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A defining error.

The glossary--not textual-definitions of delusion in various DSMs consistently use the term false belief, but the word false and the word belief are contradictory and therefore incorrect usage.

This use of false belief is grounded in semantics: The word belief is inappro priately joined with the word false, because belief requires no objective test of truth or falsity. For example, many children believe in Santa Claus, not because Santa Claus is proved true or false, but because it is convenient to be the recipient of Santa's gifts. Although they all may declare themselves true, religions depend on faith to convince believers, rather than truth or falsity. Many people believed that the world was flat at one time, but when it was proved otherwise it ceased to be a belief and the spherical world became a geographic fact.

Our interest in this question is grounded in a decade and a half of study of delusional disorder. We consider delusional disorder to fall within the category of belief and recognize its unique character, but we think it is improper to classify it as either true or false. Beliefs satisfy a universal need despite, or because of, the absence of need for proof.

We suggest that in future DSM glossaries the term false belief be replaced by a term such as thought disorder is the difference we have pointed out significant to psychiatry? It is, because it prejudges and raises a question of whether delusional disorder exists as part of a system of belief or is outside the boundaries of belief.

We also call the attention to substantial differences between the text and glossary definitions of delusions in the DSMs, and advise clinicians to review not just the text definition, but also the glossary definition, when considering diagnosis. They will discover substantive differences, even to the extent that disorders and definitions in the glossary do not appear in the text.

Carmen V. Zuk, M.D.

Gerald H. Zuk, Ph.D.

Goleta, Calif.

Dr. Rodrigo A. Munoz, professor of psychiatry at the University of California, San Diego, replies: The Zuks are probably referring to the DSM definition of delusions as "erroneous beliefs that usually involve a misinterpretation of perceptions or experiences." DSM sees "bizarre delusions" as characteristic of schizophrenia. They "are clearly implausible and not understandable and do not derive from ordinary life experience."

In delusional disorder, the delusions involve situations that can conceivably occur in real life. This would eliminate the two examples in the letter: Santa Claus and the flat conception of the world. They propose to eliminate "false belief" from the glossary of the DSM and replace it with "thought disorder." The latter term has a long history in psychiatry but includes disorders of content (delusions and hallucinations ) and disorders in the progression of thought. The proposal might not add much to what we have today, and it could decrease our ability to understand each other.
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Author:Zuk, Carmen V.; Zuk, Gerald H.
Publication:Clinical Psychiatry News
Article Type:Letter to the Editor
Date:Sep 1, 2003
Previous Article:Approching tx-resistant OCD. (treatment, obsessive-compulsive disorder).
Next Article:Constitutional Psychiatry.

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