Megalomania is a psychopathological condition characterized by fantasies of power, relevance, omnipotence, and by inflated self-esteem.   Historically it was used as a name for narcissistic personality disorder prior to the latter’s first use by Heinz Kohut in 1968, and is used today as a non-clinical equivalent.^[1][2] It is not mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DSM)^[3] or the International Statistical Classification of Diseases (ICD).

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Etymology

The word megalomania is derived from the Greek μεγαλο- megalo- “large, great”, and μανία mania “madness, frenzy”. Its first attested use in English occurred in 1890, as a translation of the French mégalomanie.

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Early Freudianism

Sigmund Freud commented of the adult neurotic’s sense of omnipotence that “this belief is a frank acknowledgement of a relic of the old megalomania of infancy”.^[4] He similarly concluded that “we can detect an element of megalomania in most other forms ofparanoic disorder. We are justified in assuming that this megalomania is essentially of an infantile nature and that, as development proceeds, it is sacrificed to social considerations”.^[5]

Edmund Bergler also considered megalomania to be normal in the child,^[6] and for it to be reactivated in later life in gambling.^[7]Otto Fenichel states that, for those who react in later life to narcissistic hurt with denial, a similar regression to the megalomania of childhood is taking place.^[8]

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Object relations

Whereas Freud saw megalomania as an obstacle to psychoanalysis, in the second half of the 20th century object relations theory, both in the States and among British Kleinians, set about revaluing megalomania as a defence mechanism that offered potential access for therapy.^[9] Such an approach built on Heinz Kohut‘s view of narcissistic megalomania as an aspect of normal development, by contrast with Kernberg‘s consideration of such grandiosity as a pathological development distortion.^[10]

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Everyday

As well as a symptom of pathology, a degree of megalomania is a way of defending against loss in everyday life—a manic defense against the experience of separation and loss.^[11] When linked to a position of power, whether military, political, orcontrol-freak bureaucratical,^[12] it is likely to lead to miscalculation as a by-product of the subject’s conceit.^[13]

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Therapy

Because the megalomaniac tends not to be particularly interested in examining or changing the self,^[14] talking cures may be less effective than medication in their treatment.^[15] The transference in a talking cure may also be compromised by the patient’s enhancement of any megalomaniac tendencies within the analyst him/herself.^[16]