Grandiose delusion: definition, causes, symptoms, and treatments
Table of content
- What is grandiose delusion?
- What are the causes of grandiose delusion?
- What are the symptoms of grandiose delusion?
- What are the treatments for grandiose delusion?
Grandiose delusion is a false belief in one’s own superiority. People with delusions of grandeur are convinced they are celebrities or people with outstanding wealth, superior intellect, and abilities or that they have secret and powerful connections. It’s not a specific mental illness but a type of delusional disorder, and it can occur due to a wide range of causes.
The causes of grandiose delusions are a combination of genes and environmental factors, but several illnesses are also involved. These include schizophrenia, bipolar disorder, dementia, delirium, and major depressive disorder with psychotic features.
Symptoms of grandiose delusion are the beliefs of being superior to others and better than everyone, trying to convince others to accept delusion, and becoming argumentative when the efforts fail. People with delusional grandeur retain their beliefs despite no evidence to confirm their accuracy.
Treatment for grandiose delusion includes psychotherapy, medications, and hospitalization. Medications are used in combination with therapy or during hospitalization under medical supervision.
What is grandiose delusion?
Grandiose delusion is an inaccurate or unfounded belief in having special powers, mission, wealth, or identity. It is a symptom of an underlying mental health condition, i.e., it can be a type of delusional disorder. A person with grandiose delusion, or delusion of grandeur, believes they are someone other than who they are, generally someone important or powerful.
In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), grandiose delusion is not a standalone mental illness but one of several types of delusional disorder. Other types of delusions are erotomanic, persecutory, jealous, somatic, mixed, and unspecified.
Delusions of grandeur can take many forms, but they are categorized into four major types. The first type of grandiose delusion is the belief in having a special ability, object, or talent. The second type is a delusion of being a famous person, whereas the third type is the belief in having a secret connection. The fourth type of grandiose delusion is religious grandeur i.e. a person believes they are a religious leader, Healthline explains.
The strength of a delusion depends on how much a person is convinced it is real.
Grandiose delusion is not the same thing as having strong confidence and high self-esteem. Both confidence and self-esteem are healthy traits that people can develop, but grandiosity takes these characteristics to the extreme. Grandiose delusion, like all types of delusions, is not supported by facts or reality, PsychCentral reports. Grandiosity and grandiose delusion aren’t synonyms. The latter is a false belief, whereas grandiosity is an inflated sense of self. However, in the most extreme cases, grandiosity can take the form of delusion.
Delusions of grandeur are often believed to be the same as narcissism or narcissistic personality disorder. Grandiose thinking is a defining characteristic of narcissism because people with this type of personality disorder believe they are special or too good for anything ordinary or average. However, delusions of grandeur aren’t the same thing as narcissism. While people with this mental illness can have this type of delusional thinking, grandiose delusions occur due to several causes. They are not exclusively tied to narcissism. The causes of grandiose delusions will be discussed further in this post.
The history of grandiose delusion is tied to the introduction of delusional disorder. A German psychiatrist, Emil Kraepelin, was the first person to introduce delusional disorder back in 1883. In his works, Kraepelin described delusions of paranoia and identified grandiose, jealous, persecutory, and erotomanic delusions.
For centuries delusions were considered the hallmark of madness. For example, the Enlightenment thinker John Locke believed people with delusions slipped from rationality into irrationality.
The term delusion of grandeur was coined in the 19th century after a significant evolution in psychological studies. The origin of the term delusion of grandeur is associated with an incident between two brothers, Henry Prouse Cooper, and Stephen Prouse Cooper. Henry had to undergo an investigation for the insanity that he publicly declared in court because he had delusions of being a grand person.
How common is grandiose delusion?
Grandiose delusion is more common than initially believed. According to a paper published by J.M. Sheffield et al. in the April 2021 issue of Frontiers in Psychiatry, grandiosity is present in the general population, although prevalence depends on the sample and ranges from 8% to 65%.
Prevalence of grandiosity appears relatively high because up to 10% of healthy people will develop grandiose thoughts at some point, even if they don’t have grandiose delusion as a disorder, R. Knowles et al. reported in their paper from the June 2011 issue of Clinical Psychology Review. The same paper also reported that grandiose delusions are present in many psychiatric conditions. For instance, two-thirds of patients with bipolar disorder and half of the patients with schizophrenia have grandiose delusions.
