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.
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.
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.
Takeaway
What is a real life example of a delusional disorder?
Delusional disorder refers to a diagnosable mental illness in which someone experiences one or more delusions within a month. Some examples of other mental illnesses that can cause delusions include schizophrenia, schizoaffective disorder, bipolar disorders, borderline personality disorder, obsessive-compulsive disorder, substance use disorders, and postpartum psychosis.
Examples of delusions someone might experience include:
- Grandiose delusions: Grandiose beliefs, like believing you are God or can control the weather, are some of the most common types of delusions. These perceived roles can significantly impact daily life and functioning.
- Persecutory delusions: These delusions involve the belief that someone is out to cause you harm, despite undeniable evidence to the contrary. For example, someone might believe the government is spying on them, that a co-worker is trying to get them fired, or that your partner is trying to harm you. These reasoning biases involve jumping to conclusions without adequate information to support the false belief.
- Somatic delusions: A somatic delusion is a belief conviction that might include things like body dysmorphia, believing the body is infested by bugs, or that you have a serious illness (like cancer) despite negative test results. This type of repetitive thinking is a relatively common feature of obsessive-compulsive disorder.
Persecutory and grandiose delusions are some of the most commonly encountered delusional beliefs. In a study by Philippa Garety et al., researchers found that though delusions can have overlapping symptoms, they often display significant differences in underlying psychological processes (nonaffective psychosis was used as inclusion criteria for this study).
What is the first red flag of bipolar disorder?
Some early signs of bipolar disorder to look out for include:
- Changes in sleep habits or appetite
- Talking faster than normal
- Elated mood
- Significant mood swings
- Social withdrawal
- Loss of interest in activities you usually enjoy
- Affective psychosis symptoms, like grandiose delusions
- Increased sensitivity
- Taking on lots of things (multitasking)
- Impulsiveness, such as spending much more money than usual
- Thoughts of self-harm or suicide
Bipolar disorder typically oscillates between multiple domains, such as manic episodes, hypomanic episodes, and/or depressive episodes. As many as 30% of people diagnosed with depression may have a primary diagnosis of bipolar disorder, so it’s a good idea to look out for bipolar disorder symptoms in those diagnosed with depression.
Recognizing and treating bipolar disorder early can improve mental health outcomes. For example, early clinical psychology reviews suggest that treatments like group therapy can help people manage grandiose identity (among other delusions) and cope with mood fluctuations.
What is the most common type of delusional disorder?
Persecutory delusions are the most common type of delusion characterized by a sense of threat or physical harm caused by someone else, like the government, a co-worker, or a spouse.
If these beliefs persist, they may increase the risk of harmful consequences like social isolation, substance abuse, low self-esteem, and increasing paranoia. A treatment plan including antipsychotic medications and individual psychotherapy is often necessary to address these psychological processes. For example, in a study on the cognitive and affective perspectives of delusions, researchers found that cognitive behavior therapy can be modified to address delusions.
How does bipolar disorder develop?
Bipolar disorder is thought to develop through a complex interaction of genetic predisposition, brain chemistry, and environmental factors.
While it’s difficult to determine exactly what causes bipolar disorder, there are some interesting correlations between sleep deprivation and cognitive and emotional processes involved in bipolar disorder. This suggests that sleep and circadian rhythm may impact important psychological processes and emotional processes central to bipolar disorder.
How to talk to someone with grandiose delusions?
Grandiose delusions are at least partially maintained by positive future expectations (optimism). Some tips for talking to someone who’s experiencing this type of severe optimism bias include:
- Adopt affective perspectives: People on schizophrenia bulletin boards often share that delusions of grandeur leave them feeling frightened, disappointed, or overwhelmed. Acknowledging this experience can validate their emotional journey.
- Treat them with respect: Not being believed or taken seriously can be possible maintenance factors for delusions. Treating the person with respect, even if you do not agree with them, can help them feel less isolated or distrustful.
- Know your boundaries: Make space to care for your own mental health needs. Setting time boundaries, for example, can help reduce the risk of caregiver fatigue and burnout.
- Educate yourself: Understanding delusions, such as the higher optimism bias associated with grandiose delusions, can be helpful.
People on different ends of the psychosis continuum may be more, or less, receptive to discussions. In general, evidence suggests that loved ones can best help by staying calm, respecting the person, maintaining boundaries, and being aware of treatment centers and emergency resources.
How do you deal with delusions of grandeur?
“Delusions of grandeur” refers to a false belief (or delusion) that you are extremely important, such as being a God-like figure, a celebrity, a genius, or someone who can control the minds of others.
These delusions can be very distressing and affect daily functioning and safety. Furthermore, grandiose delusions can become self-perpetuating. For example, grandiose beliefs often lead to social withdrawal, which may reduce access to disconfirmatory evidence, in turn further exacerbating delusions.
The most effective treatment for patients diagnosed with delusional disorders includes medications (like antipsychotics and antidepressants), talk therapy, and self-care. In some cases, in-patient care may be necessary to get delusional symptoms under control.
What is the difference between grandiose and grandeur?
Delusions of grandeur and grandiose delusions are similar, as they both involve exaggerated feelings of importance. However, in general, the term “grandeur” refers to broader greatness whereas “grandiose” refers to exaggerated self-regard that’s often competitive in nature.
Is grandiosity a symptom of schizophrenia?
Schizophrenia can have both positive and negative symptoms. Grandiosity is one type of cognitive bias (positive symptom) that someone with schizophrenia or another psychotic disorder might experience.
Maintenance factors of grandiose delusions, including fantasy elaboration, manic symptoms, and repetitive thought patterns, can lead to their persistence despite contrary evidence.
How do I stop grandiose thoughts?
Grandiose beliefs are a common type of delusional thinking where one believes they’re extremely special, such as a God-like figure or a genius. Some of the most effective treatments for delusional thoughts include antipsychotic medications, psychotherapy, and sometimes in-patient intensive care.
Some studies, such as the Oxford Cognitive Approaches to Psychosis report that certain psychoeducational programs and talk therapy can be more effective than others, and a present study is even investigating the theoretical integration of virtual reality for treatment with patients able to provide informed consent.
What are the most common delusions in schizophrenia?
According to research published in the Industrial Psychiatry Journal, the most common types of schizophrenic delusions are persecutory delusions. Other common types of delusions include delusions of grandeur, somatic delusions, delusions of control, and delusions of reference.
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