American Board of Psychiatry and Neurology (ABPN) Practice Exam 2026 - Free ABPN Practice Questions and Study Guide

The primary indicator that distinguishes a psychotic disorder from a delusional disorder is the presence of hallucinations.

In psychotic disorders, such as schizophrenia, individuals often experience hallucinations, which can affect any of the senses. These can include auditory hallucinations (hearing voices), visual hallucinations (seeing things that aren’t there), or other types of sensory misperceptions. The presence of hallucinations is a hallmark of psychotic disorders and indicates a more severe degree of impairment in reality testing.

In contrast, delusional disorder is characterized primarily by the presence of one or more delusions that are often nonbizarre in nature—meaning they involve scenarios that could occur in real life, such as being followed or having a medical condition. Unlike individuals with psychotic disorders, those with delusional disorder do not typically experience hallucinations.

While the duration of symptoms, impact on social functioning, and the nature of delusions can all provide context for understanding these disorders, the distinguishing feature that sets psychotic disorders apart from delusional disorders is indeed the occurrence of hallucinations.