It’s important to keep in mind the exact number of adults and children or teens with grandiose delusions is still unknown. According to UpToDate, the lifetime morbid risk of delusional disorder in the general population ranges from 0.05% to 0.1%. The term morbid (morbidity) risk is defined as a statistical chance that a person will develop a certain disease or disorder. The same report also shows the estimated lifetime prevalence of the delusional disorder is 0.2%.
A chapter from The Medical Basis of Psychiatry, called Delusional Disorders published in 2008 by R.R. Crowe and M-A Roy, reports that the prevalence of delusional disorders is between 24 to 30 cases per 100,000 people, while the annual incidence is around 0.7 to 3.0 new cases per 100,000 people.
In terms of the prevalence of grandiose delusion in men and women, there is no significant statistical difference between these two genders. A paper that E. de Portugal et al. published in the May 2010 issue of Psychiatry Research reported that the female-to-male ratio in the prevalence of delusional disorder is 1.6:1.
Although the exact number of children and adolescents with grandiose delusions is unknown, a study by R. Tillman et al. from the February 2008 issue of Bipolar Disorders showed that 67.7% of 257 participants aged 6-16 with bipolar disorder experienced grandiose delusions. In fact, grandiose delusions were the most common type of delusions in children and adolescents with this mental illness.
Since there is no information about the prevalence of grandiose delusions in the elderly population, a good indicator is a paper from the June 2006 issue of Neuropsychiatric Disease and Treatment. The authors, Dr. Anna EM Holt from Massachusetts Institute of Technology and Martin L. Albert from Boston University School of Medicine, reported that 30% of patients with Alzheimer’s disease and 5% of healthy elderly persons experience delusions. The July 2022 issue of the International Journal of Environmental Research and Public Health published a paper that showed that the prevalence rate of delusional disorder in adults older than 65 years of age is 0.04%. The same review also revealed the yearly incidence of new and relapsed cases in this age group is 16 per 100,000 people.
What are the causes of grandiose delusion?
The causes of grandiose delusion, as a form of delusional disorder, include a combination of causes such as genetic predisposition, biological factors, and environmental and psychological factors. Grandiose delusions are generally present in people with narcissistic personality disorder, a mental health condition indicated by having an unreasonably high sense of self-importance.
Cleveland Clinic explains that delusional disorders have a genetic component meaning parents can pass on genetic variations to their children. Biological factors include structural and functional brain abnormalities and imbalance of neurotransmitters. Environmental and psychological factors include factors affecting personal life such as substance abuse or being envious and distrustful.
However, grandiose delusions may result from other mental health conditions. The most significant causes of grandiose delusion are listed below:
- Bipolar disorder
- Major depressive disorder with psychotic features
Schizophrenia is a type of psychotic disorder that results in a combination of delusions, hallucinations, disordered speech and thinking, and bizarre behaviors. As a psychotic disorder, schizophrenia is characterized by abnormal perception and interpretation of reality. According to the National Institute of Mental Health, people with schizophrenia are usually diagnosed between the ages of 16 and 30.
Risk factors for schizophrenia are a family history of this psychotic disorder, taking mind-altering drugs, and pregnancy and birth complications such as malnutrition, and exposure to toxins, chemicals, and viruses.
Environmental risk factors for schizophrenia include the date of birth, place of birth, and seasonal effects according to a review by J. Janoutova et al. in the January 2016 issue of Neuro Endocrinology Letters.
Date of birth refers to the season of birth such as winter and spring. A paper from the June 2021 issue of Frontiers in Genetics, published by Dr. Natassia Robinson and Sarah E. Bergen at Karolinska Institute, confirmed that children born in winter and spring are at a higher risk of schizophrenia, with an increased risk at higher latitudes which are subjected to greater seasonal variations. Migration is also a risk factor for schizophrenia.
The same paper explained that 2nd generation migrants are particularly vulnerable to developing schizophrenia, which means the stress of relocating isn’t the only culprit. The higher susceptibility of 2nd generation migrants to schizophrenia could be due to social and environmental differences. Additionally, people living in urban areas are at a higher risk of schizophrenia than persons from rural areas.
The abovementioned review also identified potential risk factors that require further research such as ambient air pollutants, traumatic brain injury, and hearing impairment in childhood.
