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Delusions of grandeur, also known as grandiose delusions (GDs) or expansive delusions, are a subtype of
delusion A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other m ...
characterized by the extraordinary belief that one is famous,
omnipotent Omnipotence is the property of possessing maximal power. Monotheistic religions generally attribute omnipotence only to the deity of their faith. In the monotheistic religious philosophy of Abrahamic religions, omnipotence is often listed as ...
, wealthy, or otherwise very powerful or of a high status. Grandiose delusions often have a religious,
science fiction Science fiction (often shortened to sci-fi or abbreviated SF) is a genre of speculative fiction that deals with imaginative and futuristic concepts. These concepts may include information technology and robotics, biological manipulations, space ...
al, or supernatural theme. Examples include the extraordinary belief that one is a deity or celebrity, or that one possesses fantastical talents, accomplishments, or
superpowers Superpower describes a sovereign state or supranational union that holds a dominant position characterized by the ability to exert influence and project power on a global scale. This is done through the combined means of economic, military, tec ...
. While non-delusional grandiose beliefs are somewhat common—occurring in at least 10% of the general population—and often positively influence a person's
self-esteem Self-esteem is confidence in one's own worth, abilities, or morals. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Macki ...
, in some cases they may cause a person distress, in which case such beliefs may be clinically evaluated and diagnosed as a
psychiatric disorder A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
. When studied as a psychiatric disorder in clinical settings, grandiose delusions have been found to commonly occur with other disorders, including in two-thirds of patients in a manic state of
bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...
, half of those with
schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
, patients with the grandiose subtype of
delusional disorder Delusional disorder, traditionally synonymous with paranoia, is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Ameri ...
, frequently as a comorbid condition in
narcissistic personality disorder Narcissistic personality disorder (NPD) is a personality disorder characterized by a life-long pattern of grandiosity, exaggerated feelings of self-importance, an excessive need for admiration, and a diminished ability to empathy, empathize w ...
, and a substantial portion of those with
substance abuse Substance misuse, also known as drug misuse or, in older vernacular, substance abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder, differing definition ...
disorders.
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
Fourth edition Text Revision (DSM-IV-TR)
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 39,200 members who are in ...
(2000)
The term grandiose delusion overlaps with, but is distinct from,
grandiosity In psychology, grandiosity is a sense of superiority, uniqueness, or invulnerability that is unrealistic and not based on personal capability. It may be expressed by exaggerated beliefs regarding one's abilities, the belief that few other peopl ...
. Grandiosity is an ''attitude'' of extraordinary self-regard (feelings of superiority, uniqueness, importance or invulnerability), while grandiose delusion concerns specific extraordinary factual beliefs about one's fame, wealth, powers, or religious and historical relevance.


Signs and symptoms

According to the
DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a c ...
diagnostic criteria for delusional disorders, grandiose-type symptoms include
exaggerated Exaggeration is the representation of something as more extreme or dramatic than it is, intentionally or unintentionally. It can be a rhetorical device or figure of speech, used to evoke strong feelings or to create a strong impression. Ampl ...
beliefs of: * self-worth * power * knowledge * identity * exceptional relationship to a
deity A deity or god is a supernatural being considered to be sacred and worthy of worship due to having authority over some aspect of the universe and/or life. The ''Oxford Dictionary of English'' defines ''deity'' as a God (male deity), god or god ...
or famous person. For example, someone who has extraordinary beliefs about their power or authority may believe themselves to be a ruling monarch who deserves to be treated like royalty. There are substantial differences in the degree of grandiosity linked with grandiose delusions in different people. Some patients believe they are God, the Queen of the United Kingdom, a president's son, a famous rock star, and some other examples. Others are not as expansive and think they are skilled athletes or great inventors.. Expansive delusions may be maintained by
auditory hallucinations An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person hears a sound or sounds that did not come from the ...
, which advise the patient that they are significant, or confabulations, when, for example, the patient gives a thorough description of their
coronation A coronation ceremony marks the formal investiture of a monarch with regal power using a crown. In addition to the crowning, this ceremony may include the presentation of other items of regalia, and other rituals such as the taking of special v ...
or marriage to the king. Grandiose and expansive delusions may also be part of fantastic hallucinosis in which all forms of hallucinations occur.


