Shared Psychotic Disorder

What is shared psychotic disorder?

Shared psychotic disorder is different from any other disorder because it involves two or more people referred to as the primary and secondary. Also called folie a deux, it’s a psychological disorder as opposed to one that’s linked to some other medical condition. Another element that separates shared psychotic disorders from others is that it’s not triggered by drugs.

Shared psychosis disorder occurs within families in high numbers, between parent and child or siblings. In some cases, the parent has been drawing the child into the disorder from a young age until they interpret the delusion as everyday reality.

It can also occur between friends, relatives, and spouses. It can affect any two people that have a close relationship where the primary one already suffers from some sort of psychosis and the secondary in the relationship becomes convinced of the delusion. An example would be tag team serial killers where the primary suffered from persecutory delusions and the secondary is so influenced by the delusion they agree to go on a killing spree to attack the so-called persecutors.

An example of an extreme case of shared psychotic disorder is when a leader of a religious cult convinces masses of people to believe in their delusion. This is so severe that the primary and secondaries may even share the same hallucinations.

Shared psychotic disorder symptoms

The symptoms can depend on the type of delusions that the primary suffers from. If the primary suffers from grandiose delusions of being a celebrity, then the secondary will believe that the primary is a celebrity. Social isolation from others is a symptom as well.

It’s important to remember the secondary person is an otherwise healthy person. They would have never exhibited any signs of psychotic behavior in the past. They’re usually very normal, but when that behavior changes to psychotic delusional behavior, it’s a clear sign of shared psychotic disorder. In cases where the people are related, the result may be that the kids do not go to school or the family might not interact with the outside world. Only the primary in the relationship would be allowed out as a control mechanism.

As long as the secondary is not suffering from schizophrenia or other conditions, once they exhibit psychotic delusions that are exactly the same as the primary, then they need help. An outside person will have to step in and break them from the environment where the belief exists.

Shared psychotic disorder causes

As stated above drugs is not one of the causes. Once in treatment, the person should not indulge in drugs or alcohol while on medication. If prescribed mood stabilizers, drugs and alcohol may enhance a euphoric feeling that may lead to addiction or other problems.

There’s no concrete medical evidence for why this phenomenon happens. Due to the fact that it often does occur in families, genetics may play a role in the “why.” If the parents suffer from other psychotic disorders like schizophrenia, bipolar disorder, or depression, the child may be more susceptible to suffer from shared psychotic disorder. It’s believed that the parents’ psychosis may play a role in the development of the child’s personality, manipulating them into becoming a candidate as a secondary person in the relationship.

Another cause is the positive diagnosis of another psychotic disorder, whether they’re family or not, in the primary person in the relationship. The secondary is also more likely than not to have a disorder related to dependence or possess a submissive personality. They may be financially dependent, emotionally dependent, sexually dependent, or feel they “serve” the primary in some manner. A traumatic event can also be a cause that would make the secondary more vulnerable and likely to partake in the primary’s delusion.

In the event of a trauma that causes a psychotic event, such as the death of a child, death of a spouse, a divorce, or some major life event, a psychotic break may occur causing the secondary to fall into the hands of the primary. Their mind would be vulnerable and moldable. The assertive personality possessed by the primary will allow them to pressure the secondary into belief and easily manipulate the situation.

Shared psychotic disorder treatment

Treatment for shared psychotic disorder occurs in two phases. First, you treat the secondary person. Because you know that no underlying conditions exist it’s easier to attack their issues first. They must be separated from the primary and supported through the separation phase. No contact at all. No phone calls, visits, or correspondence of any kind can occur between the primary and secondary during separation.

If they get the opportunity to connect, the primary will surely attempt to re-convince the secondary that they need to come back and the delusion is real. They may even have some new evidence to share. Therapy sessions then occur to bring them back to reality once they’ve been effectively apart for a certain amount of time from their partner. If the delusions still persist, then antipsychotic medication may be prescribed. Depending on the length of time the relationship went on, the secondary person is usually cured through the separation. If separation, therapy, and medication don’t work, temporary hospitalization should be considered.

