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RESEARCH WEEKLY: Grandiose delusions and treatment engagement
By Elizabeth Sinclair Hancq
(October 11, 2023) Grandiose delusions are false impressions of one’s own importance and can present in different ways. For example, an individual experiencing grandiose delusions may believe they have special powers or abilities or that they are chosen by God. Other examples include feeling superior to other people or feeling invincible. Also, grandiose delusions may manifest in the belief of one’s special purpose or life mission that must be completed. Some individuals may become obsessed with this undertaking.
Despite the prevalence among people with severe mental illness, grandiose delusions are often overlooked in the treatment of psychosis, in part because they can seem less dangerous in comparison to other psychotic experiences. New research published in “Schizophrenia Bulletin” last month sought to examine patients’ difficulties with grandiose delusions, assess how often these individuals engage in behaviors that are operating within the delusions, and factors associated with these individuals seeking help.
Methods
Two cohorts of individuals participated in the University of Oxford in England study. The first was a clinical cohort that included people with affective and non-affective psychosis recruited from mental health treatment centers across England and Wales. The second non-clinical cohort was recruited via social media and had no exclusion criteria; therefore, individuals were not necessarily in treatment for severe mental illness. The cohorts were combined, and people who scored highly on grandiosity were further analyzed on their subjective harm from exceptional experiences, immersion behaviors or actions carried out within a delusion, and thoughts about exceptional experiences.
Results
The vast majority of individuals (78%) with grandiose delusions identified related harms as a result of those delusions. Additionally, the majority of those individuals (55%) expressed the desire for help. Both immersion behaviors and perseverative thinking, or the nonstop thinking of negative events, were associated with subjective harm and whether the individual wanted help for their delusions.
Implications
The findings of this research on grandiose delusions have important clinical implications. Specifically, acting on grandiose delusions, including harmful behaviors and excessive thinking, were associated with wanting help. Clinicians often focus on potentially life-threatening forms of harm, such as physical harm, which is the easiest to see. However, social and emotional harms associated with grandiose delusions, such as “being unable to control overwhelming thoughts about one’s responsibility for saving the world,” are more common and are an important entry point for clinicians to engage individuals into treatment.
Reference
Isham, L., et al. (2023, September). The difficulties of grandiose delusions: Harms, challenges, and implications for treatment engagement. Schizophrenia Bulletin.
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