Schizophrenia becomes a cause of grandiose delusion through mechanisms such as a sensibility to reward and a higher optimism bias for the future, according to a study that C. Bortolon et al. published in the April 2018 issue of Schizophrenia Bulletin. The study showed that optimism bias for the future may amplify and reinforce elated moods built on pre-existing inflated or accurate perceptions of self. Cognitive bias such as jumping to conclusions may also contribute to grandiose delusions in people with schizophrenia.
In people with schizophrenia, grandiose delusions may occur secondary to persecutory delusions. That happens when the projection of guilt (persecutory delusion) doesn’t balance internal wishes and external reality. Delusion of grandeur occurs as a fulfillment of the repressed wish. Since the external reality is contradictory to the guilt projected in the outside world, narcissistic injury to a person’s self-esteem becomes higher. That leaves a patient with the escape wish-fulfillment through grandiose delusion. More precisely, a grandiose delusion in patients with schizophrenia may result from their attempt to justify persecutory delusion with a grandiose explanation. Doing so makes a patient feel more important and leads to recovery of their wounded self-esteem. This explains why delusion of grandeur is the second most common type of delusion in schizophrenia, according to an article by F. Arantes-Goncalves et al. from the July 2018 issue of Frontiers in Psychiatry.
Schizophrenia may cause grandiose delusions because it involves structural and functional impairments in the brain, including an imbalance of neurotransmitters such as dopamine. Delusions are also linked to a disrupted balance of dopamine. Schizophrenia changes the way people perceive the world and the information they receive, which could lead to false beliefs such as delusions of grandeur.
2. Bipolar disorder
Bipolar disorder is a type of mood disorder indicated by extreme mood swings that include intense emotional highs (mania) and lows (depression). When a person is in a depressive state, they feel hopeless and lose interest in activities they used to enjoy. During a manic episode, however, a person with bipolar disorder feels euphoric, energetic, and unusually irritable. Intense mood swings have a major impact on energy levels, sleep, behavior, judgment, and thinking. People with bipolar disorder may have episodes multiple times a year or they occur rarely.
According to the National Institute of Mental Health, there are three types of bipolar disorder. The first type, bipolar I disorder, is indicated by manic episodes lasting at least seven days or by symptoms of mania that are so severe a person needs emergency medical care. Depressive episodes may occur and they tend to last atleast for two weeks. The second type, bipolar II disorder, is characterized by depressive and hypomanic episodes that are less severe than mania symptoms in bipolar I disorder. The third type, cyclothymic disorder, is indicated by recurrent hypomanic and depressive symptoms that aren’t severe enough and don’t last long enough to be classified as episodes.
Risk factors for bipolar disorder include having a first-degree relative (parent or sibling) with this mental illness, drug or alcohol abuse, and periods of major life stress such as traumatic events or the loss of a loved one, Mayo Clinic explained. Frequent ups and downs of mood are a major risk for bipolar disorder, according to a paper by J. Angst et al. from Acta Psychiatrica Scandinavica. A five-year follow-up study by S. de Lima Bach et al. in September 2021 issue of Psychiatry Research identified depression, anxiety, post-traumatic stress disorder (PTSD), and suicide risk as risk factors for bipolar disorder. Risk factors for bipolar disorder include childhood emotional abuse, Attention-deficit/hyperactivity disorder (ADHD), conduct disorders, impulsivity, and aggression, according to Dr. Tobias A. Rowland and Steven Marwaha from University of Warwick, who published a paper in the September 2018 issue of Therapeutic Advances in Psychopharmacology.
Two-thirds of people with bipolar disorder experience grandiose delusions, an article by R. Knowles et al. in the June 2011 issue of Clinical Psychology Review reported. Bipolar disorder is a cause of grandiose delusions due to the changes in chemistry and activity in the brain. These changes cause symptoms of bipolar disorder, Very Well Mind reported.
Bipolar disorder affects several brain areas such as the prefrontal cortex, gray matter, and hippocampus. These regions take part in functions such as cognitive control, impulsivity, attention, emotions, memory, and movement. Moreover, bipolar disorder may affect neurotransmitters dopamine, serotonin, and norepinephrine. This is important because delusions are associated with a reduction in grey matter volume and changes in the hippocampus. As mentioned above, an imbalance of neurotransmitters such as dopamine may also contribute to delusions. That means that bipolar disorder causes delusions through changes in brain regions and neurotransmitters, which are responsible for symptoms of this mental illness.
