Grandiose delusions
Grandiose delusions | |
---|---|
Other names | Expansive delusions, delusions of grandeur |
People with grandiose delusions wrongly hold themselves at an extraordinarily high status in their mind. | |
Specialty | Psychiatry |
Grandiose delusions (GDs), also known as delusions of grandeur or expansive delusions,
While non-delusional grandiose beliefs are somewhat common—occurring in at least 10% of the general population
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
The term grandiose delusion overlaps with, but is distinct from, grandiosity. 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
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.[6] 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.[7]
Expansive delusions may be maintained by
Positive functions
Grandiose delusions frequently serve a very positive function by sustaining or increasing a person's self-esteem. 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.[5] 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.[5]
In a case study of more than 13,000 non-clinical and almost 3,000 clinical participants, Isham et al.[8] found that the primary sources of meaning derived from grandiose delusions were:[8]
- 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
Specifically, grandiose delusions are frequently found in
Bipolar disorder
Bipolar 1 disorder can lead to severe affective dysregulation, or mood states that sway from exceedingly low (depression) to exceptionally high (mania).[13] 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.[14]
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.[15] 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 king, a creative genius, or can even exterminate the world's poverty because of their extreme generosity.[16]
Theories and mechanisms
Psychologists and psychiatrists have proposed multiple theoretical accounts of GDs:[17]
- 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.[18] Grandiose delusions are usually associated with high self-esteem and self-serving attributional style and low levels of depression, anxiety and negative self-evaluation.[8][17][19][20] Moreover, there is evidence from neurotypical persons that repetitive positive self-thinking can confer temporary increases in (non-delusional) grandiose ideas of own superiority, importance or uniqueness.[21] A functional magnetic resonance imaging (fMRI) study of patients with bipolar disorder found that such thinking is associated with exaggerated connectivity between the medial prefrontal cortex and anterior cingulate cortex (brain regions involved in self-relevant information-processing).[22]
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.[23]
The defensive hypothesis bears a strong similarity to the psychodynamic mask model of non-delusional narcissistic grandiosity,[24] which is also unsupported by the evidence.[25][26]
Neurobiology
Grandiose delusions may be related to lesions of the
Some studies indicate that GDs are associated with abnormalities in dopaminergic reward pathways and other limbic structures associated with reward and emotion processing.[29][30] 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).[31]
Diagnosis
Patients with a wide range of mental disorders which disturb brain function experience different kinds of
In diagnosing delusions, the MacArthur-Maudsley Assessment of Delusions Schedule is used to assess the patient.[41]
Treatment
In patients with schizophrenia, grandiose and religious delusions are found to be the least susceptible to cognitive behavioral interventions.[41] Cognitive behavioral intervention is a form of psychological therapy, initially used for depression,[42] but currently used for a variety of different mental disorders, in hope of providing relief from distress and disability.[43] During therapy, grandiose delusions were linked to patients' underlying beliefs by using inference chaining.[jargon][42][44] Some examples of interventions performed to improve the patient's state were focus on specific themes, clarification of patient's neologisms, and thought linkage.[44] 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.[44]
Patients with mental disorders that experience grandiose delusions have been found to have a lower risk of having
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
A relationship has been claimed[by whom?] 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.[49]
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.[50] Lucas et al. found that there is no significant gender difference in the establishment of grandiose delusion.[51] However, there is a claim[by whom?] that ‘the particular content of Grandiose delusions’ may be variable across both genders.[52] Also, it has been noted[by whom?] that grandiose delusions are more prevalent in people with greater education (those with at least grammar or high school 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.[51]
See also
References
- ISBN 978-1-317-70570-3.
- ^ ISBN 9780781787468.
Grandiose type: delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person
- ^ PMID 21482326. cites Stompe, T; Karakula, H; Rudalevičiene, P; Okribelashvili, N; Chaudhry, HR; Idemudia, EE; et al. (2006). "The pathoplastic effect of culture on psychotic symptoms in schizophrenia". World Cultural Psychiatry Research Review: 157–163.
- ^ Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
- ^ ISBN 9780748792566. Retrieved 5 August 2012.
- ISBN 9780867204421.
- ^ ISBN 9781904671329..
- ^ S2CID 251940350.
- ^ a b c Magill's Encyclopedia of Social Science: Psychology. California: Salem Press, Inc. 2003. pp. 718–719.
