A 45-year-old woman presents with an unshakeable belief that her neighbour has been in love with her for two years, despite no evidence of any real relationship. She has no hallucinations, her speech is organised, and she functions normally at work. What is the most likely diagnosis?

• A Schizophrenia, paranoid type
• B Bipolar I disorder with psychotic features
• C Schizoaffective disorder
• D Delusional disorder, erotomanic type ✓

Explanation

Delusional disorder is characterised by one or more non-bizarre delusions lasting at least one month, without hallucinations, significant disorganisation, or marked functional impairment outside the sphere of the delusion. The erotomanic subtype specifically involves the false belief that another person is in love with the individual. Schizophrenia requires additional Criterion A symptoms and broader functional decline.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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