Overvalued Ideas

Overvalued ideas are pathological thought processes with poor insight; they are belief systems that defy rational argument; and are often accompanied by strong affective responses that took precedence over all other mental activity.

Some of the main characteristics of overvalued ideas are their inner certainty, the certainty that characterizes how they are presented to others.

And the extent to which they become generalized, that is, applicable across all cases, however much of each case is different.

People with overvalued ideas sometimes fall into the gray area. Sims (1988) defines an overvalued idea as:

Overvalued ideas are distinguished from delusions by the lack of a gross abnormality in reasoning; these patients can often give fairly logical reasons for their beliefs. They differ from obsessions in that they are not seen as recurrent intrusions.

The DSM-IV (American Psychiatry Association, 1994) notes that

Characteristically, an overvalued idea is an isolated sustained belief which:

• Is held strongly, with less than delusional intensity
• Is ego-syntonic compared to most obsessions
• Often develops in an abnormal personality
• Is usually comprehensible with knowledge of the individual’s past experience and personality
• The content is usually regarded as abnormal compared to the general population (but not bizarre as some delusions)
• Causes disturbed functioning or distress to the patient and others.

Examples of overvalued ideas are readily found in the letters to the editor column and in newspaper editorials.

1. Activists such as those who believe that all animal experimentation is unjustified or who condemn all patriotic support of one’s country in time of war as a totalitarian suppression of free speech and dissention may be expressing overvalued ideas.
2. Sometimes relatively ordinary people have them too, like those New York tenants who believe that all landlords are crooks who should be vilified and punished for making too much money and for taking advantage of the poor, and
3. those patients who believe that all doctors overlook the physical cause of what are in fact emotional symptoms, or, conversely, are all out to perform unnecessary operative procedures on them just for the money.

Patients who hold overvalued ideas have usually had them for many years and typically have abnormalities of personality.

The onset of an overvalued idea follows an incident that is often trivial but is viewed as a slight or injustice; the patient becomes convinced that s/he has been treated unfairly and begins making complaints.

Appeasement seems impossible. Any accommodation, no matter how generous and genuine, is felt to be unsatisfactory; litigation usually follows.

The process is often acrimonious, with the individual becoming more embittered as his/her beliefs are rejected by authorities. In 1905, Kraeplin, another pioneer in psychiatry, commented on overvalued ideas (McKenna, 1984):

The innumerable petitions which the patient has drawn up in the course of the last few years, chiefly at night, are exceedingly longwinded, and always allege the same thing in a rather disconnected manner. In their form and mode of expression they incline to the legal document, beginning with ‘concerning,’ going on throughout with ‘evidence’ and concluding with ‘grounds.’ They abound in half or wholly misunderstood professional expressions and paragraphs of totally different laws. Often they are careless and appear to have been written under excitement, contain numerous notes of exclamation and interrogation, even in the middle of a sentence; one or more underlinings, some in red or blue pencil, marginal notes and addenda, so that every available space is made use of. Many of the petitions are written on the backs of judgments and refusals of other courts.

Though overvalued ideas share with delusions Opens in new window a degree of unshakability, they are different from delusions in that delusions usually have an alien quality about them, whereas overvalued ideas are more like normal beliefs.

Delusions also do not have the conviction and the control over behavior that overvalued ideas possess.

Overvalued ideas may, however, interfere significantly with living a normal life as much as, or more than, do delusions. Some authors (e.g. Kozak and Foza; 1994) have suggested that overvalued ideas are on a continuum between rational thought and delusions. They proposed that overvalued ideas do not fluctuate spontaneously, but are fixed and possibly modifiable only if challenged.

Jaspers (1913) viewed overvalued ideas as prevalent in social reformers, inventors, or any individual of strong conviction, whereas delusions are strictly seen in patients.

Jaspers (1913) also posited that overvalued ideas are challengeable, transient, isolated, and bound to personality and situation, whereas delusions are unchangeable and fixed, and not necessarily bound to personality or situation.

Diagnostic significance

Overvalued idea generally arises in individuals with preexisting personality disorders including querulous paranoid state, morbid jealousy, hypochondriasis, dysmorphophobia, parasitophobia, anorexia nervosa, pseudocyesis and apotemnophilia (McKenna, 1984; Veale 2002).

Apotemnophilia is a rare disorder in which a person feels that one or more limbs do not seem to belong to them. Overvalued ideas may also be features of an emerging psychosis or an organic disorder.

Not surprisingly, disorders with overvalued ideas have a chronic course with poor prognosis, unresponsive to any form of treatment.

The DSM-IV-TR defines overvalued ideas solely on the strength of the belief in that it is held with less than delusional intensity and also considers that the belief is abnormal compared to other members of the patient’s culture.