When delusional beliefs are present which are bizarre in nature, clearly implausible, have no basis in fact and are not derived from ordinary life experience, a person may be diagnosed with schizophrenia. This criterion is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a book used by psychiatrists to assess various types of mental illness and reflects a Western view of reality.

Delusions may be viewed differently in traditional cultures, where folk explanations or spiritual causes may be attributed and tolerated. Robert Whitaker, in his book Mad in America: Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill, reports that the World Health Organization has found that schizophrenia outcomes in the United States and other developed countries are worse than in many poorer countries, such as India and Nigeria.

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