Arch Iranian Med 2006; 9 (4): 417 418

Archives of Iranian Medicine, Volume 9, Number 4, October 2006 417

Shared Psychotic Disorder between A Girl with Her Mother and
Younger Sister (Folie a trois)

Fatemeh Ranjbar-Kouchaksaraei MD

*, Gholam-Reza Norazar MD*, Arash Mohaghghegi MD*

Shared psychotic disorder develops in an individual in the context of a close relationship with
another one who has an established delusion that he/she also believes. It is classified within
paranoid disorder. Herein, we present a case of two sisters with their mother. The elder sister was
the origin of paranoid delusion. Her delusion was with a dentist who tries his best to prevent her
for marrying. They separated completely from all their relatives for two years.

Archives of Iranian Medicine, Volume 9, Number 4, 2006: 417 418.

Keywords: Delusion folie a trois shared psychotic disorder


Introduction

hared psychotic disorder, also referred to
over the years as shared paranoid
disorder, folie a deux, etc, was first
described by Lasegue and Falert in 1877.
1
It is
probably rare no statistics are available on its
incidence and prevalence, and the literature
consists almost entirely of case reports. The
disorder is characterized by the transfer of
delusions from one person to another. Both persons
are closely associated for a long time and typically
live together in relative social isolation. The person
who first has the delusion (the primary case) is
often chronically ill and typically is the influential
member of a close relationship with a more
suggestible person (the secondary case) who also
develops the delusion. The most common
relationships in folie a deux are sister-sister,
husband-wife, and mother-child, but other
combinations have also been described. Almost all
cases involve members of a single family.
1
In the
literature, reported cases of secondary case are
sisters from mother, wife from husband, sister
from sister, etc. The pattern of mother from
daughter, which we are going to describe is,
however, very unusual.

Case Report

Two sisters with their mother were admitted to
psychiatric hospital with systematic paranoid
delusion with a dentist. They became convinced
that a dentist tries his best to prevent the elder
sister for marrying. The elder sister, aged 27 years,
was a university student at the faculty of dentistry
and the 21-year-old younger sister was a university
student of chemistry. Their mother, aged 49 years,
was a retired teacher of primary school. Their
father was retired too. The family was living in
Karaj, a city very far away from the university.
The origin of the delusion was from the elder sister
and gradually started after her enterance to the
faculty of dentistry. She had delusional disorder
presecutory type. She was living with her
grandmother. After six years, when her younger
sister entered university, their family moved from
Karaj to Tabriz, the city where their universities
were located. Thereafter, the younger sister and her
mother became convinced that she had become a
target of a dentist. The elder sister was visited by a
psychologist. In their visit, she had misinterpreted
her personal relationship, so they decided to
separate from all their relatives completely. In such
a way, no-body knew their address for two years.
Their father had no delusion and his idea was an


Case Report

S
Authors affiliation: *Department of Psychiatry, Tabriz
University of Medical Sciences, Tabriz, Iran.
Corresponding author and reprints: Fatemeh Ranjbar-
Kouchaksaraei MD, Department of Psychiatry, Razi Hospital,
Tabriz University of Medical Sciences, Tabriz, Iran.
Fax: +98-411-380-3353, E-mail: fk_ranjbar @ yahoo.com.
Accepted for publication: 11 November 2005
Shared psychotic disorder between two sisters and their mother
Archives of Iranian Medicine, Volume 9, Number 4, October 2006 418
overvalued idea. Their brother was a university
student in another city and had no delusions.

Discussion

In shared psychotic disorder, delusion develops
in the context of close relationships. The delusion,
developed in this way, is similar to that of the
person with established delusion.
2
Persons are
closely associated for a long time and typically live
together in relative social isolation. Occasionally,
more than two individuals are involved (e.g., folie
a trois, quatre, cinq, also folie a famille), but such
cases are very rare.
3
The majority of dyads (67.3%)
are socially isolated.
4
In our case, the elder sister
was the origin of the delusion. She had great
influence on her family, especially her mother and
younger sister. They had close relationships with
each other as well. They separated completely
from all their relatives. In folie a deux, delusions
are usually persecutory.
5
Folie a deux is rare and
information is obtained mainly from case reports.
5

About 90% of the relationships described are
within the unclear family; sister-sister dyads are
the most common forms.
5
When patients are
related, they may share the same genetically-driven
psychiatric illness.
6
Our patients had persecutory
delusion with a dentist. The suggestible persons
(the secondary case) were more than two persons;
they were folie a trois. Usually, the primary
case, i.e., the person who first develops psychotic
symptoms, can be distinguished from one or more
secondary cases, in whom the symptoms are
induced.
8
Since the 19
th
century, many studies have
reported folie a deux in subjects with endogenous
psychosis. According to German traditional
psychiatry, we-type paranoid solipsism may
correspond to psychogenic delusional, formation
mechanism, and I-type schizophrenic solipsism
to endogenous mechanism.
9
The inductor often
appears to be suffering from schizophrenia.
10

Mother with her daughter had we-type
paranoid, might have psychogenic delusion.

Acknowledgment

I would like to thank the nursing staff of Razi
Psychiatry Hospital for their helps.

References

1 Sadock BJ , Sadock VA. Kaplan and Sadocks Synopsis
of Psychiatry: Behavioral Sciences/Clinical Psychiatry.
9th ed. Philadelphia: Lippincott Williams and Wilkins;
2003: 517 518.
2 Munson CE. The Mental Health Diagnostic Desk
Reference: Visual Guides and more for Learning to Use
the Diagnostic and Statistical Manual (DSM-IV-TR). 2nd
ed. New York: Haworth Press; 2001: 154.
3 Theo C. Delusional and shared psychotic disorder. In:
Sadock BJ , Sadock VA, Kaplan HI, eds. Kaplan and
Sadocks Comprehensive Textbook of Psychiatry. 7th ed.
Philadelphia: Lippincott Williams and Wilkins; 2000:
1257 1258.
4 Silveira J M, Seeman MV. Shared psychotic disorder: a
critical review of the literature. Can J Psychiatry. 1995;
40: 389 395.
5 Bhandari S. Unusual psychiatric syndromes. In: Wright
P, Stern J , Phelan M, eds. Core Psychiatry. 1st ed.
London; New York: WB Saunders; 2000: 329.
6 Reif A, Pfuhlmann B. Folie a deux versus genetically
driven delusional disorder: case reports and nosological
considerations. Compr Psychiatry. 2004; 45: 155 160.
7 Kashiwase H, Kato M. Folie a deux in Japan--analysis of
97 cases in the J apanese literature. Acta Psychiatr Scand.
1997; 96: 231 234.
8 Wehmeier PM, Barth N, Rem-Schmidt H. Induced
delusional disorder. A review of the concept and an
unusual case of folie famille. Psychopath. 2003; 36:
37 45.
9 Shimizu M. Folie a deux in schizophrenia--
"psychogenesis" revisited. Seishin Shinkeigaku Zasshi.
2004; 106: 546 563.
10 Mentjox R, van Houten CA, Kooiman CG. Induced
psychotic disorder: clinical aspects, theoretical
considerations, and some guidelines for treatment.
Compr Psychiatry. 1993; 34: 120 126.