{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T08:08:03Z","timestamp":1791014883298,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:00:00Z","timestamp":1678752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Health Education England","award":["ICA-CDRF-2016-02-069"],"award-info":[{"award-number":["ICA-CDRF-2016-02-069"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Hypothesis<\/jats:title><jats:p>Grandiose delusions may entail difficult responsibilities and detrimental actions for patients. Recognition of these consequences by patients may provide an avenue for engagement in treatment. Furthermore, when patients carry out actions within the delusional system (\u201cimmersion behaviors\u201d) or spend considerable time thinking about their grandiose beliefs this may contribute to the persistence of the grandiosity and further harmful consequences. We, therefore, investigated grandiose-related subjective harm, immersion behaviors, and perseverative thinking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>A cross-sectional study with 798 patients with psychosis (375 of whom had grandiose delusions) and 4518 nonclinical adults. Factor analyses using data from participants scoring highly on grandiosity were used to form 3 scales: subjective harm from exceptional experiences questionnaire; immersion behaviors questionnaire; and thinking about exceptional experiences questionnaire. Associations with grandiosity were tested using structural equation modeling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Results<\/jats:title><jats:p>A total of 268 (77.9%) patients with grandiose delusions identified grandiose-related harms in the past 6 months and 199 (55.1%) wanted help. Immersion behaviors and perseverative thinking were highly prevalent, and explained 39.5% and 20.4% of the variance in grandiosity, respectively. Immersion behaviors and perseverative thinking were significantly associated with subjective harm, even when severity of grandiosity was controlled. Requests for help were associated with higher levels of subjective harm, use of immersion behaviors, and perseverative thinking but not severity of grandiosity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Acting on grandiose delusions, including harmful behaviors and excessive thinking about grandiose delusions, may be routes for clinicians to engage patients in treatment. This could be a starting point for targeted psychological interventions for grandiose delusions.<\/jats:p><\/jats:sec>","DOI":"10.1093\/schbul\/sbad016","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T08:56:11Z","timestamp":1678784171000},"page":"1194-1204","source":"Crossref","is-referenced-by-count":6,"title":["The Difficulties of Grandiose Delusions: Harms, Challenges, and Implications for Treatment Engagement"],"prefix":"10.1093","volume":"49","author":[{"given":"Louise","family":"Isham","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University of Oxford , Oxford , UK"},{"name":"Oxford Health NHS Foundation Trust , Oxford , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao Sheng","family":"Loe","sequence":"additional","affiliation":[{"name":"The Psychometrics Centre, Cambridge Judge Business School, University of Cambridge , Cambridge , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Hicks","sequence":"additional","affiliation":[{"name":"Patient Advisory Group, Oxford Cognitive Approaches to Psychosis (O-CAP), Department of Psychiatry, University of Oxford , UK"},{"name":"The McPin Foundation , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Wilson","sequence":"additional","affiliation":[{"name":"Patient Advisory Group, Oxford Cognitive Approaches to Psychosis (O-CAP), Department of Psychiatry, University of Oxford , UK"},{"name":"The McPin Foundation , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard P","family":"Bentall","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Sheffield , Sheffield , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Freeman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Oxford , Oxford , UK"},{"name":"Oxford Health NHS Foundation Trust , Oxford , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,3,14]]},"reference":[{"issue":"1","key":"2023090709172699200_CIT0001","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/papt.12260","article-title":"Understanding, treating, and renaming grandiose delusions: a qualitative study","volume":"94","author":"Isham","year":"2021","journal-title":"Psychol Psychother"},{"issue":"10","key":"2023090709172699200_CIT0002","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/S2215-0366(22)00236-X","article-title":"The meaning in grandiose delusions: measure development and cohort studies in clinical psychosis and non-clinical general population groups in the UK and Ireland","volume":"9","author":"Isham","year":"2022","journal-title":"Lancet Psychiatry."},{"issue":"6","key":"2023090709172699200_CIT0003","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1007\/s00127-005-0913-2","article-title":"Lack of motivation for treatment in emergency psychiatry patients","volume":"40","author":"Mulder","year":"2005","journal-title":"Soc Psychiatry Psychiatr Epidemiol."},{"key":"2023090709172699200_CIT0004","first-page":"850","article-title":"The structure of the extended psychosis phenotype in early adolescence-a cross-sample replication","volume-title":"Schizophr Bull","author":"Wigman"},{"issue":"3","key":"2023090709172699200_CIT0005","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/S0920-9964(97)00095-9","article-title":"Is early adulthood a critical developmental stage for psychosis proneness? 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