Positive functions

Grandiose delusions frequently serve a very positive function by sustaining or increasing a person's
self-esteem Self-esteem is confidence in one's own worth, abilities, or morals. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Macki ...
. As a result, it is essential to consider the consequences of removing the grandiose delusion on self-esteem when trying to modify the grandiose delusion in therapy. In many instances of grandiosity, it is suitable to go for a fractional rather than a total modification, which permits those elements of the delusion that are central for self-esteem to be preserved. For example, a person who believes they are a senior secret service agent gains a great sense of self-esteem and purpose from this belief, thus until this sense of self-esteem can be provided from elsewhere, it is best not to attempt modification. In a case study of more than 13,000 non-clinical and almost 3,000 clinical participants, Isham et al. found that the primary sources of meaning derived from grandiose delusions were: * Confidence in the self * Overcoming adversity * The "greater good" * Happiness * Supporting loved ones * Positive social perception * Spirituality


Comorbidity


Schizophrenia

Schizophrenia is a mental disorder distinguished by a loss of contact with reality and the occurrence of
psychotic In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or incoher ...
behaviors, including
hallucinations A hallucination is a perception in the absence of an external stimulus that has the compelling sense of reality. They are distinguishable from several related phenomena, such as dreaming ( REM sleep), which does not involve wakefulness; pse ...
and delusions (unreal beliefs which endure even when there is contrary evidence). Delusions may include the false and constant idea that the person is being followed or poisoned, or that the person's thoughts are being broadcast for others to listen to. Delusions in schizophrenia often develop as a response to the individual attempting to explain their hallucinations. Patients who experience recurrent auditory hallucinations can develop the delusion that other people are scheming against them and are dishonest when they say they do not hear the voices that the delusional person believes that he or she hears. Specifically, grandiose delusions are frequently found in
paranoid schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, hearing voices), delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin ...
, in which a person has an extremely exaggerated sense of their significance, personality, knowledge, or authority. For example, the person may declare to be the owner of a major corporation and kindly offer to write a hospital staff member a check for $5 million if they only help them escape from the hospital. Other common grandiose delusions in schizophrenia include religious delusions such as the belief that one is
Jesus Christ Jesus (AD 30 or 33), also referred to as Jesus Christ, Jesus of Nazareth, and many Names and titles of Jesus in the New Testament, other names and titles, was a 1st-century Jewish preacher and religious leader. He is the Jesus in Chris ...
, or the
Mahdi The Mahdi () is a figure in Islamic eschatology who is believed to appear at the Eschatology, End of Times to rid the world of evil and injustice. He is said to be a descendant of Muhammad in Islam, Muhammad, and will appear shortly before Jesu ...
of the end times in Muslim societies.


Bipolar disorder

Bipolar 1 disorder can lead to severe affective dysregulation, or mood states that sway from exceedingly low (depression) to exceptionally high (
mania Mania, also known as manic syndrome, is a Psychiatry, psychiatric Abnormality (behavior), behavioral syndrome defined as a state of Abnormality (behavior), abnormally elevated arousal, affect (psychology), affect, and energy level. During a mani ...
). In hypomania or mania, some bipolar patients can have grandiose delusions. In its most severe manifestation, days without sleep, auditory and other hallucinations, or uncontrollable racing thoughts can reinforce these delusions. In mania, this illness affects emotions and can also lead to impulsivity and disorganized thinking, which can be harnessed to increase their sense of grandiosity. Protecting this delusion can also lead to extreme irritability, paranoia, and fear. Sometimes their anxiety can be so over-blown that they believe others are jealous of them and, thus, undermine their "extraordinary abilities," persecuting them or even scheming to seize what they already have. The vast majority of bipolar patients rarely experience delusions. Typically, when experiencing or displaying a stage of heightened excitability called mania, they can experience joy, rage, and other intense emotions that can cycle out of control, along with thoughts or beliefs that are grandiose. Some of these grandiose thoughts can be expressed as strong beliefs that the patient is very rich or famous or has super-human abilities, or can even lead to severe suicidal ideations. In the most severe form, in what was formerly labeled as megalomania, the bipolar patient may hear voices that support these grandiose beliefs. In their delusions, they can believe that they are, for example, a monarch, a creative genius, or even someone who can exterminate the world's poverty because of their extreme generosity.