- ISBN 9780816075089.
- ISBN 9780198042457.
- ^ Bernama (28 April 2016). "Man who claimed to be 'Imam Mahdi' gets 24 months' jail". Malaysiakini. Retrieved 30 November 2022.
- ISBN 9781606237656.
- ISBN 9780275981525.
- ISBN 9781475906493.
- ISBN 9781605296456.
- ^ S2CID 22462383.
- PMID 21482326.
- ^ Garety, P. A., Gittins, M., Jolley, S., Bebbington, P., Dunn, G., Kuipers, E., ... & Freeman, D. (2013). Differences in cognitive and emotional processes between persecutory and grandiose delusions. Schizophrenia bulletin, 39(3), 629–639.
- PMID 16436270.
- ^ Bortolon, C., & Raffard, S. (2021). Pondering on how great I am: Does rumination play a role in grandiose ideas?. Journal of behavior therapy and experimental psychiatry, 70, 101596.
- ^ Ghaznavi, S., Chou, T., Dougherty, D. D., & Nierenberg, A. A. (2023). Differential patterns of default mode network activity associated with negative and positive rumination in bipolar disorder. Journal of Affective Disorders, 323, 607–616.
- PMID 31785077.
- ^ Beck, A. T., & Rector, N. A. (2002). Delusions: A cognitive perspective. Journal of Cognitive Psychotherapy, 16(4), 455–468.
- ^ Bosson, J. K., Lakey, C. E., Campbell, W. K., Zeigler-Hill, V., Jordan, C. H., & Kernis, M. H. (2008). Untangling the links between narcissism and self-esteem: A theoretical and empirical review. Social & Personality Psychology Compass, 2, 1415–1439. doi:10.1111/j.1751-9004.2008.00089.x
- ^ Campbell, W. K., & Foster, J. D. (2007). The narcissistic self: Background, an extended agency model, and ongoing controversies. The self, 115, 138.
- PMID 19365594.
- ISBN 9780826119681.
2. Temporal lobe lesions have been primarily reported in patients with delusions of persecution and of guilt, while frontal and frontotemporal involvement have described [sic] in patients with grandiose delusions, Cotard's syndrome, and delusional misidentification syndrome.
- ^ Bracht, T., Viher, P. V., Stegmayer, K., Strik, W., Federspiel, A., Wiest, R., & Walther, S. (2019). Increased structural connectivity of the medial forebrain bundle in schizophrenia spectrum disorders is associated with delusions of paranoid threat and grandiosity. NeuroImage: Clinical, 24, 102044.
- ^ Stegmayer, K., Horn, H., Federspiel, A., Razavi, N., Bracht, T., Laimböck, K., ... & Walther, S. (2014). Ventral striatum gray matter density reduction in patients with schizophrenia and psychotic emotional dysregulation. NeuroImage: Clinical, 4, 232–239.
- ^ Ping, L., Zhou, C., Sun, S., Wang, W., Zheng, Q., & You, Z. (2022). Alterations in resting‐state whole‐brain functional connectivity pattern similarity in bipolar disorder patients. Brain and Behavior, 12(5), e2580.
- S2CID 31949452.
- ^ McHugh, P.R; Folstein, M.F (1975). "Psychiatric syndromes in Huntington's chorea". Psychiatric Aspectes of Neurological Disease.
- S2CID 33819397.
- PMID 7304799.
- S2CID 19413218.
- PMID 6691503.
- PMID 6046067.
- ^ Jefferson, J.W.; Marshall J.R. Neuropsychiatric Features of Medical Disorders. New York: Plenum/Medical Book Company.
- S2CID 144556510.
- ^ S2CID 15263352.
- ^ a b Beck, A.T.; Rush A.J.; Shaw B.F.; Emergy G (1979). "Cognitive Therapy of Depression". New York, NY. Guilford Press.
- ^ Salkovskis, P.M. (1996). Frontiers of Cognitive Therapy. New York: Guillford.
- ^ PMID 10665619.
- PMID 10837879.
- ^ Stompe, T.; et al. (2007). "Paranoid-hallucinatory syndromes in schizophrenia results of the international study on psychotic symptoms". World Cultural Psychiatry Review: 63–68.
- S2CID 38400554.
- S2CID 15263352.
- PMID 10671389.
- S2CID 31993235.
- ^ PMID 13931397.
- PMID 18695349.