Delusions and self-esteem

Objective: To investigate the hypothesis that the content of delusions and hallucinations is significantly influenced by subjects' global self-esteem and by 5 specific areas of self-esteem. Method: The delusions and hallucinations of 40 psychotic patients were assessed by 2 independent raters for content indicative of positive or negative self-esteem and for the extent to which the delusional content would be self-enhancing (or diminishing) and comforting (or discomforting) to the subject. These ratings were correlated with the results of self-esteem inventories completed by the subjects. Results: The content of delusions reflects both global self-esteem and self-regard. Conclusions: This study demonstrates that 2 specific personality factors, global self-esteem and self-regard are reflected in the content of delusions and influence whether those delusions are experienced as comfortable (or uncomfortable) and enhancing (or diminishing). Delusional content is therefore consistent with patients' views of themselves, and this may partially account for the persistence of delusions.