When a belief feels absolutely real and true to you, but the people around you see it differently, it can be lonely and frightening — and it can strain the relationships that matter most. At OhanaPsych we approach this with respect, patience, and without judgment. You are welcome here.
What delusional disorder is
Delusional disorder is a condition in which a person holds one or more fixed beliefs that are not based in reality, lasting a month or longer — while the rest of their thinking and day-to-day functioning often remains relatively intact. That last part is what sets it apart from schizophrenia: outside of the specific belief, behavior may not seem unusual. It is uncommon, affecting roughly 0.2% of people over a lifetime (American Psychiatric Association, 2022).
The beliefs tend to fall into recognizable themes, such as:
- Persecutory — believing one is being watched, followed, cheated, or harmed.
- Jealous — conviction that a partner is unfaithful, despite no real evidence.
- Erotomanic — believing that someone, often of higher status, is secretly in love with them.
- Grandiose — believing one has a special talent, identity, or mission.
- Somatic — believing something is wrong with one’s body, such as an infestation or odor.
Signs and symptoms
The hallmark is a strongly held belief that does not change even when there is clear evidence against it. People may feel distressed, angry, or fearful, may withdraw, or may come into conflict with loved ones over the belief — while other areas of life carry on. Because the belief feels true, many people do not see it as a problem, which is why a trusting relationship with a caring provider matters so much.
How it is understood and evaluated
Delusional disorder is understood through a careful clinical evaluation over time, ruling out medical conditions, substances, and other psychotic or mood disorders that can cause similar beliefs. We move at your pace and lead with the relationship — trust comes first.
How it is treated — and how we approach it at OhanaPsych
We will be honest about the evidence: delusional disorder has been less studied than many conditions, and there are no large clinical trials (Skelton et al., 2015). That said, antipsychotic medication helps a meaningful share of people, and reviews suggest it is a reasonable first option (Muñoz-Negro & Cervilla, 2016); in a large national study, antipsychotic use was linked to markedly fewer psychiatric hospitalizations (Lähteenvuo et al., 2021). Cognitive behavioral therapy can also help ease the distress and preoccupation a belief causes, even when the belief itself is slow to change (O’Connor et al., 2007), and we always treat any co-occurring depression or anxiety.
Most of all, we approach this work without confrontation and with aloha, building trust and working toward lōkahi (balance and harmony) so you can feel safer, less alone, and more connected to your ʻohana. We coordinate care with your therapist and primary-care team.
Getting care by telehealth
Most of our care is delivered by secure video, so you can begin from a private, comfortable place of your own. Some parts of care — such as certain controlled medications — still follow the federal Ryan Haight Act and DEA rules and may call for an in-person step; we will tell you clearly if that applies to you.
Lasting access by telehealth
As we complete the final stages of becoming a Rural Health Clinic (RHC), telehealth for mental-health care is here to stay with us. Under Medicare’s rural-health rules, RHCs are permanently authorized to provide behavioral and mental-health care by telehealth — including into your home, anywhere in Hawaiʻi — not under the temporary flexibilities that expire and must be renewed. For our patients, that means dependable, lasting telehealth access to the care you need.
Wherever you live, OhanaPsych is your statewide practice. We provide care across the entire state of Hawaiʻi by telehealth, reaching every island — Hawaiʻi Island, Maui, Oʻahu, Kauaʻi, Molokaʻi, Lānaʻi, and Niʻihau. If you would rather be seen in person, you have that option at our offices in Hilo and Honolulu.
When to reach out
You do not need to be in crisis to reach out — new patients are welcome. Call (808) 777-9460 or start your request online.
If you or someone you love is thinking about suicide or self-harm, or a belief is leading to thoughts of harming oneself or others, get help right away. Call or text the 988 Suicide & Crisis Lifeline (call or text 988, or chat at 988lifeline.org). In Hawaiʻi, Hawaiʻi CARES is available by calling or texting 988, or at 808-832-3100 / 800-753-6879. In a life-threatening emergency, call 911.
Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner, OhanaPsych / Ohana Care Clinic.
Last reviewed: June 28, 2026. Citations verified: June 28, 2026.
This page is general health education from OhanaPsych. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have a mental health condition, reach out to us or another licensed provider. In an emergency, call 911.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787
Lähteenvuo, M., Taipale, H., Tanskanen, A., Mittendorfer-Rutz, E., & Tiihonen, J. (2021). Effectiveness of pharmacotherapies for delusional disorder in a Swedish national cohort of 9076 patients. Schizophrenia Research, 228, 367–372. https://doi.org/10.1016/j.schres.2021.01.007
Muñoz-Negro, J. E., & Cervilla, J. A. (2016). A systematic review on the pharmacological treatment of delusional disorder. Journal of Clinical Psychopharmacology, 36(6), 684–690. https://doi.org/10.1097/JCP.0000000000000595
O’Connor, K., Stip, E., Pélissier, M.-C., Aardema, F., Guay, S., Gaudette, G., … Leblanc, V. (2007). Treating delusional disorder: A comparison of cognitive-behavioural therapy and attention placebo control. The Canadian Journal of Psychiatry, 52(3), 182–190. https://doi.org/10.1177/070674370705200310
Skelton, M., Khokhar, W. A., & Thacker, S. P. (2015). Treatments for delusional disorder. Cochrane Database of Systematic Reviews, (5), CD009785. https://doi.org/10.1002/14651858.CD009785.pub2
Frequently Asked Questions
Does OhanaPsych accept QUEST, Medicaid, and insurance for delusional disorder care?
Yes. We are in network with the Hawaiʻi QUEST Integration plans — AlohaCare, HMSA, ʻOhana Health Plan, and UnitedHealthcare Community Plan — and we also accept Medicare and most commercial insurance. If you are not sure about your coverage, contact our office and we will help you check.
Can I receive delusional disorder care by telehealth, or do I need to come into the office?
We offer both. You can be seen in person at our Honolulu or Hilo office, or by secure telehealth from anywhere in Hawaiʻi. Some visits or treatments may require an in-person appointment, and we will let you know if that applies to your care.
How do I make an appointment for delusional disorder care?
You can request an appointment through our online scheduling page, or call us at (808) 777-9460 for Honolulu or (808) 867-8002 for Hilo. We welcome new patients and will help match you with the right provider.
Who provides delusional disorder care at OhanaPsych?
Care is provided by our team of licensed, board-certified psychiatric providers. You can read about each member of our team on our Providers page.
