Delusional Disorder

Running head: DELUSIONAL DISORDER
DELUSIONAL DISORDER
Name of the Student
Name of the University
Author note

DELUSIONAL DISORDER1
Case Formulation
Delusional disorder (paranoid disorder) is a type of severe mental condition where the
patient suffering from it is unable to distinguish between reality and imagination (APA,
2013). One good example of delusional disorder can be drawn from the movie ‘Lars and the
Real Girl’ where the leading character lars (played by Ryan Gosling) believes that his partner
Bianca, an inflatable sex-doll that he ordered online, is real and thus continues a series of
socially uncommon display of romantic and emotional behaviour indicating towards his
incompatibility to distinguish the reality from his imagination (Aubrey, Cameron & Kimmel
(Producers) & Gillespie (Director), 2007).
Lars’ case in the movie is undoubtedly that of delusion, however, that cannot be stated
without significant referencing. The 4P’s, namely, Predisposing, Precipitating, Perpetuating
and Protective factors that is at the core of every psychological case formulation, needs to be
analysed in depth.
There are a few significant social, biological and psychological factors that contribute
to Lars’ case in the movie. Lars displays several instances of social anxiety throughout the
movie, for instance when he tells the doctor that hugs and touches feel like burns to him
(Aubrey, Cameron & Kimmel (Producers) & Gillespie (Director), 2007).. Lars also blames
himself for the death of his mother, which is a rather common instance noted in people whose
mothers died during childbirth. These two factors also contribute to the biological reasoning
behind his case. The lack of a human partner along with major isolation from human contact
might refer to aspects of sexual deprivation, which could also provide reasoning for his
browsing adult sites and ordering a real life sex-doll. These also form the predisposing factors
for Lars. The most significant impact however can be noted in the psychological
backgrounding of his condition. Lars’ isolation and social anxiety fuelled by his denial of
confronting his issues has led him to the development of a psychosis of believing that Bianca

DELUSIONAL DISORDER2
is real. For Lars, she fills the emotional void in his life, rather than the sexual void (Kelly,
2018). This is more evident when his co-worker Margo, for whom he clearly has feeling but
is unable to express because of his social awkwardness, invites him for dinner and he takes
Bianca along (Aubrey, Cameron & Kimmel (Producers) & Gillespie (Director), 2007)
indicating that Bianca also serves a therapeutic purpose for Lars, enabling him to move out of
his comfort zone. Lars’ ideation that he is responsible for his mother’s death and his social
anxiety thus forms a trigger, more commonly known as the precipitating factors for his
illness. Similarly, his denial of confrontation serves as the perpetuating factors for his
condition while his strong belief that Bianca is real and helps him with his social – emotional
burdens formulates the protective aspect of his condition (Hintzen, Wilhelm & Garlipp,
2010).
Diagnosis
Delusions are defined as unshakeable beliefs in an imagined concept, entity or
scenario which is generally not based on any form of reality (Skelton, Khokhar & Thacker,
2015). However, people suffering from delusional disorder are unable to process the gap
between actual reality and their imagined reality. Delusional disorder can severely derail the
social and emotional stability of the person and therefore requires urgent clinical and
psychotherapeutic intervention. There are six primarily identified types of delusional
disorders as identified by DSM - V (APA, 2013) as mentioned below:
 Erotomanic – where the person believes that someone is in love with them and
therefore attempts to contact that person, often leading to instances of stalking
behaviour.