Theories and mechanisms

Psychologists and psychiatrists have proposed multiple theoretical accounts of GDs: *Delusion-as-defense: defense of the mind against lower self-esteem and depression. *Emotion-consistent: result of exaggerated positive emotions. Empirical evidence largely supports emotion-consistent models, but also suggests additional factors like reasoning biases. Grandiose delusions are usually associated with ''high'' self-esteem and self-serving attributional style and ''low'' levels of depression, anxiety and negative self-evaluation. Moreover, there is evidence that repetitive positive self-thinking can confer temporary increases in (non-delusional) grandiose ideas of own superiority, importance or uniqueness. A
functional magnetic resonance imaging Functional magnetic resonance imaging or functional MRI (fMRI) measures brain activity by detecting changes associated with blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When an area o ...
(fMRI) study of patients with bipolar disorder found that such thinking is associated with exaggerated connectivity between the
medial prefrontal cortex In mammalian brain anatomy, the prefrontal cortex (PFC) covers the front part of the frontal lobe of the cerebral cortex. It is the association cortex in the frontal lobe. The PFC contains the Brodmann areas BA8, BA9, BA10, BA11, BA12, BA ...
and
anterior cingulate cortex In human brains, the anterior cingulate cortex (ACC) is the frontal part of the cingulate cortex that resembles a "collar" surrounding the frontal part of the corpus callosum. It consists of Brodmann areas 24, 32, and 33. It is involved ...
(brain regions involved in self-relevant information-processing). Qualitative research likewise indicates that grandiose delusions, far from occurring against a backdrop of negative self-evaluation, conferred a sense of uniqueness, purpose, and belonging, and added meaning to adverse events. The defensive hypothesis bears a strong similarity to the psychodynamic mask model of non-delusional narcissistic
grandiosity In psychology, grandiosity is a sense of superiority, uniqueness, or invulnerability that is unrealistic and not based on personal capability. It may be expressed by exaggerated beliefs regarding one's abilities, the belief that few other peopl ...
, which is also unsupported by the evidence.


Neurobiology

Grandiose delusions may be related to lesions of the
frontal lobe The frontal lobe is the largest of the four major lobes of the brain in mammals, and is located at the front of each cerebral hemisphere (in front of the parietal lobe and the temporal lobe). It is parted from the parietal lobe by a Sulcus (neur ...
.
Temporal lobe The temporal lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The temporal lobe is located beneath the lateral fissure on both cerebral hemispheres of the mammalian brain. The temporal lobe is involved in pr ...
lesions have been mainly reported in patients with delusions of persecution and of guilt, while frontal and frontotemporal involvement have been described in patients with grandiose delusions, Cotard's syndrome, and
delusional misidentification syndrome Delusional misidentification syndrome is an umbrella term, introduced by Christodoulou (in his book ''The Delusional Misidentification Syndromes'', Karger, Basel, 1986) for a group of four delusional disorders that occur in the context of mental i ...
. Some studies indicate that GDs are associated with abnormalities in dopaminergic reward pathways and other limbic structures associated with reward and emotion processing. GDs seem to be related to impaired connectivity between the left middle temporal gyrus and more dorsal regions of the left temporal lobe, regions forming a central hub of the default mode network and mediating a variety of cognitive functions (namely social and linguistic ones).


