Delusional disorder DSM-5: Criteria and assessment template

Key Takeaways

Delusional disorder is a psychotic disorder marked by one or more nonbizarre delusions lasting at least a month, classified in DSM-5 under schizophrenia spectrum and other psychotic disorders.

DSM-5 lists five diagnostic criteria (A through E), including a specifier for whether the delusion’s content is bizarre, that clinicians must document to reach the diagnosis.

Seven subtypes, erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified, describe the delusion’s theme and help guide treatment and risk planning.

Practice management software like Pabau, including its Echo AI documentation tool, helps structure this assessment and keep criterion-by-criterion documentation consistent.

A patient sits across from you, utterly convinced a coworker has been tracking their movements for months, yet calm and reasonable about everything else in their life.

That split, one fixed false belief sitting inside an otherwise intact mind, is the signature of delusional disorder, and it’s exactly what makes it so easy to misdiagnose as schizophrenia or a mood disorder with psychotic features.

DSM-5 sets out five specific criteria for the diagnosis, and how well you document each one against mental health practice documentation standards shapes the treatment plan and how the note reads to whoever picks up the chart next.

Delusional disorder means one fixed, nonbizarre belief with everything else intact

Delusional disorder is a psychotic disorder characterized by the presence of one or more delusions lasting at least one month.

According to DSM-5, individuals maintain relatively preserved functioning outside the delusional belief system, a key distinction from schizophrenia, where functioning is typically more impaired across multiple domains.

The delusions in delusional disorder are nonbizarre, meaning they describe things that could plausibly happen even though they’re false: a spouse’s infidelity, a coworker’s conspiracy, a hidden illness, a secret talent.

Schizophrenia, by contrast, can involve bizarre delusions, a separate specifier covered in more detail below, on top of hallucinations and disorganized thinking that delusional disorder doesn’t include.

Delusional disorder sits within the schizophrenia spectrum and other psychotic disorders chapter of DSM-5. Using a structured psychiatric evaluation template helps clinicians organize the assessment, document onset and duration precisely, and systematically rule out exclusion criteria, all essential for accurate diagnosis.

Five criteria make up the DSM-5 diagnostic checklist for delusional disorder

DSM-5 lays out five diagnostic criteria (A through E) for delusional disorder:

• Criterion A: Presence of one or more delusions for one month or longer
• Criterion B: Criterion A for schizophrenia has never been met (no hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms). Note: hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects tied to delusions of infestation).
• Criterion C: Functioning is not markedly impaired, except for the impact of the delusions
• Criterion D: Any mood episodes that have occurred during the delusional period have been brief relative to the duration of the delusional periods
• Criterion E: The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder

Clinicians must document the specific onset date, duration in months or years, and any triggering events. Structured SOAP note documentation keeps all five criteria addressed systematically, cutting down on diagnostic ambiguity and supporting the treatment plan that follows.

Criterion B is the one that trips people up most. A patient reporting the sensation of bugs under their skin, tied directly to a somatic delusion of infestation, doesn’t rule out delusional disorder on its own.

What rules it out is a hallucination unrelated to the delusional theme, or the presence of disorganized speech, catatonia, or negative symptoms. Treating theme-consistent hallucinations as automatically exclusionary is one of the most common documentation errors on this diagnosis.

Seven subtypes and a bizarre-content specifier shape how you document the diagnosis

DSM-5 classifies delusional disorder into seven subtypes based on the predominant theme of the delusion:

Alongside the subtype, DSM-5 asks you to specify with bizarre content or without bizarre content, a separate call from the subtype itself.

Bizarre content means the delusion is clearly implausible, not something a same-culture peer would understand, and not drawn from ordinary life experience, closer to believing you’ve been replaced by a double than believing your spouse is cheating.

Most delusional disorder presentations are without bizarre content, since a delusion has to be at least plausible to fit the diagnosis in the first place. Content that reads as bizarre should prompt a hard second look at whether schizophrenia fits better instead.

Identifying the subtype also matters for risk planning. Persecutory delusions can escalate into confrontation with whoever the patient believes is responsible, and somatic delusions tend to drive repeated medical visits and second opinions.

Jealous-type delusions, in particular, carry a well-documented risk of harm toward a partner. A structured tool like a danger assessment gives you a formal way to screen for that risk rather than relying on a gut feeling during the interview.

Walk the DSM-5 template through your Pabau intake workflow in five steps

The delusional disorder DSM-5 template integrates into your clinical assessment workflow using Pabau’s digital forms system. Import the template into your intake forms or progress notes structure to streamline assessment during patient consultations.

Step 1: Add the template to your intake process. Import the delusional disorder DSM-5 PDF as a digital form in Pabau. When a patient presents with suspected psychotic symptoms, clinicians access the form directly from the client record.

