I am wondering if delusions of grandeur (eg, I am God, prophet, world leader, secret agent) are cognitive attempts (ie, functional processes) to compensate for immense feelings of inferiority and powerlessness that some patients experience? Or rather if these delusions are organically caused by anatomical or physiological dysfunction? Is there research to support either of these alternatives?

It is a difficult question. There are psychological explanations e.g, there is a relationship between paranoid symptoms and grandiosity. Anyone who is paranoid about people following them or being after them has some element of grandiosity in it as well. In addition, there is abnormalities in many areas in the brain including the limbic system. Some studies are suggesting a stronger relationship between bipolar disorders and schizophrenia and we know that in manic state people have grandiose ideas. There is some genetic linkage between Bipolar disorder and schizophrenia. This is the reason in DSM 5, Bipolar disorder is excluded from Mood disorders as it is more closely liked to schizophrenia.

Historically there has been a divide between neurosis and psychosis in diagnostic schemas, who is expert in these areas, and associated separate research and treatment.

It has been argued though that these are intertwined; that 'in many cases delusions are a direct representation of emotional concerns, and that emotion contributes to delusion formation and maintenance' - see:

Freeman, D., & Garety, P. A. (2003). Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behaviour research and therapy, 41(8), 923-947.

There would appear to be some 'meaning making' going on beyond the 'neurotransmitter imbalances' you mention.

Regarding the issue of delusions of grandeur in particular, and their being 'so common', there are cultural difference in the literature that are worth considering. For example, there were significant differences in the frequencies of delusions of grandeur, guilt and religious delusions between patients experiencing schizophrenia in Austria and Pakistan:

Stompe, T., Friedman, A., Ortwein, G., Strobl, R., Chaudhry, H. R., Najam, N., & Chaudhry, M. R. (1999). Comparison of delusions among schizophrenics in Austria and in Pakistan. Psychopathology, 32(5), 225-234.

The diagnosis of a mental disorder is based on symptoms that are not related to the emotional experiences that have resulted in a particular defensive strategy generated to manage the anxiety of whatever experience(s) contributed to the disorganized thinking characteristic of schizophrenia. Delusions of grandeur are part of the defense system. Delusions are neurological in that they are neural pathways that have crisscrossed or mixed with each other and disabled the network related to a problem with a major chemical imbalance and psychosocial in that it is traumatic life experience that overloaded the mind in a way that prohibited a more effective defense. An individual's ontogenetic endowment and the challenges of the environment are factors in the development of delusions of grandeur.

To start with the diagnosis of schizophrenia is a hit and miss affair with little basis in science. While delusions of grandeur are common in patients it is a mistake to see this as a sign of disease. People with mental disorders feel threatened much of the time, threatened by dissociative thought and threatened by their environment and the people in it. The second of these fears is often very real and constructing a 'protective carapace' of grandeur may simply be a method of taking control. Delusions of grandeur should be seen as a reaction to the illness not a sign of it.

Barry,

Thanks for your response. Personally, I think there is abundant evidence for a diagnosis of schizophrenia, though I will admit that it can be misdiagnosed, especially in a differential diagnosis between Bipolar Disorder, Schizoaffective Disorder, and Major Depressive Disorder.

While I concede that delusions of grandeur COULD be, at least in part, a reaction to illness, I don't think it would be accurate to contend that all delusions are not included in the signs and symptoms of several DSM disorders. Do you have any research references that you would like to share that support your POV?

Neil

I am a little sceptical of many of the 'research references' that circulate among psychiatric circles and have little faith in diagnostic markers that range across such a wide range of non empirical criteria. I recognise that some conditions are characterised by certain signs, but then again so are societal norms.

I was not suggesting that the delusions of grandeur were a reaction to 'the illness', rather a reaction to the treatment of those marginalised by these 'diagnoses'.

I have a lot of experiences with patients and have in the last three decades met quite a few Celtic Gods, reincarnations of Christ and Buddha and members of the aristocracy of many countries (strangely enough I have never met Napoleon, in spite of he providing the archetypal delusion of grandeur)

In just about all cases the delusion appeared to me to be a shield rather than a symptom and I have observed this in people who are not in any sense psychotic or personality disordered, whatever that means. I can appreciate that it is convenient to label people but helpful it is not.

As for the DSM, with so many psychiatrists now rejecting this gaggle of theories and nostrums I have no further comment.

Barry,

You've made some interesting observations. How is it possible to meet a person who claims to be a Celtic God, or Christ, or Buddha (the entity itself, not a disciple or an emissary) and believe that the person in question is "not in any sense psychotic or personality disordered"?

It seems likely that such a belief is some type of shield from the trials and tribulations of our world, but such unusual defenses are precisely what causes one to question their connection to what most clinicians would consider the objective world.

We'll have to agree to disagree on the merits of the DSM. For better or worse, it is the standard of the diagnosis of psychological disorders. There may be many professionals who reject or question some elements of it, but I personally know of no clinicians or researchers who reject it wholesale.

One particular Celtic God I used to know was always threatening suicide but his motive was interesting.  It was not that he would die it was that should he, as he often threatened jump in front of a train the whole of the human race would come to an end.

He died in suspicious circumstances which involved a set of weights being dropped across his throat during what appeared to be a normal exercise session.  It was uncertain whether this was an accident caused by a heart attack or whether he had deliberately done this.  

It was a sad loss and a sad end to what had been a very sad and disturbed life but it appears that the human race survived.

Delusion of Grandeur is comparatively MORE common in Mania (Affective disorder) than in Schizophrenia. 

So if any relations are to be hypothesized, it would be better to go with organic predisposition of mood/affect disorders. probably you could think of serotonin for example 

This question is intriguing but it s related to the wider question: why delusions more or less can be classified in few typical fields in psychosis? Most of the time delusions concern grandeur ( grandiosity ), persecution ( danger from the outside, or toxic substances put inside ), relatedness ( voices, thought transmission,etc), bodily trasformations. All these themes have the common factor of describe a status of the self, a distortion in the relation between ourself and the world.

Well also erotomania concern the relation between ourself and the world

Theories of delusion formation don't address the sources of disparate delusional themes. Does difference lie in early experience? Are delusional themes chance phenomena? Some people with delusions switch themes over time, from somatic to paranoid for instance but, in most cases, the same general theme reappears with each episode recurrence, although specific targets of preoccupation may change. There is a touch of grandiosity in erotomanic delusions. In general, chronic grandiosity is very hard to treat since the person, while distressing others, is not himself/herself distressed. Is there a good biography available of a person with delusions of grandeur? There is The Three Christs of Ypsilanti (1964) but I don't remember that the book went into the early histories of the three protagonists.