Overview Show A delusion is a false belief held by a person. It contradicts reality or what is commonly considered true. The strength of a delusion is based on how much the person believes it. Specifically, a delusion of grandeur is a person’s belief that they are someone other than who they are, such as a supernatural figure or a celebrity. A delusion of grandeur may also be a belief that they have special abilities, possessions, or powers. Delusions are generally the result of a mental health disorder. However, not all people with delusions meet the full diagnostic criteria for any mental health disorder. Many types of mental health disorders classified as psychotic disorders can lead to delusions. These include: Psychotic disorders can change a person’s sense of reality. They may be unable to tell what is real and what is not. Any delusion has four main characteristics:
Delusions of grandeur can take many forms, such as beliefs of: Having a special ability, object, or talentThe person with the delusion may believe that they have a secret talent, object, or ability that no one else has or even knows about. For example, they may believe they possess a secret record from Elvis Presley that no one else knows about. Being a famous personA person with a delusion of grandeur may actually believe that they are a famous person and that the real famous person is an imposter or decoy. Having a secret connectionThis delusion involves believing in a special and sometimes secret connection or relationship with someone or something important. For example, a person with this delusion of grandeur may believe they are a spy or that they alone are responsible for relaying messages to the president or other world leaders. Religious grandeurA person with a religious-themed delusion of grandeur may believe that they are a religious leader. Delusions of grandeur can be difficult to identify because the person having them believes the delusion to be true. Also, delusions can be hard to distinguish from what is called an “overvalued idea,” or a belief a person has that isn’t totally accurate, but isn’t exactly a delusion, either. One study used the example of gambling — if a person is a regular gambler, they probably believe they have an ability that allows them to win. But this is generally not considered a delusion of grandeur. The key marker of delusions of grandeur is that they are not tied to a person’s experience. So, a person who regularly gambles and believes he is close to winning, even if he’s not, isn’t necessarily delusional. This is because the belief is tied to the action. A delusion, on the other hand, is usually not related to anything happening in life at the moment. A delusion of grandeur would be more like a belief you can fly or that you are secretly the star of a reality TV show. A delusion of grandeur is easier to spot if it occurs with other mental health symptoms. Delusions of grandeur are more common with bipolar disorder and schizophrenia. If a person has a history of bipolar disorder and has had delusional thoughts in the past, delusions are more likely to happen again. In some cases, delusions can also be brought on or intensified by the use of substances such as alcohol or marijuana. Also keep watch for the effects the belief has on the person’s life. If the false belief is so great that it has changed how the person lives life or performs daily activities, it could be a delusion. If you have any concerns about your thoughts or if you think a loved one may be having delusional thoughts of grandeur, you should see a doctor. A psychiatrist is the preferred expert, but a general practitioner can help with a referral. Research shows cognitive behavioral therapy can help treat delusions of grandeur, but the outcome depends on the underlying mental health disorder. If you have any thoughts about harming yourself or others, call 911 immediately. And if you witness someone having a delusion and are concerned they might harm themselves or others, call emergency services. A mental health emergency is just as real as any other kind of emergency. You can also call the hotline from National Alliance on Mental Illness, Monday through Friday, from 10 a.m. to 6 p.m. EST at 1-800-950-NAMI. You can also text “NAMI” to 741741 anytime for help for you or a friend. If you think you’ve had delusions of grandeur, know that you are not alone. Many people face mental health challenges, and resources are available to help you manage your health. You can seek help anonymously online, speak to your doctor, or confide in a trusted friend who can help arrange for you to see a specialist. All of these options can get you started on bettering your mental health. Q: My mother is 80. She is very active (despite breaking her hip 2 years ago), she still attends water therapy 3 times a week at the YMCA, she drives to the base (which is 20 miles away) and pays her bills on time. She is a retired Psych nurse and has shown signs in the past of paranoia. Lately, she has “heard” voices of her grandchildren in her home and called my sister. She also has difficulty with getting the right words to say out and has her sleep pattern out of whack and will call people at odd times of the night. With her independence comes the fact she won’t share any medical information because she thinks we are out to get her committed. How can I test her/question her to find out the level of decline she may be in to make sure she is safe? — K A: Great question. As you may know, it’s