Delusions of grandeur (also known as megalomania) describe an overestimated sense of self-worth to an extreme degree. This relates to such things as the delusional idea of being an important person or figure (with a job). Delusions of grandeur often occur as a symptom in mental disorders from the circle of narcissistic or schizophrenic personality disorders.
What is delusions of grandeur?
Delusions of grandeur are a form of delusion and are thus accompanied by the fact that sufferers lose a grip on reality. They are not aware of the nonsense between their own experience and evaluation of the situation and reality, while at the same time no perceptual error is realized on the part of the affected person (ego syntonia). Megalomania is only a subtype of madness and can be further differentiated. It is often a symptom of a narcissistic personality disorder, schizophrenia or manic depression at the time of mania. Even proving that the content of the delusion is a misperception will not change the subjective belief of the person affected. In this case, the delusion of grandeur is so pronounced that affected persons believe themselves to be, for example, a religious or political figure. They may also be a great inventor or destined to redeem mankind. Accordingly, delusions of grandeur can take on very different forms and range from excessive overconfidence to a readiness for martyrdom. For historical reasons, it must also be distinguished from the Caesar mania: This refers to the belief in one’s own infallibility and the greed for universal significance of many leader personalities in monarchist or absolutist systems. However, it is unclear here to what extent the psychological suffering per se is meant and to what extent the description of historical figures is due to the cult of personality and contemporary observation. Accordingly, in the case of delusion in the sense of a disease, the Caesar delusion is excluded, although this is also called delusion of grandeur in common usage.
Causes
The delusion of grandeur can be explained in its origin most like a mania. Thus, however, many triggers are also considered unexplained here. The only thing that is certain is that manias of all kinds are often associated with depression (and a corresponding imbalance in hormone balance). Thus, delusions of grandeur are always accompanied by an enormous feeling of elation, which speaks for a disturbance in the system of neurotransmitters. The dopamine and norepinephrine levels are significantly elevated in affected individuals in most cases. In addition, delusions – unlike hallucinations – are tied to a stimulus. In most cases, a more or less concrete reference point can be identified. In the case of megalomania, this is often a historically or currently significant person with whom the sufferer identifies. The mechanisms that lead to the selection of the supposedly imitated person, for example, are not known. However, people with disorders that have delusions of grandeur as a symptom are particularly prone to delusions after drastic experiences. These may be breakups, a career change, a death, and much more. Basically, all major events are likely to negatively influence a mental illness.
Symptoms, complaints and signs
Megalomania is manifested as a delusion by the fact that the delusion is not contradictory, irrefutable and reliveable for the sufferer. Thus, the megalomaniac does not mime a great personality, but actually believes he is such. He may be (or have been born to be) a great politician, a warlord on a mission, or simply a man of genius. The symptoms that accompany this are correspondingly different. What they all have in common, however, is an increased feeling of elation, a strong sense of self-esteem, a loss of empathy, an increased readiness to act, and the development of paranoia. The latter often feeds on the conviction of those affected that their mission would be hindered by others. According to the historical models that are often used for the content of the delusion, this is consistent in itself. The delusion of grandeur can be divided, for example, into a political delusion, a religious delusion, a delusion of omnipotence, a delusion of world improvement, and a self-centered delusion of exaltation.The symptomatology varies from espousing a strong conviction to actually engaging in all sorts of activities to prove one’s omnipotence. Characteristically, even failure – no one listens or follows; ideas prove impractical; actions fail – does not cause the madman to doubt. Further, megalomaniacs show a tendency to disregard legal and social norms. Long episodes of madness (however, it can also become chronic) are expressed in the fact that the complete life can be subordinated to the madness. More subtly, however, the megalomania occasionally manifests itself: for example, when a delusion of world improvement leads to a very restricted conversational behavior. The further symptoms of megalomania are to be assigned to the illnesses, which cause the megalomania itself. These include depressive episodes in manic-depressive disorder, disturbed perceptions in schizophrenia, or disturbed bodily sensations in very pronounced narcissism. The symptoms of mania itself – that is, the effects on the actions of the person affected – can vary greatly. They range from episodic delusions of grandeur (usually due to a trigger) to chronic delusions of grandeur that have taken complete possession of the sufferer. Signs of delusions of grandeur can only be seen by outsiders, as delusions by definition do not allow for questioning of one’s own perceptions. Relatives will notice in people who fall prey to a delusion that they exhibit behavior that appears irrational. Sufferers tolerate less to no contradiction or do not respond to it. Sometimes they try to prove the content of their delusion. Accordingly, it can lead to actions that are perceived with great concern by those around them, such as preaching in the open street or presenting all kinds of supposed inventions. In cases of manic-depressive disorder or schizophrenia, however, it is more common for the other symptoms of the particular illness to manifest themselves first.
Diagnosis
The diagnosis of delusions of grandeur is based on the other conditions noted as well as the definition of the delusion. If the affected person is completely convinced of the content of his megalomania and shows appropriate behavior, the diagnosis is easy. However, a great deal of emphasis must be placed here on the precise diagnosis of the associated conditions, since megalomania is not treatable in itself. Finally, it results in almost all cases from other mental disorders. In addition, this form of mania must still be examined for possible organic causes. Imaging procedures regarding the brain are part of this. The discussions with the affected person are usually completed by discussions with relatives. For the further course it is important that the megalomania is understood and correctly classified by the treating physicians. In addition, other symptoms must be able to be separated from the delusion. Accordingly, the diagnosis can take a long time. Accordingly, as with many mental illnesses, many years often pass between the onset of the illness and the diagnosis.
