A patient's conviction of having ruined her family through a moral failing years ago persists despite her family directly and repeatedly telling her this never happened. Why does this remain a delusion of guilt rather than resolving once corrected?
Delusions of guilt are, by definition, fixed and unresponsive to factual correction — this is exactly what separates them from ordinary guilt or remorse, which is proportionate to a real event and open to reassurance. No amount of direct or repeated correction from family resolves a genuinely delusional belief, which is itself the clinically important marker that this has crossed from distress into delusion.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 4, 'Disorders of Thought and Speech'.