fairly common for aging parents to develop problems like the ones you are describing. Understandably, these problems are frustrating and worrying for adult children. You are absolutely right to be concerned about your mom’s safety. I do have some ideas for how you can get started assessing her, which I share below. But first I want to explain the most common causes of this type of behavior in older adults. That’s because one of the things you must do is help your mother and the doctors figure out why she’s developed these behavior changes and other symptoms. A fair number of people don’t get around to the medical evaluation because they assume that these crazy behaviors are either normal aging (definitely false) or dementia such as Alzheimer’s (true about 40% of the time). Furthermore, it’s often hard to get a resistant older parent medically evaluated. Still, it’s worth persisting in this, because many causes of paranoia or other odd behavior in older people can be treated. Paranoid symptoms (e.g. believing that someone is out to get you, or is taking your stuff, or is in the house at night) falls into a category of mental symptoms that is technically called “psychosis.” Symptoms of psychosis can include:
Psychosis is uncommon in younger people but becomes much more common as people get older. That’s because any of these symptoms can emerge when people’s brains aren’t working properly for some reason. A 2015 review article on “late-life psychosis” estimates that 23% of people will develop symptoms of psychosis in late life. I like this review article because the authors organize the causes of late-life psychosis into six “Ds”:
The authors of this review article also note that it’s common for older adults to have vision and hearing problems, both of which can trigger or worsen delusions and hallucinations. So as you can see, when older adults experience delusions, hallucinations, and paranoid thoughts, there is almost always something more going on with their health. Figuring out what is beneath the “crazy” or “irrational” or “paranoid” behavior is key. Hence I recommend you keep these six causes of paranoid symptoms in mind, as you try to find out more about how your mom has been doing. How to check on “levels of decline” and safetyIt’s great for you to be proactive and want to help check on your mother safety and situation. Ultimately you’ll need to work with professionals, but you can speed the process along by checking for common red flags, and bringing them to the attention of your mother’s doctor. As a geriatrician, I generally try to assess an older person in the following five domains:
Because concerned family members often ask me about checking on an older parent, I created a guide with five checklists based on the five sections above. You can print the guide and use the checklists to spot these red flags that often represent serious safety or health problems. Now, no guide is going to enable you to diagnose your parent. And no guide can guarantee that you’ve identified and addresses the most important safety issues. You’ll need to work in person with professionals to do that. But by being methodical in observing your mom and in documenting your observations, you will make it much easier for professionals to figure out why your mother has developed these behaviors you are concerned about. Also, by identifying specific red flags or problem areas, you’ll be better equipped to work with your mom and other family members on addressing safety concerns. That’s because it’s much more effective to focus on issues that are specific and concrete (“I noticed that you seem to be having trouble with your grocery shopping”), rather than simply telling an aging parent that you are worried about their safety. Tips on following up on safety issues and memory problemsOnce you’ve identified safety issues and signs of underlying health problems, you’ll want to follow up. You’ll need health professionals to help evaluate and manage any underlying health problems, and you may find you need help from other types of experts as well. If your older parent is paranoid and resisting your involvement, this often becomes a stuck spot for families. How to get unstuck depends on the situation. Here are some ideas that often help:
When it comes to contacting the doctor and hiring an expert to help, it’s best if you can get your mom’s agreement before proceeding. (Or at least, not have her explicitly forbid you from doing these things). Here are some tips to help with your conversations:
For more suggestions on approaching a parent who is resistant to help, see this article: “4 Things to Do When Your Parents Are Resisting Help.” Now, if you find it causes your mother intense anxiety or agitation to discuss your concerns and your suggestions for helping her, it may be reasonable to just proceed. After all, you do have reasons to believe that some kind of health issue is affecting her thinking. So especially if you’ve identified any safety problems, it’s reasonable to move ahead despite her preference that you not intervene. In closing, I’ll reiterate that this is a very tough situation to navigate, and it usually takes time and persistence for families to make headway. Do try to take care of yourself as you work through this. Connecting with others facing similar challenges is a great way to get support and practical ideas on what to do next. Good luck! This article was first published in 2016; it was reviewed & minor updates were made in August 2022. |