Grandiose Delusions

Delusions are associated with psychosis or mania, and as such are considered a serious medical condition. In some instances, the delusions may be the only symptom of mental illness present, and they may not even be recognized as a sign of a mental disorder.

Manifesting in connection with a variety of mental and physical conditions, grandiose delusions are the second most common type of delusion, trailing only persecutory delusions in their rate of incidence. Grandiosity is defined as an exaggerated sense of self-importance, and people with clinical delusions of grandeur do in fact have a distorted and unrealistic belief in their own greatness.

Delusions of grandeur are signs of an underlying mental health condition, and those who are absorbed by their delusions will need expert intervention to restore their relationship with reality.

People absorbed by grandiose delusions spin fantastic stories in their own minds, casting themselves in the role of the hero. They don’t realize their expansive delusions are based solely on imagination, and unless and until they get help they will remain absolutely convinced their delusions are real, despite the best efforts of their loved ones to persuade them otherwise.

Delusions of grandeur can be molded into a vast array of forms. Wrapped up in their megalomania, people with grandiose delusions may believe they are:

• Blessed with great intelligence or beauty
• Destined to accomplish great things, or to be rich and famous
• More important than other people
• Misjudged and unappreciated by friends and family
• Possessed with supernatural powers
• Secretly wealthy
• Connected to powerful people, who rely on them for advice
• Already famous, but hiding behind a secret identity

Delusions of grandeur are different from narcissism or egomania, since they are based on false perception rather than self-serving assumptions. Those who experience these delusions see them as objective facts, which it would be illogical not to acknowledge. They don’t go out of their way to draw attention to themselves, but are simply acting in ways that from their perspective seem totally rational.

When megalomania and delusions of grandeur are the only apparent symptoms of ill health, the person may be exhibiting symptoms of grandiose delusional disorder. This is one of six varieties of delusional disorder, and people who have this condition may appear perfectly normal despite their unshakeable belief in their own importance.

If they have a mild-to-moderate disorder, they may be able to function without much difficulty, and their outward appearance and behavior may give no hint to the depth of their grandiose fantasies. More severe forms of delusional disorder can be more disabling, and interfere with functioning in a number of ways, but even then the person may appear normal much of the time.

Delusional disorders (of all types) are rare conditions. Only two out of every 1,000 people will be diagnosed with a delusional disorder, and only about one percent of those who request mental health treatment services will have one. Consequently, most people who experience persistent delusions of grandeur will have other conditions that cause that effect.

Grandiose delusions are a common side effect of certain mental and behavioral health disorders. Studies of these conditions have found the following rates of incidence for this type of delusion:

• Bipolar disorder, 59-88 percent
• Schizophrenia, 40-49 percent
• Substance use disorders, 30 percent
• Depression, 21 percent

With bipolar disorder, delusions of grandeur are associated with manic states, and are one of the primary markers of that half of the condition. Grandiose delusions associated with schizophrenia are usually accompanied by hallucinations and other symptoms of a psychosis, and in this context, they are a sign of a serious mental illness that needs immediate attention.

In some instances, grandiose delusions may manifest as a side effect of physical illness, neurological disorders, or poor nutrition. These types of delusions are known as secondary mania, and some of the conditions known to cause them are Huntington’s disease, Parkinson’s disease, hypothyroidism, brain tumors, multiple sclerosis, and chronic deficiencies in B vitamins, specifically B3 and B12.

Up to 10 percent of the population will experience grandiose delusions at some point in their lives. But in most instances these thoughts and feelings are only temporary, and do not represent a true break with reality.

Residential treatment programs for delusional disorders, bipolar disorder, schizophrenia, major depression, and substance use disorders are comprehensive and inclusive, meaning they are designed to address all symptoms of poor mental health (including delusions) with evidence-based treatment methods.

Each of the conditions that produces grandiose delusions has specific treatment protocols. But regardless of the disorder involved, dealing with grandiose symptoms is a delicate and complicated process.

Therapists will not confront expansive delusions abruptly, since that approach could cause significant distress, extreme confusion, and a catastrophic loss of self-esteem. Instead, they will strive to deconstruct the delusions gradually, at a pace that won’t stress the patient but will keep them fully engaged in their recovery as their awareness of reality slowly grows.

In addition to therapy, medications may be administered, with the list of possibilities including antipsychotics (for schizophrenia), antidepressants (for depression), and mood-stabilizers (for bipolar disorder). These may or may not have an effect on the delusions, but could be necessary to treat other symptoms of the underlying disorders responsible for the grandiose beliefs.

Grandiose delusions—and the disorders that cause them—take time and effort to overcome. But with proper treatment and the support of loved ones, people lost in delusional fantasies can eventually reconnect with reality, giving them the freedom to choose their fates and to no longer be controlled by false perceptions.

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