Dementia is an umbrella term for progressive diseases that are characterized by impaired memory, thinking, decision-making, and overall functioning. The most common type of dementia is Alzheimer’s disease. Other types of dementia include vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed dementia. It’s important to keep in mind that dementia isn’t a normal part of aging. While people tend to experience old-age forgetfulness, it doesn’t progress into serious territory. Dementia worsens over time.
Risk factors for dementia include older age (65 years or older), family history of dementia, and Down syndrome. Other risk factors for dementia, according to Mayo Clinic, include unhealthy diet, excessive alcohol use, depression, diabetes, smoking, exposure to air pollution, head trauma, sleep disturbances such as sleep apnea, and medications such as over-the-counter sleep aids containing diphenhydramine (Aleve PM, Advil PM) and medications for urinary urgency like oxybutynin (Ditropan XL). High blood pressure, high cholesterol, atherosclerosis, and obesity are also risk factors for dementia.
Dementia causes grandiose delusions because it slowly reduces a person’s ability to think clearly. A paper from the January-February 2004 issue American Journal of Alzheimer’s Disease and Other Dementias, published by C. Fisher, R. Bozanovic-Sosic, and M. Norris, revealed that patients with dementia have different types of delusions including persecutory and grandiose delusions. Risk factors for delusions in dementia included depression, advanced age, limited education, advanced neuropathology, selective frontal lobe dysfunction, preserved intellect, and rapid cognitive decline. Delusions in people with dementia are strongly linked to increased caregiver stress, earlier institutionalization, and aggression.
Another explanation for grandiose delusions in dementia is memory loss. People with dementia can’t put memories and pieces of information together correctly. When that happens, they draw false conclusions to fill the gaps in their memory. This leads to delusions i.e. false beliefs. A person with dementia may develop delusions as their condition is getting worse, Alzheimer’s Society from the UK explains.
Delirium is a serious change in a mental state that occurs suddenly. When that happens, people experience confused thinking and a lack of awareness of their surroundings. Delirium makes a person appear distracted and disoriented. This change in mental state is more common in older adults, particularly those with dementia.
There are two types of delirium. People with the first type, hyperactive delirium, become overactive, restless, or agitated. The second type, hypoactive delirium, is indicated by underactive behaviors including sleepiness or being slow to respond. According to Cleveland Clinic, hypoactive delirium is more common and is present in 75% of people with delirium. It’s possible to experience hyperactive and hypoactive delirium together.
Risk factors for delirium include a history of delirium episodes, hearing or vision loss, multiple medical problems, and brain disorders such as dementia, Parkinson’s disease, or stroke according to Mayo Clinic. Any medical condition that requires a hospital stay can increase the risk of delirium, especially for people who are in recovery after surgery.
Delirium causes grandiose delusions because the affected person becomes easily distressed. They become distressed due to not understanding where they are. Delirium also makes people lose track of time. As a result, people may develop symptoms of psychosis, such as delusions. Delusions usually happen in people with hyperactive delirium. Additionally, delirium is an altered medical state that leads to confused thinking, disorientation, and memory problems. This could also lead to delusions, according to a post from the American Family Physician.
5. Major depressive disorder with psychotic features
Major depressive disorder with psychotic features is a mental disorder wherein a person has depression and psychosis. That means a person with this condition experiences depressive symptoms such as hopelessness, loss of interest, and persistent sadness in addition to hallucinations and delusions. Psychosis means a person is disconnected from reality and doesn’t process it properly. This type of depression is underdiagnosed and undertreated, despite estimates suggesting 14.7% to 18.5% of people with major depression will experience it, according to a paper from the July 2013 issue Schizophrenia Bulletin, published by Dr. Anthony J. Rothschild at University of Massachusetts.
Risk factors for major depressive disorder with psychotic features include a family history of mental illness and psychosis, being socially isolated, childhood abuse, substance abuse, exposure to trauma in adulthood, and brain injuries or diseases such as the history of concussions, stroke, or conditions like Alzheimer’s disease.