Complications
The complications that can occur in the context of megalomania are numerous and strongly dependent on how pronounced the pathological perception is. For example, some forms of megalomania are comparatively harmless and may, for example, in the worst case merely mean financial loss due to excessive cultivation of a hobby of tinkering or publishing. In more serious cases, the megalomaniac can get into all kinds of situations due to his madness, which put him and others in danger. Mentioned here, for example, are situations in which the sufferer presents himself as a leader figure and tries to convince strangers of his worth. The same applies to unsolicited preaching or other proclamations of messages. However, while in these cases the purely verbal level is seldom left, a delusion of salvation or an omnipotence delusion mean a risk for completely absurd actions. For example, the belief in one’s own infallibility may lead the sufferer to interfere in medical operations, at construction sites or elsewhere, or even to take action himself. Accordingly, the megalomaniac can also cause immense damage if he is given the space to act. Not to be underestimated are also the financial, professional and social complications that accompany megalomania.For example, many forms of delusion, especially when they become chronic, mean that sufferers become incapacitated. Social problems result from a lack of acceptance of reality as well as paranoia. In extreme cases, self-mutilation or suicide occurs due to the megalomania. This may occur, for example, when the sufferer believes himself to be a religious martyr or is convinced that his demise may otherwise be profitable for those around him (or humanity).
When should one go to the doctor?
Basically, a delusion of grandeur together with the other disorders associated with it is a case for a visit to a doctor. Here, psychiatrists and other doctors who specialize in mental illnesses are in the foreground. The competencies of general practitioners, on the other hand, are quickly exhausted. In this context, it is problematic that the delusion as such is not seen as a problem by the megalomaniac. At best, other symptoms therefore push him to a psychiatrist, who then recognizes the megalomania. In many cases, excessive delusions of grandeur may also prompt relatives to take the step of seeing a doctor. This can sometimes (if there is a danger to life and limb) also result in a forced admission to a psychiatric sanatorium.
Treatment and therapy
Treatment of delusions of grandeur involves treating the underlying disorder. This also explains the importance of an accurate diagnosis. This involves medication where it seems possible. Neuroleptics help to reduce the psychotic episodes (which seem to be responsible for some forms of megalomania). Therapy is usually hampered by the lack of insight of the sufferer himself. Accordingly, coercive measures may be used in some cases. In cases of known illnesses, such as manic depression or schizophrenia, the treatment plan is designed according to these illnesses. It can be assumed here that delusions of grandeur will be treated as a symptom as well. A strongly manifested delusion of grandeur, on the other hand, is considered difficult or even impossible to treat. If the affected person cannot be brought to any insight and other symptoms do not mean a strong need for action, a delusion of grandeur can accordingly also remain. In the case of organic causes (brain damage), neuroleptics can be used at best. However, no causal cure is to be expected here.
Outlook and prognosis
According to the very different courses of mental illness, it is difficult to provide a unified prognosis. It is the case with many forms of megalomania that there is some likelihood of relapse despite cure. This is especially true when key stimuli can promote the content of megalomania. Basically, different psychological conditions have different probabilities of developing megalomania as a symptom. It is very common in narcissism and manic-depressive disorder. Delusions of grandeur can also manifest themselves throughout life. If it only leads to an obsession (for example, for inventions, a hobby, or a political orientation), the affected person can live with it well, insofar as it is otherwise socially functional. Other forms of megalomania, on the other hand, which result in sometimes dangerous or highly irrational acts, impose a permanent burden. Moreover, the prognosis depends primarily on the underlying disorder.
Prevention
There is no way to specifically prevent megalomania. Only the best possible protection of one’s mental health can prove beneficial. However, due to the complexity underlying the development of most mental illnesses, even this is only possible to a limited extent.
Aftercare
Delusions of grandeur require follow-up care only if there was a need for treatment. As a rule, megalomania has no disease value. However, if other people come to harm as a result or if the affected person suffers from his or her own delusions of grandeur, aftercare may be appropriate. The decisive question is whether a pathological overestimation of one’s own abilities occurred in the context of a mental illness requiring treatment. Delusions of grandeur are often the result of an affective disorder or mania. If a manic episode occurs, an aftercare period following acute treatment is also useful. Since mania occurs in episodes, a reversal of megalomania is usually observed in the phase between two manic episodes.Dealing with shame, feelings of inferiority and regret is not exactly easy when you have just felt great and full of energy. Sufferers need help in the aftermath of an acute episode. However, a mild form of megalomania, for example in a neurotically predisposed person, has no disease value. At best, such people are irritating. They may cause trouble with their exaggerated sense of self, but they usually do no harm to anyone. This is called hypomania. Since this usually does not turn into mania, neither treatment nor aftercare is necessary. Nevertheless, with the help of psychotherapy, these people can also become more realistic in their self-assessment.
Here’s what you can do yourself
Due to the definition of megalomania, there are no ways in which sufferers can help themselves. This would require an insight into the illness, which, however, cannot be given in the case of megalomania. Only an attentive environment can act in such a way that it induces the affected person to seek treatment as early as possible. Since in most cases these are people suffering from mental illnesses, this is also desirable with regard to these courses of the disease.
