnan studies