Religious Delusions in Bipolar Disorder

Religious delusions are a type of delusion with religious content. Although there are no clear guidelines to differentiate normal religious beliefs from pathological ones, a belief is generally only considered delusional if it is idiosyncratic, grandiose, and not an accepted part of a particular culture or subculture. 

Researchers note that there is no consensus on where the boundary between religious belief and psychopathology lies. 

Having an increased focus on religion or religious activities is a possible symptom of mania and hypomania in bipolar disorder. Bipolar disorder is a mental health condition characterized by extreme shifts in mood, activity, and energy levels. According to the National Institute of Mental Health (NIMH), approximately 4.4% of people in the United States experience bipolar disorder at some point during their lives.

What Are Religious Delusions?

Delusions are defined as false beliefs that are firmly held and conflict with reality. Different types include paranoid or persecutory delusions, delusions of reference, delusions of grandeur, delusional jealousy, and others.

Two of these, in particular, may express themselves in a religious context. Here are a few examples:

Religious Paranoid Delusions

"Demons are watching me, following me, waiting to punish me if I do anything they don't like," or "If I put on my shoes, God will set them on fire to punish me, so I have to go barefoot all the time." Auditory hallucinations, such as, "The voices keep telling me there are devils in my room," are often combined with religious paranoia.

Religious Delusions of Grandeur

"God has exalted me above you, normal people. He tells me I don't need help, don't need medicine. I'm going to heaven, and all of you are going to go to hell," or "I am Christ reborn."

Mental Illness and Increased Religiosity

It isn't uncommon for people to experience increased religiosity due to a mental health condition. A heightened focus on religion isn't necessarily unique to bipolar disorder. It is also associated with schizophrenia, schizophreniform disorder, schizoaffective disorder, and other psychotic disorders.

The increased religiosity may take many forms—some more subtle than others, and not all are indicative of psychosis. Here are some examples (using hypothetical patients):

• Janie was raised in a Protestant home but stopped going to church in her teens. After the onset of bipolar symptoms, though, she began going to more than one service a week, volunteering, joining study groups, and seeking personal religious counseling from the minister.
• Ed had never been to any religious service or events in his life, but as he developed symptoms of mental illness and was later diagnosed with schizophrenia, he began talking to friends about God more and more, reading the Bible, eventually falling to his knees and praying aloud regardless of where he was.
• When Terri, a devout Jew all her life, developed a schizoaffective disorder, she became convinced that God felt she was unworthy and attempted suicide.
• Jerry, who has bipolar disorder, began to focus more on his religious beliefs when his symptoms began, finding that they helped sustain him in difficult times.

Terri's doctor may provide an immediate diagnosis of having religious delusions. But in the cases of Janie and Ed, a psychiatrist might feel such a diagnosis would be premature. And in Jerry's case, at this point, his beliefs appear to be supportive rather than problematic.

Koenig found that some spiritual approaches may benefit the patient—as in Jerry's case. When religious delusions aren't immediately obvious, the treating clinician needs to examine the patient's religious beliefs and behaviors carefully, Koenig concluded.

Cultural Effects on Religious Delusions

Cultural variables may play a role in how religious delusions are expressed. However, more research is needed to better understand how a person's religious background might impact how delusions occur.

One meta-analysis of 55 studies examined the relationship between religious delusions (RD) and religious hallucinations (RH) in countries around the world.

• In the United States, the level of religious involvement predicted the severity of religious delusions, and Protestants were more likely to experience religious delusions than Roman Catholics.
• In England, there was a higher association between religious belief and religious delusion in subjects with schizophrenia.
• In Pakistan, Muslim patients with schizophrenia in Pakistan were more likely to experience religious delusions and to hear voices of 'paranormal agents.' 
  

Impact of Religion and Religious Delusions

Religious and spiritual beliefs can be a positive coping mechanism for people with bipolar disorder that can lead to better well-being and outcomes. One study found that suicide was less common in bipolar people who were religious.

Conversely, having religious delusions has been found to be associated with a more serious course of illness and poorer outcomes. Research has shown that patients with religious delusions had more severe psychotic symptoms, a longer history of illness, and poorer functioning prior to the onset of a psychotic episode.

You can see why, then, it's essential for clinicians to be aware of these differences.

Keep in Mind

Despite the conflicting research on whether a country's culture affects the incidence of religious delusions, it is certainly an area of interest for further study. More research is needed to better understand how to differentiate between normal religiosity and delusional religious beliefs.

If there's one thing that researchers do agree on, it's that those who treat people with psychoses need to be sensitive to a patient's non-delusional religious beliefs, both in distinguishing them from delusions and in evaluating how helpful they are potentially to the patient.