Narcissism can often involve a persistent pattern of selfishness and a firm belief in your own superiority, which can resemble a delusion in some cases.

Delusions are fixed beliefs that defy evidence to the contrary. They are official symptoms of psychosis and other mental health conditions.

Although there are many types of delusions, delusions of grandeur are most often associated with narcissistic personality disorder (NPD). These refer to the belief that you are superior and more deserving than others.

Having a high opinion of yourself, even if you have received a diagnosis of narcissistic personality disorder, does not make you a delusional narcissist. This term lacks empathy and is inaccurate.

Do narcissists suffer from delusions?

Delusions are not an official symptom of narcissistic personality, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).

However, some people with BPD may experience delusions if they are living with another condition or experiencing an episode of psychosis.

“In fact, there is no such thing as delusions of narcissistic personality disorder, at least not in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),” explains Dr. Raffaello Antonino, a clinical psychologist from London.

Antonino points out that the main difference lies in how delusions are defined. He explains that clinical delusions tend to lead to drastic and dysfunctional actions and are not the same as fixed thoughts or unusual fantasies.

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“People with narcissistic personality disorder often have grandiose fantasies, but by definition, these do not reach the realm of fantasies,” Antonino adds. “People with narcissistic personality disorder, although great, are not delusional, which means that expressions of their greatness are less drastic.”

For example, believing that you are the best performer at your company when others do not believe you are is not a delusion. As an opinion, you are allowed to think too much about yourself.

Clinically, opinions do not have to be supported by evidence. On the other hand, delusions can be proven false by facts, even if the person is not convinced by them.

Are narcissists delusional?

According to Antonino, most people living with narcissism or a narcissistic personality are not delusional. There is no such thing as narcissistic psychosis either.

“If narcissism (in general) is related to delusions, then we are all likely to be delusional,” he says. “So no, not all narcissists are delusional, and in fact, most are not.”

Living with NPD and Delusions

Antonino points out that in extreme cases, a person with BPD may experience grandiosity to the point where it becomes delusional by definition.

He points out that when this happens, it is possible for a person to live with other mental health diagnoses such as:

• Obsession
• Delusional disorder
• schizophrenia
• Schizotypal disorder
• Schizoaffective disorder
• Brief psychotic disorder
• Substance abuse disorder

Delusions of grandeur may be the most likely type of delusion to occur due to the nature of narcissistic personality disorder, but there are other forms of delusions that may appear, depending on the coexisting disorder.

Other types of delusions may include:

• Fake jealousy
• strange (impossible circumstances)
• Erotic (being loved by a famous person)
• Persecution (conspiring against or harassing someone or something)
• Somatic (physical sensations)
• Mixed (multi-subject)
• Broadcasting (feeling that your ideas are being projected onto others)
• Thought insertion (someone/something has inserted their thoughts into yours)
• Magical thinking (beliefs regarding mystical abilities or special powers)

Can narcissism and psychosis occur together?

Yes. You can develop psychosis and narcissistic personality disorder.

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If this happens, a mental health professional may diagnose a comorbid disorder that fits your psychotic symptoms.

“In the current DSM-5 system, NPD does not have any specifiers, so if delusions appear, other diagnoses must be taken into consideration,” Antonino says.

For example, narcissistic personality disorder with severe delusions of grandeur may indicate a comorbid diagnosis of delusional disorder.

Antonino points out that 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 to get an accurate diagnosis.

Delusions of grandeur are also possible in bipolar I disorder, for example.

In this case, someone may score high on the narcissism scale, or live with narcissistic personality disorder, but also have symptoms of bipolar disorder. These changes may include significant changes in mood and behavior that would not be present in BPD without an accompanying condition.

Another example is suffering from narcissistic personality disorder and brief psychotic disorder, which includes one or more of the following psychotic symptoms:

• Delusions
• Hallucinations
• Disorganized speech
• Disorganized behavior

However, delusions related to brief psychotic disorder last less than a month and may never recur.

If you have delusions of narcissistic personality disorder, a mental health professional can explore your specific symptoms and the possibility of co-occurring disorders.