The primary also has to be treated. Antipsychotic medications can be prescribed and therapy will follow. Cognitive behavior therapy is also an option, where the doctor describes the reality to the patient and why their delusions aren’t true, and asks the patient to question their own negative or obsessive thought processes. Once the primary has been treated and comes back to complete reality, they may have to enforce space between themselves and the secondary to maintain a healthy lifestyle and keep the delusions to a minimum.

It’s in the best interest of the secondary to maintain separation from the primary in order not to relapse. In the case of a family, they may not be able to live together for the mental health of the secondary person.

Shared psychotic disorder prevention

The key to preventing shared psychotic disorder is keeping the primary person from falling into a delusional state. If they are on medication, they must stick to the prescription and doctor’s orders. However, they must be monitored to ensure they don’t take more than their recommended dosage, for fear of overmedication. Furthermore, they must not take too little in case they do not receive the full effects of the medicine and possibly relapse into a psychotic episode.

Secondary persons in the relationship cannot allow themselves to be isolated. One of the first things the dominant personality may do is isolate the submissive personalities from others so they can control them. Next comes extensive manipulation so that sometimes the primary’s delusions sound possible and plausible. In isolation, it’s easier to convince their counterparts.

If you are the secondary person, stay in therapy long enough to figure out why you fell into the delusion. Pinpoint the triggers that caused your mind to submit to the idea. Identify the signs of submission. If prescribed medication, take it on time daily.

In the case of a family, attend family therapy sessions; every person should attend their own individual sessions.

People can’t be afraid to reach out to loved ones when they don’t seem to be acting normal. It’s OK to check in with friends and loved ones and ask what’s going on in their lives. For instance, you may notice signs of manipulation if a close relative or friend has become involved with a new, controlling partner and their attitude and behavior has changed. Some manipulation is as simple as being a good liar, but other kinds can be serious enough to see a doctor.

Most people who suffer from shared psychotic disorder will never be diagnosed. The primary doesn’t ever think they have a problem. They think their delusion is a reality so they will not come forward. What’s more, the secondary person is being controlled by the primary and won’t turn their back on them or defy them by not believing. Friends and loved ones have to pay attention to those warning signs and symptoms.

Some may be subtle and gradual but others may be obvious. Immediately act on the separation aspect of treatment no matter how angry or upset the secondary person may be. It will take some time for them to come to the realization that the delusions are not reality. Once they’re back to normal it will be clear what’s real and what’s fantasy. If the primary person does not seek treatment, the secondary person cannot be around them again, especially in cohabitation.

Another way you can prevent shared psychotic disorder from developing is to live a healthy, active lifestyle. Get out and socialize, eat well, drink lots of water, and exercise regularly. Engage in meditation, yoga, Tai Chi, or anything that helps support a healthy mind. Live as stress-free as possible and don’t obsess about what you can’t control. Stress weakens the mind and makes you more susceptible to things like mental health disorders and the controlling habits of others.

Maintain healthy relationships and don’t accept abuse from anybody. Healthy relationships should exist within your family structure and your personal relationships. If the relationships show signs of being unhealthy, exit the relationship. If you need help getting out of an unhealthy relationship to reach out to additional family members, peers, or friends.

Signs of abusive relationship


An abuser will usually act to isolate their partner or secondary person. Isolation allows total control of the environment and stimulants within that environment. They’ll control communication, media, who they see, how they look and how they speak.

Underlying fear of the primary by the secondary

The secondary may have an underlying fear of the primary or being ridiculed by the primary that they do not speak of.

Physical abuse

In some cases, there are signs of physical abuse in addition to the mental abuse.

Withdrawn behavior

Even while interacting outside of the primary person’s controlled environment the secondary will act withdrawn, unusually quiet and anti-social.

Mental health issues come in all shapes, sizes, ages, ethnicities, income brackets, and locations around the world. No case fits in a tight neat box of diagnosis and treatment but it’s nothing to be ashamed of.

This disorder can be spotted and treated in a timely manner by the right doctors, medications and treatment plans. Do your homework and research the best doctors and therapy. How long have they treated cases like yours, what’s the success rate, what medications do they give, what type of therapy do they use? These are all questions that should be asked and answered before a person goes to see a doctor. You’re entitled to the resources that work best for you.

Last Reviewed:
September 12, 2017
Last Updated:
September 12, 2017
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