Symptom Breakdown: Delusions of Grandeur in Schizophrenia

Delusions of grandeur manifest as the belief that the individual is of high social importance, or that they possess highly developed skills of some kind. The individual’s belief in their self-importance is similar to the presentation of narcissistic personality disorder, but occurs only during the psychotic period/acute stage of schizophrenia and is not as extreme in the prodromal or residual stages.

Some sufferers may believe that they have direct contact and influence over an important public figure, or may believe that they themselves are the public figure and the public figure is an imposter. The needs or wants of others become secondary to the individual experiencing a grandiose delusion, as the perceived social importance of the individual is so much greater than those around them.

As mentioned previously grandiose delusions are thought to be the opposite of paranoid delusions, with individuals who experience grandiose delusions reporting higher self-worth, higher self-value, and lower rates of depression than those who experience paranoid delusions  (Garety, et al., 2013), some researchers believe that these positive emotions are necessary for the development and maintenance of the delusion (Lai, et al., 2013). The persistent positivity inherent to these delusions may explain why, when compared to other forms of delusion, these delusions become such deeply held beliefs (Appelbaum, Robbins & Roth, 1999).

Delusions of grandeur are not considered to be dangerous, as they have such a strong association with positive emotions and experiences. However, people suffering from these delusions can pose a danger to themselves or others in very specific circumstances. Individuals who believe that they are powerful or influential in some way but do not want, or feel that they are not worthy of, that power or influence have been known to become suicidal and to become violent or generally aggressive towards others (Joseph, Victor, & Rimona, 2011). For these reasons it is very important for the people around the individual experiencing these delusions to be aware of how they’re responding to the delusion, and whether or not they are in a safe space of mind.

References

Appelbaum, P. S., Robbins, P. C., & Roth, L. H. (1999). Dimensional approach to delusions: comparison across types and diagnoses. American Journal of Psychiatry, 156(12), 1938-1943.

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.

Joseph, Z., Victor, K., & Rimona, D. (2011). “Ego-Dystonic” Delusions as a Predictor of Dangerous Behavior. Psychiatric quarterly, 82(2), 113-120.

Lai, D. C., Chang, W. C., Tam, W. W. Y., Hui, C. L. M., & Chen, E. Y. H. (2013). Cognitive and affective perspectives on formation and maintenance of grandiose delusions of a patient with schizophrenia. East Asian Archives of Psychiatry, 23(4), 160.