or a famous person. More commonly, those with delu-
sions of grandiosity may believe that they have
achieved a great accomplishment for which they have
not received sufficient appreciation and respect.
Some theorists believe that delusions of grandios-
ity result as a consequence of low self-esteem and
negative emotions. This is known as the delusion-as-
defense hypothesis. Other researchers argue that the
delusions of grandiosity are an exaggerated manifes-
tation of the individual’s true emotions and belief.
This is known as the emotion-consistent hypothesis.
One study investigated both hypotheses in a sample of
20 patients with grandiose delusions and found that
there were no differences between covert and overt
self-esteem in the sample. The authors of the study
concluded that the grandiose delusions may be exag-
gerations of the emotional state of individuals.
Grandiose delusions can be associated with schizo-
phrenia or delusional disorder and are a common
symptom of the manic phase of bipolar disorder.JJeeaalloouuss DDeelluussiioonnss
Jealous delusions, or delusions of infidelity, involve
the false belief that the delusional individual’s spouse
or sexual partner is unfaithful or having an affair.
Delusional jealousy can involve stalking or spying on
the spouse/lover as the delusional individual seeks
evidence to confirm the existence of the affair. This
type of delusion often stems from pathological jeal-
ousy and can seriously affect romantic relationships,
and in certain cases the delusional individual’s jeal-
ousy can escalate into violence and even murder.PPeerrsseeccuuttoorryy DDeelluussiioonnss
Individuals with persecutory delusions believe that
specific individuals, or people in general, are “out to
get them.” Individuals with delusions of persecution
suspect that others are participating in intricate plots
to persecute them. In some cases, they may believe
that they are being spied on, drugged, or poisoned. In
more extreme cases, the individuals may believe that
they are the subject of a conspiracy and someone
(often a government agency) wants them dead. Some
delusions of persecution are vaguer and more general,
such as the false belief that one’s coworkers are giving
one a hard time. In other cases, the delusions can be a
network of numerous well-formed false beliefs that
are highly intricate and involved, such as an elaborategovernmental conspiracy that can explain every
aspect of the individual’s life.
Persecutory delusions are a hallmark symptom of
several disorders, including paranoid schizophrenia;
delusion disorder, paranoid type; and paranoid per-
sonality disorder. Paranoid delusions have also been
noted in cases of severe depression and dementia.OOtthheerr DDeelluussiioonnss
Other types of delusions include delusions of control,
nihilistic delusions, delusions of guilt or sin, somatic
delusions, and delusions of reference. Those with delu-
sions of control have the false belief that someone else
is controlling their thoughts, emotions, and behaviors.
This can include the belief that outside forces are insert-
ing or removing thoughts from their mind, that their
thoughts are being broadcast out loud, or that someone
is controlling their bodily movements. Nihilistic delu-
sions refer to false beliefs that the world is coming to an
end. Delusions of sin or guilt refer to intense feelings of
guilt or sin for something the person has not done; for
example, individuals with such delusions may falsely
believe that they have committed a horrible crime for
which they should be punished or that they are some-
how responsible for natural disasters, even though this is
impossible. Somatic delusions usually involve the false
belief that the individual has a medical disorder or a
physical deformity. These beliefs differ from hypochon-
driasis, as somatic delusions are often very specific and
in some cases quite strange. Finally, individuals who
experience delusions of reference believe that they may
be receiving special messages from the television, news-
paper, radio, or the way things are arranged around
them. Individuals with this disorder may believe that
people are talking about them or taking special notice of
them even when that is not the case.
Delusions of control, nihilistic delusions, and delu-
sions of reference are considered bizarre delusions.
However, persecutory delusions, somatic delusions,
grandiose delusions, as well as most delusions of jeal-
ousy and guilt are generally considered nonbizarre.Assessment of Delusions
If a delusional disorder is suspected, an individual
should be evaluated by a physician to rule out any
organic etiology (such as dementia). This may include a
thorough medical history, a review of the medications
the patient is taking, blood workup, and possibly brain194 ———DelusionsD-Cutler (Encyc)-45463.qxd 11/18/2007 12:41 PM Page 194