The reason why major depressive disorder causes psychosis, and thereby grandiose delusions, isn’t fully understood. Psychosis may occur in severe cases of depression. People may have a genetic predisposition, but biology and brain chemistry can also be involved in the psychotic features of major depressive disorder. Healthline explains that imbalances in neurotransmitters such as dopamine and serotonin are involved in the development of both depression and psychosis. Additionally, a paper by K. Cherian et al. from the November 2019 issue Schizophrenia Research suggests that high levels of the stress hormone cortisol are also involved. More precisely, severe depression is associated with strong changes in brain chemistry that may affect a person’s interpretation of reality and lead to psychosis, in this case, delusions.
What are the symptoms of grandiose delusion?
Symptoms of grandiose delusion revolve primarily around a person believing in their own greatness and superiority. Delusion is an incorrect or unreasonable belief, which is why a person with grandiose delusion may think they’re a movie star. They may believe they are blessed with superior intelligence, hidden wealth, and connections to powerful people. Delusion of grandeur isn’t tied to personal experience. A regular gambler who firmly believes he’s better than others or believes he’s close to winning big isn’t delusional because his belief is associated with a specific action. In addition to beliefs of being superior or destined to accomplish great things, grandiose delusion causes other symptoms, which are listed below:
- Continuing believing in delusion despite evidence to the contrary
- Frequent arguments with others or not getting along with friends, family, or colleagues due to delusion of grandeur
- Being persistent in trying to get others to believe you and your delusion
- Getting angry when people don’t accept the delusional belief
- Behaving as if delusion is true
- Experiencing other types of delusions, such as paranoid delusions, and symptoms of underlying mental health conditions such as schizophrenia
- Changes in mood such as being highly irritable
Who is affected by grandiose delusion?
Adults with underlying mental health conditions such as bipolar disorder and schizophrenia are primarily affected by grandiose delusion. It affects women more often than men. Delusions of grandeur tend to affect persons with a personal or family history of psychosis and mental illness. Men and women with narcissistic personality disorder tend to develop grandiose delusions, as well.
What are the risk factors for grandiose delusion?
Risk factors for grandiose delusion are a combination of physical, psychological, and environmental influences that lead to the development of this kind of false belief. A lot more research is necessary to identify the specific risk factors for grandiose delusion. However, they are similar to factors associated with delusional disorder. The most significant risk factors for grandiose delusion are listed below:
- Personal history of psychotic symptoms and mental illnesses such as schizophrenia or bipolar disorder
- Family history of psychosis
- Social isolation or absence of close relationships
- Sensory impairment
- Substance abuse
- Other types of delusions such as persecutory delusions
- History of brain injury
- Having a neurodegenerative condition such as dementia
- Major life stress
How is grandiose delusion diagnosed?
Healthcare professionals perform a physical exam and psychiatric evaluation to diagnose grandiose delusion. There is no specific diagnostic test for delusions of grandeur. Instead, a physician may assess medical history and order blood tests, urine tests, or imaging tests such as MRIs. These tests reveal whether a specific physical health problem is the cause of the symptoms.
The patient is referred to a psychiatrist as well. The process of psychiatric evaluation may involve completing a questionnaire about symptoms, thoughts, behaviors, delusions, and emotions. Psychiatrists may ask a patient about their family and personal history of mental illnesses and get a detailed insight into the symptoms they experience. In order to get a clearer picture of a patient’s condition, a psychiatrist may also interview their family members.
The psychiatrist will use DSM-5 to check whether a patient meets the diagnostic criteria listed there. For example, mental health professionals will diagnose delusional disorder if a patient has one or more delusions that last at least a month and has never been diagnosed with schizophrenia. Upon diagnosis of delusional disorder, based on the nature of the false belief, the psychiatrist diagnoses the grandiose type.
In order to diagnose schizophrenia, for example, a patient needs to have at least two of five symptoms for at least one month. The symptoms include delusions, hallucinations, disorganized or incoherent speaking, disorganized movements, and negative symptoms (e.g. lack of interest). These symptoms should be accompanied by social or occupational dysfunction. On the other hand, bipolar disorder is diagnosed when a patient experiences at least one episode of mania or hypomania for a week (nearly every day).
More precisely, the psychiatrist uses DSM-5 to pinpoint a specific reason people experience grandiose delusion. Although delusion of grandeur is a type of delusional disorder, there are other causes of this type of thinking, including the conditions mentioned above.
