We present and discuss instances of exaggeration in consultations between psychiatrists and patients suffering from psychotic disorders. Drawing on a corpus of 15 consultations as well as on instances of exaggeration from non-clinical talk, we discuss how the use of exaggerations in psychiatric interactions differs from the use of exaggerations in everyday conversations. In some interactions involving patients suffering from psychotic disorders, the exaggerations are handled differently from everyday conversations – especially in terms of how the interactants respond to the exaggerations. When an excessive exaggeration is used in an everyday conversation, the interactant typically responds by signalling an understanding of the prior utterance as hyperbolic, for instance by laughing. In contrast, a strategy often chosen by the psychiatrists is to not confirm or challenge the factual content of the exaggeration, but rather to avoid alignment and to change the topic. This strategy appears to be selected when the exaggeration is more exact and less typically hyperbolic in design. While the strategies used to respond to exaggerations in everyday conversations suggest that the interactants understand these exaggerations as figures of speech, the psychiatrists’ responses suggest that they think the patients actually believe in the content of the exaggerations.