Megalomania (grandiosity)
En español: lee sobre esta manía en Fobias.org.
You may have heard megalomania used about a boss, a celebrity or a politician, usually as a criticism. Or you may be here because someone you love has started talking about a special mission, secret powers or a plan to change the world, and you are worried. Those are two very different things.
This page explains the difference between the everyday word and clinical grandiosity, where grandiosity can show up and when to get help. Being confident or ambitious is not a problem, and nothing here is meant to label anyone.
What it is
In everyday speech, megalomania means an inflated sense of your own importance or power. It is an opinion, often an insult, not a diagnosis, and doctors rarely use the word today. In mental health the terms are grandiosity and grandiose delusions. The NHS describes a delusion as an unshakeable belief in something untrue, and a grandiose delusion as believing you have special power or authority, such as being a national leader or being able to raise the dead.
Grandiosity is a symptom, not a condition in itself. It can appear during mania in bipolar disorder, when people may feel untouchable or that they understand things others cannot. It can be part of psychosis, which can happen with schizophrenia, bipolar disorder or very severe depression. It is different from narcissistic personality disorder, where a person has an inflated sense of self-importance and a strong need for admiration, often with fragile self-esteem underneath, but does not lose touch with reality.
Nobody can be diagnosed from a distance, from the news or from social media, and that includes public figures. Only a professional who has properly assessed someone can say what is going on.
How it differs from a phobia
A phobia is a fear that makes you avoid something. Grandiosity is not a fear at all. It is a change in how someone sees themselves, often linked to changes in mood, energy or contact with reality, and the person usually feels certain rather than anxious.
Read more about manias and phobias
Common signs
- Firm belief in special powers, talents or identity
- Feeling chosen for a unique mission
- Ideas that do not shift whatever the evidence
- Anger or suspicion when others doubt the belief
- Big announcements of discoveries or plans
- Much less sleep and more energy, when linked to mania
When it tends to show up
- During a manic episode in bipolar disorder
- After several nights of very little sleep
- During or after heavy alcohol or drug use
- During a relapse of psychosis
- At times of intense stress
- Rarely, in the weeks after having a baby
- At work, with promises that cannot be kept
- Online, contacting famous people or authorities about a mission
Symptoms
In your body
- Lots of energy and little need for sleep, when linked to mania
- Fast or non-stop speech
- Restlessness and constant activity
- Exhaustion once an episode passes
In your mind
- Certainty about having special powers or status
- A sense of a unique mission
- Fast-changing ideas
- Difficulty accepting the belief might not be true
- Frustration or anger when others disagree
What you might do
- Announcing big projects or discoveries
- Spending or investing large sums at once
- Contacting important people or the media
- Leaving work or study for unrealistic plans
- Neglecting sleep, food or self-care
What causes it
There is no single cause, because grandiosity depends on the condition it is part of. With mania and psychosis, family history plays a part, and poor sleep, stress, drugs or alcohol, some prescribed medicines and childbirth can trigger an episode. With narcissistic personality disorder the cause is not known, but genes, brain function and early experiences such as too much admiration or too much criticism may all contribute. In no case is it a moral failing or something a person chooses.
How it can affect your life
Someone going through grandiosity often feels very good or very sure of themselves and does not see a problem. Family and friends usually notice the effects first: debts, risky work decisions, rows over different opinions or promises that cannot be kept. When an episode passes, shame, sadness or exhaustion can follow. With narcissistic traits, the difficulties show up mostly in relationships and work, and people more often seek help for depression, drink or drug problems or another mental health difficulty than for the grandiosity itself.
Treatment
In the UK, a GP is the usual first step, and they can refer to a psychiatrist or mental health team. When grandiosity is part of mania or psychosis, treatment usually includes medication a psychiatrist may discuss, talking therapies such as CBT, family support and sometimes a hospital stay during a severe episode. With narcissistic personality disorder, the main treatment is talking therapy.
Any decision about medication is made with the doctor. Hypnotherapy is not a suitable treatment for grandiosity or grandiose delusions.
Things that can help day to day
- Keep every appointment, even when feeling well
- Take medication as prescribed and talk to the doctor before any change
- Keep regular sleep times and avoid alcohol and drugs
- Agree a crisis plan with the care team and someone trusted
- Put off big money or work decisions until talked through
- For relatives: stay calm, do not argue or mock, and talk about what you notice
When to get help
Talk to a GP if someone has grandiose ideas that do not fit with reality, especially alongside less sleep, high energy, sudden mood changes or risky decisions. If the person will not go, relatives can still ask the GP for advice on how to approach things. Mind, and Bipolar UK where mood swings are involved, offer information for families.
If someone has gone days without sleep, is putting themselves in danger, seems to have lost touch with reality, cannot look after themselves or has thoughts of harming themselves or others, call 999 or go to A and E. For urgent mental health advice, call NHS 111 and choose the mental health option. If you are also feeling very low, talk to your GP or call Samaritans free on 116 123.
See also: Mania (manic episode) · Hypomania
Common questions
What does it mean to call someone a megalomaniac?
In everyday speech it means someone who seems to have an inflated sense of their own importance or power. It is an opinion, not a diagnosis. In mental health, grandiosity is only treated as a symptom when it reaches fixed false beliefs or is part of a condition a professional has assessed.
Is megalomania the same as narcissism?
Not exactly. In narcissistic personality disorder there is an inflated sense of self-importance and a need for admiration, often with fragile self-esteem, but the person stays in touch with reality. Grandiose delusions are fixed false beliefs and are more often part of mania or psychosis.
Can you tell if a public figure has megalomania?
No. Calling a politician, boss or celebrity a megalomaniac is a judgement about their behaviour, not a diagnosis. Mental health conditions can only be assessed by a professional who has properly seen the person.
Can hypnotherapy help with megalomania?
No. Hypnotherapy is not a suitable treatment for grandiosity or grandiose delusions, and it should not be used during an episode or when someone holds fixed beliefs that are not true. The right help is a GP and a mental health team or psychiatrist.
Further reading: NHS: Psychosis, symptoms · NHS: Psychosis, overview · Mind: About hypomania and mania · Mayo Clinic: Narcissistic personality disorder, symptoms and causes · NHS: Where to get urgent help for mental health