Diagnosis

Patients with a wide range of mental disorders which disturb brain function experience different kinds of
delusions A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other m ...
, including grandiose delusions. Grandiose delusions usually occur in patients with syndromes associated with secondary mania, such as
Huntington's disease Huntington's disease (HD), also known as Huntington's chorea, is an incurable neurodegenerative disease that is mostly Genetic disorder#Autosomal dominant, inherited. It typically presents as a triad of progressive psychiatric, cognitive, and ...
,
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a neurodegenerative disease primarily of the central nervous system, affecting both motor system, motor and non-motor systems. Symptoms typically develop gradually and non-motor issues become ...
, and
Wilson's disease Wilson's disease (also called hepatolenticular degeneration) is a genetic disorder characterized by the excess build-up of copper in the body. Symptoms are typically related to the brain and liver. Liver-related symptoms include vomiting, wea ...
. Secondary
mania Mania, also known as manic syndrome, is a Psychiatry, psychiatric Abnormality (behavior), behavioral syndrome defined as a state of Abnormality (behavior), abnormally elevated arousal, affect (psychology), affect, and energy level. During a mani ...
has also been caused by substances such as
L-DOPA -DOPA, also known as -3,4-dihydroxyphenylalanine and used medically as levodopa, is made and used as part of the normal biology of some plants and animals, including humans. Humans, as well as a portion of the other animals that utilize -DO ...
and
isoniazid Isoniazid, also known as isonicotinic acid hydrazide (INH), is an antibiotic used for the treatment of tuberculosis. For active tuberculosis, it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. F ...
which modify the monoaminergic neurotransmitter function.
Vitamin B12 deficiency Vitamin B12 deficiency, also known as cobalamin deficiency, is the medical condition in which the blood and tissue have a lower than normal level of Vitamin B12, vitamin B12. Symptoms can vary from none to severe. Mild deficiency may have fe ...
,
uremia Uremia is the condition of having high levels of urea in the blood. Urea is one of the primary components of urine. It can be defined as an excess in the blood of amino acid and protein metabolism end products, such as urea and creatinine, which ...
,
hyperthyroidism Hyperthyroidism is a endocrine disease in which the thyroid gland produces excessive amounts of thyroid hormones. Thyrotoxicosis is a condition that occurs due to elevated levels of thyroid hormones of any cause and therefore includes hyperth ...
as well as the
carcinoid syndrome Carcinoid syndrome is a paraneoplastic syndrome comprising the signs and symptoms that occur secondary to neuroendocrine tumors (formerly known as carcinoid tumors). The syndrome is caused by neuroendocrine tumors most often found in the gut ...
have been found to cause secondary
mania Mania, also known as manic syndrome, is a Psychiatry, psychiatric Abnormality (behavior), behavioral syndrome defined as a state of Abnormality (behavior), abnormally elevated arousal, affect (psychology), affect, and energy level. During a mani ...
, and thus grandiose delusions. In diagnosing delusions, the MacArthur-Maudsley Assessment of Delusions Schedule is used to assess the patient.


Treatment

In patients with
schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
, grandiose and religious delusions are found to be the least susceptible to cognitive behavioral interventions. Cognitive behavioral intervention is a form of psychological therapy, initially used for depression, but currently used for a variety of different mental disorders, in hope of providing relief from distress and disability. During therapy, grandiose delusions were linked to patients' underlying beliefs by using inference chaining. Some examples of interventions performed to improve the patient's state were focus on specific themes, clarification of patient's neologisms, and thought linkage. During thought linkage, the patient is asked repeatedly by the therapist to explain his/her jumps in thought from one subject to a completely different one. Patients with mental disorders that experience grandiose delusions have been found to have a lower risk of having
suicidal Suicide is the act of intentionally causing one's own death. Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or acad ...
thoughts and attempts.


