08/06/2026
Info to keep in your back pocket when questioning yourself or professionals https://pmc.ncbi.nlm.nih.gov/articles/PMC8918655/
Delusions
Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence (15). The false belief is not accounted for by the person's cultural or religious background or his or her level of intelligence (19).
Karl Jaspers in his masterpiece, Allgemeine Psychopathologie (16), proposed three crucial criteria to define delusions: (1) subjective certainty, incomparable to other convictions; (2) imperviousness to counterarguments; (3) implausibility of content. Although it is commonly considered one of the main features of Schizophrenia Spectrum Disorder, delusional beliefs can be recognized in different psychiatric conditions: bipolar disorder, major depressive disorder with psychotic features, neurological and medical disorders like dementia, delirium, or drug intoxication (20), and finally, ASD (21).
Childish “Fantasies” and Delusional Beliefs in ASD
The presence of delusional beliefs, suspiciousness, and paranoid ideation (22, 23) in autistic children is reported since the early descriptions of Autism and labeled by different authors as schizophrenia-like states (24), borderline conditions (25–27), or severe disturbances of ego development (28). The most common delusional beliefs in ASD individuals are expansive (29), persecutory and passivity delusions, delusion of reference (30) or delusion of thought insertion and withdrawal (31) and “unusual idea” (32).
In some cases, it is not easy to distinguish between “childish fantasies” and delusional beliefs (33). In this regard, Eugene Bleuler in 1950 explained “autistic thinking” as an infantile wish to avoid unsatisfying realities and replace them with imagination and hallucinations. On the contrary, Michael Rutter (34) claimed that ‘the autistic child has a deficiency of fantasy rather than an excess'. So, according to the authors, the word autism may refer to someone who fantasized excessively or someone who did not fantasize at all (35).
Along this line of research, a central question is whether ASD children are able to distinguish between their subjective perceptions and reality. If we assume that the autistic condition implies an intrinsic difficulty in distinguishing between fantasy and reality, the recognition of a delusion in these patients becomes a very complex psychopathological task (36).
There is strong evidence for the existence of a high comorbidity between autism and psychosis with percentages reaching up to 34. 8% and several significant implications for treatment and prognosis of these patients. However, the identification of ...