Narcissism can often involve a persistent pattern of self-centeredness and a firm belief in your superiority, which may resemble a delusion in some cases.
Delusions are unwavering beliefs that defy evidence to the contrary. They’re a formal symptom of psychosis and other mental health conditions.
While there are many types of delusions, delusions of grandeur are often associated with narcissistic personality disorder (NPD). These refer to believing you are superior and more deserving than other people.
Having a high opinion of yourself, even if you’ve received an NPD diagnosis, doesn’t make you a delusional narcissist, though. This term lacks empathy and isn’t accurate.
Delusions aren’t a formal symptom of a narcissistic personality, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).
Still, some people with NPD might experience delusions if they live with another condition or go through an episode of psychosis.
“There’s, in fact, no such thing as NPD delusions, at least not in the DSM-5,” explains Dr. Raffaello Antonino, a clinical psychologist from London.
Antonino points out the key difference lies in how delusions are defined. Clinical delusions tend to lead to drastic, dysfunctional actions and aren’t the same as fixed ideas or unusual fantasies, he explains.
“People who have NPD often have grandiose fantasies, but by definition, these don’t cross to the realm of delusions,” adds Antonino. “People who have NPD, in spite of their grandiosity, aren’t delusional, meaning that the expressions of their grandiosity are less drastic.”
Believing you’re the best performer in your company when others don’t think so, for instance, doesn’t qualify as a delusion. As a matter of opinion, you’re allowed to think highly of yourself.
In clinical terms, opinions don’t have to be supported by evidence. Delusions, on the other hand, can be proven untrue with facts, even if the person isn’t convinced by these.
Are narcissists delusional?
Most people living with narcissism or narcissistic personality aren’t delusional, according to Antonino. There’s no such thing as narcissistic psychosis, either.
“If narcissism (in general) was related to delusions, then we would all be potentially delusional,” he says. “So no, not all narcissists are delusional, and, in fact, most of them aren’t.”
Formal characteristics of narcissism
To receive a formal diagnosis of narcissistic personality disorder per the DSM-5-TR, persistent patterns of grandiosity, admiration-seeking, and lack of empathy may be present for at least 6 months.
In general, mental health professionals will look for five or more of the following symptoms of NPD:
- a grandiose sense of self-importance
- preoccupation with fantasies of limitless success, power, ideal love, beauty, or brilliance
- a belief of being better than and unable to be understood by the average person
- need for constant admiration
- a sense of entitlement
- tendency to use manipulation tactics for personal gain
- low empathy
- feeling envious or believing others are envious
- arrogance or sense of entitlement
Antonino indicates that in extreme cases, someone living with NPD may experience grandiosity to the point where it becomes a delusion by definition.
He suggests that when this occurs, it’s possible that the person lives with other mental health diagnoses such as:
- delusional disorder
- schizophreniform disorder
- schizoaffective disorder
- brief psychotic disorder
- substance use disorder
Grandiose delusions may be the most likely type of delusion experienced due to the nature of NPD, but there are other forms of delusions that may emerge, depending on the co-occurring disorder.
Other types of delusions may include:
- delusional jealousy
- bizarre (impossible circumstances)
- erotomanic (being loved by someone famous)
- persecutory (being conspired against or harassed by someone/something)
- somatic (bodily sensations)
- mixed (multi-themed)
- thought broadcasting (a sense that your thoughts are projected to others)
- thought insertion (someone/something has inserted their thoughts into yours)
- magical thinking (beliefs related to mystical abilities or special powers)
Yes. You can have both psychosis and narcissistic personality disorder.
If this happens, a mental health professional may diagnose a comorbid disorder that fits the experienced psychotic symptoms.
“In the present DSM-5 system, NPD doesn’t have any specifiers, so if delusions appear, other diagnoses […] must be considered,” says Antonino.
NPD with intense delusions of grandeur, for example, may indicate a comorbid diagnosis of delusional disorder.
Antonino indicates there are a number of other conditions that can present with these types of symptoms, making it important to consider every aspect of someone’s experience for an accurate diagnosis.
Grandiose delusions are also possible in bipolar I disorder, for example.
In this case, someone may score high on the narcissism scale, or live with NPD, but also be experiencing bipolar disorder symptoms. These may include significant changes in mood and behavior that wouldn’t be present in NPD without a co-occurring condition.
Another example would be experiencing NPD and brief psychotic disorder, which would include one or more of the following symptoms of psychosis:
- disorganized speech
- disorganized behavior
Delusions related to brief psychotic disorder, however, last less than a month and may never recur.
If you’re experiencing delusions with NPD, a mental health professional can explore your specific symptoms and the possibility of co-occurring disorders.
“Delusional narcissist” isn’t an accurate or empathetic term. Delusions aren’t part of the list of formal symptoms of narcissistic personality disorder. When someone with NPD experiences delusions, a second diagnosis is likely.