Folie a Deux: Shared Psychotic Disorder

Sharing is caring – or is it? A rare psychiatric condition called Folie a Deux shows that snacks and good times aren’t the only things that may be shared amongst people who care deeply for one another. Read on to learn more about the condition in which features of mental illness are shared between people.

Folie a Deux: What Does It Mean

Literally translated from French, Folie a Deux means “madness of two”. This disorder may also be referred to as “shared psychotic disorder” or “induced delusional disorder”. The symptom that most commonly gets shared is a delusion: a thought that you hold onto firmly, even though this idea is clearly irrational.

Usually, this disorder exists between people who already have an established and close bond, including romantic partners, siblings or a parent and child. While the symptoms are usually shared between two people, three (folie a trois) or four (folie a plusieurs) people can also become symptomatic and, in fact, even a whole family or group can be diagnosed.

What Causes Folie a Deux?

These shared delusions are caused by having an extended and close social proximity to someone who has a psychotic disorder (such as schizophrenia or delusional disorder). The person who initially has a mental health concern is referred to as the ‘primary case’ and the person who develops the symptoms of the other person’s condition is known as the ‘secondary case’. Usually, when the two are separated the secondary’s symptoms will begin to resolve. Researchers are still not sure exactly why the symptoms get transmitted, but people who have enmeshed relationships and otherwise live in socially isolated circumstances are thought to be at risk.

Signs and Symptoms of Folie a Deux

Folie a Deux is classified as a psychotic disorder, which is diagnosed in a person who becomes disconnected from reality.

What are the Common Behaviors/Characteristics?

The symptom that most commonly gets shared in Folie a Deux is a delusion, which is a belief that is strange, irrational and unlikely to be changed even when the person is presented with contradictory evidence. Examples include the belief that one of you is the leader of a cult, an alien, or that you’re both being followed by the FBI.

Stats: How Many Suffer from this Disorder?

Folie a Deux is a rare condition and for this reason, reliable statistics on the disorder’s prevalence are hard to come by.

Testing: What are the Diagnostic Criteria Per the DSM 5?

Although the term ‘Folie a Deux’ is frequently used by mental health professionals, this wording isn’t used in the DSM 5, which is the diagnostic ‘bible’ for mental health professionals. Instead, you would qualify for the following diagnosis, which is used to diagnose people who have psychotic symptoms that don’t fit neatly into one of the other disorders: “Other specified schizophrenia spectrum and other psychotic disorder”.

There’s an additional label that would be attached in the case of Folie a Deux: “Delusional symptoms in partner of individual with delusional disorder”. The DSM explains that this label should be used in cases where a primary transmits their symptoms to another person who doesn’t already have another delusional or psychotic disorder.

Simply put, on paper, the secondary is likely to receive the following, incredibly clunky diagnosis: “Other specified schizophrenia spectrum and other psychotic disorder: delusional symptoms in partner of individual with delusional disorder”. You can surely understand now why clinicians choose to use the term ‘Folie a Deux’ instead!

Folie a Deux and Other Conditions

Folie a Deux centers on the presence of shared delusional thoughts. There are many other conditions that include this symptom – including psychosis that is caused by psychological factors, substance use, brain injury or another medical condition. Read on to learn about the relationship between Folie a Deux and related conditions,

Folie a Deux vs Delusional Disorder

Delusional disorder is diagnosed when the main concern is the presence of one or more delusional thoughts. For this reason, Folie a Deux looks fairly similar to delusional disorder. The obvious difference, however, is that Folie a Deux involves two people who share the same delusion.

Secondary vs Primary Delusional Disorder

There are two types of delusions that mental health professionals may refer to: primary’ and ‘secondary’ delusions. In the case of Folie a Deux, both types may be present. The main difference between these two is that primary delusions appear to be bizarre and obviously out of touch with reality. For example, if you believe that a snake lives in your intestines or that your mother-in-law is an extraterrestrial, you may be thought to have a primary delusion.

Secondary delusions, on the other hand, are slightly less bizarre and may be somewhat plausible. For example, a man that suffers with feelings of sadness and guilt made a minor mistake on his latest tax return. Now, he has a delusion that the revenue service and the CIA are spying on him. This is a secondary delusion because although his idea is out of touch with reality, it’s not completely implausible and one can understand why he has developed this sort of thought pattern.

Related Conditions

Folie a Deux is closely related to and shares symptoms with other disorders that involve psychosis. Examples include schizophrenia, schizophreniform disorder, schizoaffective disorder and even bipolar disorder with secondary psychosis.

Usually, however, the primary’s condition is more severe, and the secondary won’t have the other psychotic symptoms – hallucinations, disorganized thought or language patterns and odd muscular movements – that they would need to be diagnosed with another full-blown psychotic disorder.

Example Case of Folie a Deux

Angela (35) was a single mom living with her daughter, Sheila (16). They lived alone on a remote freeholding in Connecticut and they shared an incredibly close relationship, given that they hardly ever saw other people (Sheila received online homeschooling).

