What Are Grandiose Delusions In Schizophrenia?

Delusions are a common schizophrenia symptom in which an individual generally holds unfounded beliefs. These beliefs may come in several forms. For instance, the individual might think they're being followed or monitored. They might believe they're receiving communications from or can communicate with entities that no one else can hear.

Roughly 50% of individuals with schizophrenia experience what are known as grandiose delusions (GDs), or delusions in which they have special abilities, importance, power, wealth, knowledge, or identity. For example, someone with schizophrenia may believe that they are a famous historical or religious figure, have special powers, or have a special mission or destiny. These beliefs tend to be firmly held despite evidence to the contrary and may not be influenced by logical reasoning or evidence.

GDs are not exclusive to schizophrenia and can occur in other mental health conditions, such as bipolar disorder, delusional disorder, and certain types of personality disorders. Why some schizophrenia patients have delusions of grandeur and others do not is currently unknown, but a growing body of research and clinical practice case studies are exploring the potential reasons. Often, delusions and other schizophrenia symptoms can be treated with a combination of medication and therapy.

Delusions can be a common symptom of schizophrenia

Learn to manage them with online therapy

Why do some people with schizophrenia have grandiose delusions?

Clinical psychology reviews and research on grandiose delusions in schizophrenia are limited, and professionals still do not fully understand why some people experience this symptom while others do not. Contributing factors might include the following: 

• Psychology: Personality traits, coping mechanisms, and cognitive styles may influence the subject matter and intensity of an individual's delusions. 
• Biology: Recent research suggests there may be a connection between increased structural connectivity of the medial forebrain bundle and delusions of paranoia and grandiosity in schizophrenic patients.
• Environment and upbringing: Studies suggest that autobiographical memory may influence grandiose delusions. Additionally, stressful life events, trauma, substance use, and social factors can all impact the onset and course of schizophrenia symptoms, including delusions. 
• Genetics: There is some evidence to suggest that genetics play a role in the presence of specific types of delusions and other symptoms in several psychotic disorders.  
• Co-occurring conditions: Schizophrenia often co-occurs with other mental health disorders, such as bipolar affective disorder, substance use disorder, personality disorders, or delusional disorders. The presence of these additional conditions can influence the type and severity of symptoms experienced, including the presence of GDs.

How grandiose delusions affect individuals with schizophrenia

Like other symptoms of psychosis, individuals tend to experience GDs in unique ways. A recent qualitative study backed by the NHS Health Research Authority surveyed the cognitive and affective perspectives of individuals with grandiose delusions to help clinicians understand more about the psychological mechanisms that drive them, the potential impacts of GDs on the individual, and how this information may be used to develop better treatment plans for individuals with psychotic disorders.

Impact of grandiose delusions in schizophrenia on mental health

In the study, 15 patients under psychiatric care who had experienced one or more delusions were interviewed to investigate the consequences and psychological experiences of their past and present encounters with GDs. The researchers found that grandiose delusions typically harmed the participants in areas of physical, emotional, social, occupational, and sexual well-being. However, they also noted that the participants’ experiences with GDs were often meaningful to them, providing a sense of belonging, purpose, or identity. In some cases, they served as a way to cope with unusual or difficult incidents in daily life. 

Grandiose delusions in schizophrenia overview

GDs often occur in addition to other schizophrenia symptoms during certain phases of an episode or "disturbance." Learning more about how the symptoms of schizophrenia can evolve and how mental health experts may use these patterns to arrive at a diagnosis can be helpful. 

Schizophrenia symptoms vs delusional disorder

Symptoms of schizophrenia are typically categorized into three subtypes: positive, negative, and cognitive. 

Positive symptoms 

Positive symptoms generally refer to those that represent an individual's break from reality and can be easily observable to others, such as those listed below:

• Hallucinations: Hallucinations typically involve hearing, seeing, smelling, tasting, or feeling stimuli that aren't real. Auditory hallucinations, such as hearing voices, are the most common.
• Delusions: Delusions can be defined as false beliefs that are firmly held despite evidence to the contrary. Delusions can take many forms, such as paranoid delusions or grandiose delusions.
• Disorganized thinking: Trouble organizing thoughts often makes it difficult to communicate coherently. The individual's speech may be fragmented or nonsensical, a phenomenon sometimes referred to colloquially as "word salad."
• Disorganized or abnormal motor behavior: This can manifest as agitation, unpredictable movements, or, in some cases, a decrease in overall movement and response to outside stimuli (catatonia).

Negative symptoms

Negative symptoms usually involve disruptions to emotions and behaviors. 

• Anhedonia: A lack of or diminished ability to experience pleasure
• Avolition: Marked reduction in motivation to function in daily life
• Flat affect: Reduced emotional expression
• Asociality: Social withdrawal and isolation

Cognitive symptoms

Cognitive symptoms can affect memory, attention, and executive function (the ability to plan and execute tasks). Some of these symptoms may include a diminishment in:

• Problem-solving abilities
• The ability to process information in a timely manner
• Working memory
• Attention and concentration
• Social cognition 
• Verbal learning

Stages of schizophrenia

Schizophrenia is often characterized by different phases or stages, though not all individuals experience them in the same way. These phases can vary in duration and intensity. 

