What To Know about Delusions of Grandeur

Delusions of grandeur, also known as grandiose delusions, are a type of delusion or false belief. People who experience delusions of grandeur may believe they are famous, God-like, wealthy, powerful, talented, or gifted in some other way. These delusions often have religious or supernatural themes.

While it's unclear what exactly causes delusions of grandeur, it often occurs in people with mental health conditions. Around two-thirds of people diagnosed with bipolar disorder (BD) and about half of people diagnosed with schizophrenia will experience delusions of grandeur. These delusions can also occur in people with substance use disorder (SUD). 

About 10% of the population without a mental health condition will experience grandiose thoughts that do not meet the criteria for a delusion. Delusions of grandeur are more severe delusions in which a person cannot tell the difference between real and unreal.

Types

When someone experiences delusions of grandeur, they have an inflated sense of who they are, their abilities, and their accomplishments. These delusions can appear in several different ways. The most common types of delusions of grandeur include:

• Religious delusions: Believing you have been chosen by God, have supernatural abilities or gifts that others do not have, or are somehow more special than others
  
• High social status: Believing you are popular, well-known, or famous or have wealth, power, or celebrity status
• Superiority: Seeing yourself as superior to others in terms of intellect, morality, ethics, talents, creativity, or physical abilities
• Invincibility: Believing you cannot be killed, harmed, or injured by others or that you are immune to certain diseases
• Special powers: Believing you are gifted in some way (e.g., prophetic, psychic, or having extraordinary musical, athletic, or artistic abilities)
• Unique purpose: Believing you have a special purpose or calling in life, possibly becoming obsessed with fulfilling this purpose

Symptoms

Symptoms of delusions of grandeur vary tremendously from person to person and are influenced by the underlying cause of their delusions. Someone with bipolar disorder (BD) who experiences delusions of grandeur may show different symptoms than someone with schizophrenia who experiences delusions.

Some common symptoms will appear when someone is experiencing delusions of grandeur, such as:

• Unreasonable or untrue beliefs about your importance, abilities, or status
• A strong conviction that your beliefs are true despite being presented with contradictory information
• Anger or dismissiveness when your delusions are challenged
• Difficulty getting along with others, especially if your delusions get in the way
• Behaving as if your beliefs are true, sometimes even putting your life at risk
• Spending a lot of time thinking about the delusions
• Fluctuating and sometimes extreme moods like euphoria or paranoia

What Causes Delusions of Grandeur?

Researchers do not know what causes delusions of grandeur. Despite being a common issue, it is not well studied. That said, delusions of grandeur can be a symptom of delusional disorder (DD), in which a person cannot tell the difference between what is real and imagined.

Delusions of grandeur can stem from a mental health condition like BD or schizophrenia. Research also connects delusions of grandeur to narcissistic personality disorder (NPD), substance use disorder (SUD), and even traumatic brain injury (TBI). Even extreme stress or trauma can lead to delusions of grandeur.

Risk Factors

Research suggests that people who have a family history of psychotic disorders like schizophrenia are more likely to experience delusions of grandeur.

Having abnormal dopamine activity in the brain or issues with other neurotransmitters also may increase risk. Dopamine is a neurotransmitter involved in many brain functions, including movement, positive reinforcement, mood, impulse control, and the reward pathway.

Diagnosis

Delusions of grandeur is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) as a symptom of delusional disorder (DD). It can also be a symptom of other mental health conditions like BD, schizophrenia, SUD, and NPD.

According to the DSM-5-TR, if a person's delusions of grandeur are part of DD, they will meet the following criteria:

• One or more delusions for at least one month
• No other odd behaviors or difficulty functioning
• No hallucinations or other mood symptoms

Delusions of grandeur may be a symptom of other mental health conditions like BD or schizophrenia, but not always.

Treatment for Delusions of Grandeur

Treating delusions of grandeur can be challenging, especially because the person who experiences them may feel like nothing is wrong. If the delusions are part of a mental health condition like delusional disorder, bipolar disorder, or schizophrenia, the person may experience fewer delusions as their condition is treated.

Some common treatments for people with delusions of grandeur include:

• Medication: Delusional thought processes are often treated with medications, including antipsychotics (which block dopamine receptors in the brain), antidepressants, and tranquilizers (drugs that reduce anxiety, fear, and tension). Medication alone does not usually resolve symptoms.
• Therapy: Therapists typically use cognitive behavioral therapy (CBT) to treat delusions of grandeur as well as the underlying mental health condition. Once trust is established, the person with delusions will learn to recognize harmful thought patterns and behaviors and work on restructuring them into more helpful ones.
• Involuntary commitment: A psychiatrist may recommend involuntary hospitalization for delusions of grandeur if they feel the person could potentially harm themselves or others. Each state has different laws regarding how long a person can be required to get treatment against their will. Most healthcare providers prefer to honor a person's autonomy and only use this option as a last resort.

Prevention

It's unclear what exactly causes delusions of grandeur, so preventing it may not be possible. Early diagnosis and treatment may help reduce delusions and improve the person's overall quality of life.

Delusions of grandeur are usually a symptom of an underlying mental health condition, such as BD, schizophrenia, DD, or SUD. When these conditions are treated effectively, the frequency of delusions of grandeur may decrease.

If you have a friend or family member who experiences delusions of grandeur, understand that it's normal for them to resist giving up their beliefs. Be empathetic and focus on what they feel. Arguing is likely to make them shut down or feel they are being judged. Offer support without confirming or denying the delusion. This will help build trust, pave the way for you to get them the help they need, and ultimately prevent the delusions in the future.

Complications

When delusions of grandeur, as well as the mental health disorders that accompany them, are left untreated, it can lead to depression and other mood disorders. It can also make it challenging for the person experiencing the delusions to relate to others, especially if their friends or family members try to show them that their delusions are not real or authentic.

In extreme cases, delusions of grandeur can lead to violence, arrests, and legal issues like stalking and harassment when the person is trying to live out their beliefs. It can also put them at risk for harm, especially if they believe themself to be invincible. People with delusions of grandeur may take unnecessary risks (e.g., stepping into traffic) or endanger themselves because they believe they possess supernatural abilities (e.g., flying or walking on water).

A Quick Review

With delusions of grandeur, people believe they are famous, God-like, wealthy, powerful, talented, or gifted in some other way. These delusions are often a symptom of a mental health condition like bipolar disorder, schizophrenia, substance use disorder, or delusional disorder.

It's unclear what exactly causes delusions of grandeur, but having a family history of psychotic disorders may increase your risk. Delusions of grandeur are typically treated with medications and therapy.

If you suspect a loved one is experiencing delusions of grandeur, it is important to get them mental health treatment. Left untreated, these delusions—as well as the underlying mental health condition—could negatively affect their health and quality of life.