A patient describes unrealistic thought content. Before revealing the answer, decide what distinguishes undirected fantasy thinking from a delusion.

Ask whether the person recognises the content as their own imagination, or whether it is held as a fixed, literal belief about the real world. Undirected fantasy thinking differs from a delusion in that the content is recognised by the person as imaginative rather than held as a literal, believed fact about the world, with thought content not bound by realistic constraints but understood by the person themselves to be a private daydream rather than genuine reality. A delusion, by contrast, is a false, or at least unverifiable, belief that is out of keeping with the person's cultural and social background, held with fixed, unshakeable conviction, essentially impervious to counter-evidence or reasoned argument, and not arrived at through an ordinary, understandable process of reasoning. Whether the content is acknowledged as fantasy or held with fixed, unshakeable conviction as literal fact is the key distinguishing feature.