Epidemiology

In a study of over 1000 individuals of a vast range of backgrounds, Stompe and colleagues (2006) found that grandiosity remains the second most common delusion after
persecutory delusions A persecutory delusion is a type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an i ...
. cites The prevalence of grandiosity delusions in schizophrenic patients has also been observed to vary cross-culturally. In research done by Appelbaum ''et al.'' it has been found that GDs appeared more commonly in patients with bipolar disorder (59%) than in patients with schizophrenia (49%), followed by presence in substance misuse disorder patients (30%) and depressed patients (21%). A relationship has been claimed between the age of onset of bipolar disorder and the occurrence of GDs. According to Carlson ''et al.'' (2000), grandiose delusions appeared in 74% of the patients who were 21 or younger at the time of the onset, while they occurred only in 40% of individuals 30 years or older at the time of the onset.


Prevalence

Research suggests that the severity of the delusions of grandeur is directly related to higher self-esteem and inversely related to severity of depression and negative self-evaluations. Lucas ''et al.'' found, in 1962, that there is no significant gender difference in the establishment of grandiose delusion. However, the particular content of religious Grandiose delusions is variable across genders, with men more likely to consider themselves to be God, whereas women are more likely to consider themselves to be saints. Knowles et al. (2011) cites Lucas ''et al'' also noted that grandiose delusions are more prevalent in people with greater education. Similarly, the presence of grandiose delusions in individuals who are the eldest is greater than in individuals who are the youngest of their siblings.


See also

*
God complex A god complex is an unshakable belief characterized by consistently inflated feelings of personal ability, privilege, or infallibility. The person is also highly dogmatic in their views, meaning the person speaks of their personal opinions as t ...
*
Illusory superiority In social psychology, illusory superiority is a cognitive bias wherein people overestimate their own qualities and abilities compared to others. Illusory superiority is one of many positive illusions, relating to the self, that are evident in ...
*
Messiah complex The messiah complex is a mental state in which a person believes they are a messiah or prophet and will save or redeem people in a religious endeavour. The term can also refer to a state of mind in which an individual believes that they are respo ...
* Organic personality disorder *
Persecutory delusions A persecutory delusion is a type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an i ...
*
Put on airs To put on airs, also give airs, put in airs, give yourself airs, is an English language idiom and a colloquial phrase meant to describe a person who acts superior, or one who behaves as if they are more important than others. Origin It is derive ...
*
Pronoia The ''pronoia'' (plural ''pronoiai''; Greek: πρόνοια, meaning "care", "forethought" or "providence," from πρό, "before," and νόος, "mind") was a system of granting dedicated streams of state income to individuals and institutions i ...
*
Dunning–Kruger effect The Dunning–Kruger effect is a cognitive bias in which people with limited competence in a particular domain overestimate their abilities. It was first described by the psychologists David Dunning and Justin Kruger in 1999. Some researcher ...
* Haughtiness *
Hubris Hubris (; ), or less frequently hybris (), is extreme or excessive pride or dangerous overconfidence and complacency, often in combination with (or synonymous with) arrogance. Hubris, arrogance, and pretension are related to the need for vi ...
* Icarus complex *
Overconfidence effect The overconfidence effect is a well-established bias in which a person's subjective ''confidence'' in their judgments is reliably greater than the objective ''accuracy'' of those judgments, especially when confidence is relatively high. Overconfide ...
*
Self-serving bias A self-serving bias is any cognitive or perceptual process that is distorted by the need to maintain and enhance self-esteem, or the tendency to perceive oneself in an overly favorable manner. It is the belief that individuals tend to ascribe succ ...
*
Vanity Vanity is the excessive belief in one's own abilities or attractiveness compared to others. Prior to the 14th century, it did not have such narcissistic undertones, and merely meant ''futility''. The related term vainglory is now often seen as ...
*
Chūnibyō is a Japanese colloquial term typically used to describe adolescents with delusions of grandeur. These teenagers are thought to desperately want to stand out and convince themselves that they have hidden knowledge or secret powers. It is someti ...


References

{{DEFAULTSORT:Grandiose Delusions Delusional disorders symptoms of schizophrenia Delusions