Back when Angela was 21, she received a diagnosis of Schizophrenia. However, that was the first and last time that she had experienced any psychotic symptoms. One day, however, Angela started behaving a strangely, talking to herself and spending a lot of time locked in her room.

Sheila asked her what was going on, and Angela revealed to her that God had been communicating with her, saying that she (Angela) was the Messiah. At first, Sheila didn’t know what to make of this. She decided to ignore the situation and hope that her mom would go back to her normal self soon. Gradually, however, with time, Sheila started thinking that her mom might indeed be speaking to God.

One day Angela’s cousin (Adam) decided to pay the two a visit. When he arrived at the house, he recognized immediately that Angela had relapsed back into psychosis, pacing agitatedly and speaking incoherently about being the “chosen one”. Adam quickly found Sheila and explained that they needed to find help because Angela’s symptoms had returned. Sheila disagreed vehemently and said that it was impossible that her mom was sick because Angela held a direct line of communication with God.

Adam drove them both to the nearest emergency room. The couple were seen by a psychiatrist who diagnosed Folie a Deux in Sheila and a Schizophrenia episode in Angela. Angela was placed back on her antipsychotic medication and had to spend 6 weeks in a treatment facility until her symptoms disappeared completely. During that time, Sheila lived with Adam and saw a psychologist twice a week while she continued with online homeschooling.

Three months later, Angela and Sheila were asymptomatic and happy to be re-united. They decided to move to a nearby city where they could be in closer contact with their friends and family; as well as the psychiatrist and psychologists who had helped Sheila overcome Folie a Deux.

Folie a Deux Treatment

Folie a Deux is typically treated by separating the pair. It may also be necessary for each of them to see their own therapist, which can help them to develop coping skills and establish a firmer sense of their own identity as separate from their partner. In some cases – usually when there is a risk of suicide, homicide, neglect or abuse – temporary hospitalization might also be necessary.

Possible Medications for Folie a Deux

The secondary experiences delusions, but usually no other psychotic symptoms. These delusions result from being social connected to someone with a psychiatric condition, rather than due to their own pre-existing medical condition. For this reason, the secondary is not usually given medication. The primary, however, is likely to be given antipsychotic to help treat their delusions and other psychotic symptoms.

Home Remedies to help Folie a Deux

Folie a Deux is a serious and high-risk condition: there are no effective home remedies that can be used in the place of a consultation with a qualified health professional. However, your doctor or therapist might recommend certain strategies that you can adopt to make it easier to live with this condition. Read on to learn more.

Living with Folie a Deux

  • Self-care is important for people with Folie a Deux. Psychotic symptoms can be triggered by stress or depression, so do not take on too much. You may need to consider working a part time job so that you can minimize workplace stress and maximize leisure time.
  • Be kind to yourself! Do this by starting a new hobby or resuming an old one that you once enjoyed. If you’re feeling a bit down, meet a friend for coffee or take a walk in nature. You may feel guilt or shame about your condition, but don’t be too hard on yourself – you are not to blame!
  • It can be very comforting to share your experience with people who have gone through something similar. Look for support groups in your area related to Folie a Deux or psychosis more generally.
  • It may be helpful for you to develop a daily routine to give you a sense of stability and predictability.

Insurance Coverage for Folie a Deux

Depending on your health insurance plan, you may have some mental health coverage options. Speak to your doctor or insurance company to find out about what’s available to you.

How to Deal/Coping With Folie a Deux

Cope with your condition by consulting with a licensed professional and working together with them to prevent a relapse. Do this by adhering to any recommendations they might have about therapy sessions, doctors’ visits and medication. Be sure that your family and close friends are able to recognize the warning signs of psychosis, so that you can get the assistance that you need immediately should your symptoms start to resurface.

Look out for These Complications/Risk Factors

Risk factors for developing this illness include having an overfamiliar relationship and being isolated from other social influences; or else having a genetic predisposition to psychotic illnesses. It’s also thought that being passive and suggestible in relationships, or having histrionic personality traits, may put you at risk.

Finally, females are thought to be more at risk than males, with over half of all Folie a Deux cases involving either two sisters or a mother and daughter pair. This doesn’t mean, however, that males can’t be affected!

Complications involve, in extreme cases, suicidal or homicidal behavior; as well as neglect and abuse when the secondary is a child or vulnerable person. If you think that you or someone you know may be in danger, reach out for help immediately by contacting 911 or the National Suicide Prevention Lifeline on 1-800-273-8255

How to Find a Therapist

The doctor who diagnosed you may be able to refer you to an appropriate therapist. Otherwise, speak to your general practitioner for recommendations, or search online for therapists in your area.

What Should I be Looking for in an LMHP?

You’ll want to find someone who has experience working with this disorder, or at the very least with other psychotic disorders. However, it is also important to find someone that you trust and feel comfortable talking to.

Questions to Ask a Potential Therapist

  • Have you treated Folie a Deux or psychosis before?
  • What are your treatment methods?
  • How will treatment help me?
  • How often will sessions take place?
  • Will my family be asked to attend any sessions?
  • What do you charge for a session and will sessions be covered by insurance?

Folie a Deux Resources and Support Helpline

author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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