Sense of meaning key contributor to grandiose delusions

An overall sense of meaning was found to be inherently tied to grandiose delusions, results from a cross-sectional, self-report questionnaire study showed in The Lancet Psychiatry.

“Grandiose delusions are unfounded or inaccurate beliefs that one has special powers, wealth, mission or identity. These beliefs are relatively common — representing approximately a third of delusions experienced by patients diagnosed with non-affective psychosis and up to 60% of those in bipolar mania,” Louise Isham, MA, MSc, DClinPsy, a research clinical psychiatrist with the University of Oxford, and colleagues wrote.

Isham and colleagues aimed to define and develop measures of the experience of meaning in grandiose delusions and the sources of the meaning. They also tested whether the severity of grandiosity in clinical and nonclinical populations is associated with a level of meaning.

The researchers administered a questionnaire in two cohorts: nonclinical participants aged 18 years and older, with U.K. or Irish residence; and patients with affective or nonaffective psychosis diagnoses, aged 16 years and older, who were accessing mental health services in England and Wales.

A total of 13,323 nonclinical patients were enrolled from Aug. 20, 2019, to Nov. 21, 2020 (mean age, 39.5 years; 76% female). A total of 798 patients with psychosis were enrolled from March 22, 2021, to March 3, 2022 (mean age, 43.4 years; 60% male).

Participants with high grandiosity completed two large item pools: one assessing the experience of meaning in grandiose delusions; and one assessing the source of meaning. The authors used structural equation modeling to test the association of meaning with the severity of grandiosity.

Isham and colleagues reported the experience of meaning in relation to grandiose delusions had three components: coherence, purpose and significance. The source of meaning had seven components: positive social perceptions, spirituality, overcoming adversity, confidence in self, greater good, supporting loved ones, as well as happiness.

According to the study, the measurement of meaning was invariant across both the clinical and nonclinical cohorts. In clinical participants, each person typically endorsed multiple meanings and sources of meaning for the grandiose delusion.

Meaning in grandiose delusions was strongly associated with the severity of grandiosity, contributing 53.5% of variance, while grandiose delusion conviction showed 27.4% of variance. Grandiosity was significantly associated with sense of purpose, as well as grandiose delusion conviction with coherence. Similar findings were shown in the nonclinical population.

“This study provides a framework for research and clinical practice to understand the different types of meaning of grandiosity,” the authors wrote. “The framework is likely to have clinical use in psychological therapy to help guide patients to find sources of equivalent meaning from other areas of their lives and thereby reduce the extent to which the grandiose delusion is needed.”