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Treatments for megalomania depend upon the underlying condition causing it, but can include medication and psychotherapy. Four conditions are associated with this state, where individuals believe themselves omnipotent, have a deluded sense of possessing extraordinary power, or exhibit grandiosity, which is a view of personal superiority and disdain for others. These conditions are narcissistic personality disorder (NPD) antisocial personality disorder (APD), schizophrenia, and bipolar disorder. Treatment differs in these conditions, and antisocial personality disorder is not presently considered treatable.
Bipolar disorder may have megalomania as a feature when people are in a manic state. Some schizophrenics have delusions of grandiosity, believing they have exceptional power. In these two conditions, states of megalomania and grandiosity are especially dangerous because individuals may make decisions based on a faulty perception of personal power. A schizophrenic might stand in front of a car believing it cannot hit him, and the bipolar person could sleep with numerous people without recognizing the consequences to a marriage.
In one sense, these disorders are easier to treat because both will respond to medication. Treatments for megalomania in schizophrenia and bipolar directly address the underlying chemical dysfunctions responsible for the disorders. Mood stabilizers can help return bipolar sufferers to a normal mood, and schizophrenics may be treated with antipsychotics. Both conditions additionally benefit from ongoing therapeutic support and psychoeducation.
Treatments for megalomania in personality disorders are a different matter. In many traditional views, personality disorders are thought to arise from some failure of development in childhood to create a whole self, often as a result of trauma or neglect. This cannot be addressed with medication unless people have a comorbid biological disorder. Psychotherapy is the main approach to personality disorders, and it can take several different forms.
The classic therapeutic approach comes from the various Object-Relations schools of therapy. The empathetic therapist helps a client build this lost part of the self and learn to connect with and reflect upon narcissism as a defense. Learning compensatory measures to deal with narcissism is also emphasized. This form of therapy can take many years. Other approaches, which may be more time-limited, include dialectical and cognitive behavioral therapies.
Most people with megalomania don't seek therapy because they don't believe they are responsible for any problems they might have. Those with NPD, bipolar, or schizophrenia are often brought to treatment by family members or referred by court systems. Individuals with antisocial personality disorder are most likely to be in treatment by court mandate or because they are in correctional facilities.
When megalomania is discussed, historical figures like Hitler are referenced. In the general population, few people with personality disorders have the power he possessed. Hitler met the qualifications for antisocial personality disorder: complete disregard for human life, enjoyment of hurting others, and an ability to charm or influence others. Unfortunately, there are still no successful treatments for those who exhibit megalomania within the context of antisocial personality disorder. The therapies used in NPD aren't usually effective, and many of these individuals badly hurt others and spend their lives in correctional facilities.
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