Step 2: Document onset and duration. Use the template’s timeline section to record the exact date delusions began and duration to the present. This directly satisfies DSM-5 Criterion A requirements.

Step 3: Complete criterion-by-criterion checklist. Walk through criteria A through E, documenting presence or absence of each. The template prompts clinicians to check for schizophrenia-spectrum symptoms (Criterion B), functional impairment (Criterion C), and mood episodes (Criterion D), flagging the theme-consistent hallucination exception under Criterion B so it doesn’t get miscoded as automatically exclusionary.

Step 4: Specify subtype based on delusional theme. Document which of the seven subtypes the patient’s delusions match, along with whether the presentation is with or without bizarre content. Both specifiers appear in the diagnostic formulation.

Step 5: Generate clinical notes with Echo AI. Pabau’s Echo AI clinical documentation tool can summarize your assessment findings into structured progress notes, reducing documentation burden while ensuring all criteria are documented for treatment planning.

See how Pabau streamlines psychiatric assessment

Digital forms, AI-powered documentation, and integrated client records make delusional disorder assessment faster and more compliant.

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What your documentation needs to include for accurate delusional disorder coding

For billing and compliance, delusional disorder is coded as ICD-10-CM F22.

Payers and auditors expect documentation that ties clinical observations directly to DSM-5 criteria, which is easier with psychiatry EMR software built around structured, criterion-level notes rather than free text. Record the specific delusional statements the patient makes, the impact on functioning, and the timeline.

HIPAA-compliant documentation in Pabau protects patient privacy while maintaining audit readiness. All psychiatric assessment forms are encrypted, access-controlled, and timestamped for regulatory compliance.

Layering a signed counseling informed consent form into the same digital chart keeps the treatment-planning conversation on record alongside the diagnostic workup.

Before you close out the note

Before you close out the note, run it against a quick sign-off list:

• Duration confirmed: has the delusion been present for at least one month, with the date on record?
• Criterion B checked correctly: are any hallucinations documented as tied to the delusional theme, not treated as automatically exclusionary?
• Subtype specified: which of the seven themes fits best, and is more than one theme present (mixed)?
• Bizarre-content specifier noted: with or without, and is that judgment written down rather than assumed?
• Functional impact scoped precisely: what’s actually impaired, limited to where the delusion touches rather than described as broad impairment?
• Schizophrenia, mood disorder, substance use, and medical causes ruled out and stated as such, not just implied

A differential diagnosis checklist for ruling out delusional disorder look-alikes

Delusional disorder diagnosis requires excluding other psychotic and mood disorders. Use this checklist during assessment:

• Schizophrenia: Does the patient have hallucinations, disorganized speech, or negative symptoms? If yes, schizophrenia diagnosis is likely. Delusional disorder requires their absence.
• Schizoaffective disorder: Are there significant mood symptoms (depression, mania) that occurred alongside or independent of the delusions? If yes, schizoaffective disorder fits better.
• Bipolar disorder with psychotic features: Did the delusions occur only during a mood episode? If so, bipolar is the diagnosis.
• Major depressive disorder with psychotic features: Are the delusions mood-congruent (e.g., guilt, worthlessness, disease)? Did they emerge only during depressive episodes?
• Substance-induced psychosis: Does the patient have active substance use, medication, or recent withdrawal? Rule this out first.
• Medical condition (e.g., neurological, endocrine, infectious): Rule out neuroimaging abnormalities, thyroid dysfunction, infections, and medications before finalizing the diagnosis.

Criterion D is often the quiet tie-breaker, since bipolar disorder and major depressive disorder with psychotic features both hinge on how long any mood symptoms lasted relative to the delusion itself.

A short, repeatable measure like the CORE-10 questionnaire can help you track whether low mood is a brief blip or the more persistent pattern you’d expect in a primary mood disorder.

Documenting the differential diagnosis process in informed consent conversations helps patients understand why you’re ordering specific tests or ruling out conditions, improving therapeutic alliance and compliance.

Conclusion

Delusional disorder is a narrow diagnosis by design, one theme, five criteria, and a diagnosis built mostly on what you rule out. Get the one-month duration on record, keep Criterion B’s hallucination exception straight, and note both the subtype and the bizarre-content specifier, and the rest of the chart tends to fall into place.

Practice management software like Pabau, including its Echo AI documentation tool, keeps that criterion-by-criterion structure built into the patient record itself rather than living on a separate PDF. If you want to see how a template like this fits inside an actual chart, book a demo with Pabau.

Continue your research

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Want to streamline informed consent? Group therapy informed consent guide covers consent documentation and therapeutic disclosure essential for psychotic disorder treatment planning.

Looking for mental health practice management? Mental health EMR software provides integrated client records, digital forms, and compliance workflows designed for psychiatry and psychology practices.

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