Prodromal phase

The prodromal stage usually precedes the onset of full-blown schizophrenia symptoms and typically includes negative and cognitive symptoms, such as social withdrawal, reduced motivation, difficulty concentrating, and mild perceptual disturbances. This phase can last for weeks, months, or even years. Still, the prodromal phase’s subtlety and similarity to other disorders, like depression and anxiety, can make this challenging to recognize as a phase of schizophrenia.

Acute phase

The acute phase is normally marked by the onset of the characteristic symptoms of psychosis, such as hallucinations, delusions (including grandiose delusions), disorganized thinking, and abnormal behavior. This phase can be triggered by stress or other environmental factors.  

Residual phase

As symptoms of the acute phase begin to decrease, symptoms like those experienced in the prodromal phase may emerge in what is frequently referred to as the residual phase. The symptoms most commonly experienced in the residual stage may include social withdrawal, reduced affect, and demotivation. 

Diagnostic criteria to rule out other conditions like bipolar disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to receive a diagnosis of schizophrenia, a person must meet the following criteria:

• The individual must display at least two of the core symptoms for a significant portion of time during a one-month period (or less with successful treatment).
• The individual's level of functioning in social, occupational, or self-care areas must be significantly below the level achieved before the onset of symptoms.
• Continuous signs of disturbance must persist for at least six months, with at least one month of active-phase symptoms (which may include prodromal or residual symptoms).
• The disturbance cannot be better explained by another mental disorder, such as schizoaffective disorder, depressive or bipolar disorder with psychotic features. Additionally, the disturbance cannot be attributable to substance use or a medical condition.

Mental health treatment and management

Some individuals with schizophrenia may not realize that they have a mental illness, which can make it challenging to engage them in treatment. However, early intervention and ongoing support tend to be helpful for managing symptoms and promoting recovery. The treatment and management of schizophrenia typically involve a combination of methods.

Medications 

Antipsychotic medications are usually considered the first line of treatment for schizophrenia. These medications may alleviate psychotic symptoms, such as hallucinations, delusions, and disorganized thinking, by blocking dopamine receptors in the brain. In general, there are two main classes of antipsychotics: first-generation (typical) and second-generation (atypical). The choice of medication usually depends on individual factors, such as symptom severity, side effects, and response to treatment. In some cases, doctors may also prescribe mood stabilizers or antidepressants to treat negative or comorbid symptoms.

Never start, stop, or change the way you take any form of medication without consulting your psychiatrist or doctor.

Psychosocial interventions 

Psychosocial interventions are another component of schizophrenia treatment, and they may help individuals manage the challenges of living with the disorder. These interventions may include the following:

• Psychoeducation: Learning about schizophrenia, its symptoms, treatment options, and management strategies can reduce stigma and promote understanding.
• Individual therapy: Methods like cognitive behavioral therapy (CBT) can help individuals identify and challenge distorted thoughts and beliefs, manage symptoms, improve coping skills, and reduce relapse risk.
• Family therapy: Involving family members in treatment can improve communication, reduce stress, and enhance support networks.
• Social skills training: Social skills training usually teaches individuals interpersonal and communication skills, problem-solving techniques, and coping strategies to improve social functioning and relationships.
• Supported employment and education: Programs that provide vocational training, job placement assistance, and educational support can help individuals with schizophrenia achieve and maintain employment or pursue academic goals.
• Rehabilitation services: Rehabilitation services, such as housing assistance, case management, and financial support, generally aim to help individuals with schizophrenia achieve community integration and maintain independence in daily living activities. 
• Support groups: Peer support programs can provide individuals with schizophrenia opportunities to connect with others who have similar experiences, share information, offer encouragement, and reduce feelings of isolation.

Delusions can be a common symptom of schizophrenia

Learn to manage them with online therapy

In general, schizophrenia is a chronic disorder requiring ongoing treatment to manage symptoms and prevent relapses. Mental health professionals must continue to monitor symptoms, encourage medication adherence, and help individuals with schizophrenia manage any side effects through follow-up appointments. However, people with schizophrenia may have difficulty adhering to a psychosocial intervention plan due to challenges associated with attending sessions or financial constraints. The emotional and social dysfunction often associated with schizophrenia may also make it difficult to establish solid therapeutic relationships between clinician and client. 

Benefits of virtual therapy for people with schizophrenia

Some individuals with schizophrenia find that virtual therapy can be as effective as in-person therapy, and the online format can provide practical solutions to some potential treatment barriers. For example, online therapy platforms typically provide connections to a broader pool of mental health professionals with diverse backgrounds and experience. If there are compatibility issues, individuals can easily switch therapists as needed. Online therapy can also offer greater scheduling flexibility and is often more affordable than in-person treatment without insurance.