How to prevent grandiose delusion?
Therapy is a good way to recognize and manage distorted thinking. Even though a foolproof strategy to prevent grandiose delusion doesn’t exist, it is possible to reduce the risk or avoid severe symptoms and potential complications.
People with a history of trauma and those diagnosed with delusional disorder, schizophrenia, bipolar disorder, and depression can also benefit from therapy. Regular therapy sessions aid the management of mental illnesses and thereby improve psychological functioning.
Since social isolation is a risk factor for grandiose delusion, it can help to socialize more. Options to make that happen are numerous, including spending time with family and friends, volunteering, traveling, signing up for classes, or joining a gym.
What are the treatments for grandiose delusion?
Treatments for grandiose delusion are challenging because people who experience these delusions usually feel good and don’t see a problem. Keep in mind that persons with delusions are convinced of the reality of their beliefs. To them everything is real. Since a person doesn’t see the problem, it can be challenging to motivate them to receive treatment and stick to it. Treatments for grandiose delusion are listed below:
- Medications: a psychiatrist may prescribe medications to reduce the severity of delusions. The exact medications depend on the symptoms and underlying condition. The most commonly prescribed medications for this purpose are antipsychotic medications. There are two types of antipsychotics i.e. first generation (typical) and second-generation (atypical). Typical antipsychotic medications manage delusions by blocking dopamine receptors in the brain. Atypical antipsychotic medications work by blocking receptors for both dopamine and serotonin. These neurotransmitters are involved in delusions. A paper from the April 2020 issue World Journal of Psychiatry, published by A. Gonzalez-Rodriguez et al, suggested that although patients with delusional disorder are considered treatment-resistant they can respond to antipsychotic medications. Antipsychotics may take four to six weeks to reach their full effect. A patient may receive a prescription for other medications depending on the underlying mental illness they have. These medications may include antidepressants or anxiolytics (for the management of anxiety). However, medications alone aren’t enough to manage grandiose delusions and illnesses that cause them. For that reason, they are used in combination with therapy.
- Psychotherapy: the integral component of treatment for grandiose delusions. The main objective of psychotherapy is to help patients overcome their delusions and learn how to manage their condition properly. While there are many types of psychotherapies, the therapist usually relies on cognitive-behavioral therapy (CBT). As a structured form of therapy, CBT revolves around identifying negative or irrational thoughts, because the theory is that they lead to negative emotions and behaviors. Once a patient identifies the negative thoughts, they can start work on replacing them with more realistic alternatives. Patients also learn skills that improve their functioning. In the treatment of grandiose delusions, CBT helps patients understand how their thoughts affect their actions. A randomized controlled trial by K. O’Connor et al. from the March 2007 issue of Canadian Journal of Psychiatry showed CBT produced a greater impact than the placebo control group on the treatment of the delusional disorder. Cognitive-behavioral therapy works by identifying the most troublesome problems and how they affect thinking and behavior. Patient engagement plays an important role in CBT and its efficacy. Homework is assigned to patients between two sessions. Patients usually need to practice skills they learned during the session as their homework. The specific number of sessions depends on each patient. Cognitive-behavioral therapy for psychosis needs at least 10 sessions, explained Dr. Narsimha R. Pinninti and Rama Rao Gogineni in a post they published in October 2016 on Psychiatric Times. When it comes to therapy for grandiose delusion treatment, besides individual or one-on-one therapy, group therapy is also beneficial. Group therapy helps improve relationships with other people.
- Hospitalization: only recommended as a treatment for patients whose delusions put them at risk of harming others or themselves. A patient may need to stay in a hospital or a treatment center until their mental state is stable. Hospitalization involves therapy and medications provided under medical supervision.
Do grandiose delusions have a cure?
No, grandiose delusions can be managed successfully, but may not be entirely cured. Treatment of grandiose delusions can be complicated. Delusions of grandeur make people feel good, which is why they may be reluctant to give them up. Long-term treatment protocol relying on therapy and medications is necessary.
When one treatment stops working, a psychiatrist recommends another approach. It could be useful to help a person see how their delusions negatively affect their relationships and overall quality of life. People with grandiose delusions can establish healthy relationships and improve their life with proper treatment and support. The outcome of the treatment greatly depends on the underlying disorder.