Bipolar disorder involves episodes of mania and depression. Symptoms of a manic episode may include a heightened sense of self-importance and grandiosity. These also feature in narcissistic disorder.
In this article, we look at the relationship between bipolar disorder and narcissism, including their symptoms and treatments.
Bipolar disorder is a mood disorder that causes fluctuations between high moods, or manic episodes, and low moods, or depressive episodes.
There are different types, including bipolar I, bipolar II, and cyclothymia.
Narcissism is a personality trait that involves feelings of self-importance, grandiosity, and a need for validation. A person with narcissistic traits may have narcissistic personality disorder.
Narcissistic personality disorder is part of a group of personality disorders called cluster B disorders. These feature dramatic, emotional, or unpredictable thinking and behavior.
The main guide that mental health professionals use for diagnoses — called the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) — does not list narcissism as a symptom of bipolar disorder.
However, when a person with bipolar disorder experiences mania, they may display some behaviors that also help characterize narcissistic personality disorder.
- high levels of confidence
- feelings of self-importance
- elevated energy levels
- grandiose self-perception
Due to this overlap in symptoms, a manic episode of bipolar disorder and narcissistic personality disorder can appear similar. This sometimes results in a misdiagnosis.
Also, during periods of depression, a person with a bipolar disorder might neglect caring duties, avoid social contact, or appear insensitive to the needs of others.
This most likely happens when overwhelming symptoms of depression make it hard for the person to think of others.
Meanwhile, people with narcissistic personality disorder may seem disinterested or insensitive to the needs of others, which may be based on a fear of inadequacy.
They, too, may be prone to depression, which can manifest as high self-confidence.
While some symptoms of bipolar disorders and narcissistic personality disorder appear to overlap, the conditions differ in various ways:
People with bipolar disorder experience intense mood changes: periods of mania and depression. These are more pronounced than the mood swings that most people experience.
For a person to receive a diagnosis of bipolar disorder, they must experience mania, or an elevated mood, for at least 7 days — or fewer, if the symptoms are severe enough to require hospitalization.
During an elevated mood, a person may experience:
- high self-esteem
- an exaggerated belief in their own importance
- an increased sense of self-worth
- high energy
- little sleep
- rapid thinking and speaking
- a feeling of being “wired”
For the diagnosis, a person must also experience symptoms of depression that last for at least 2 weeks at a time.
During an episode of depression, a person may experience:
- intense sadness
- feelings of guilt, shame, and hopelessness
- sleep problems
- low energy
Other features that some people experience
Sometimes, anxiety, drug or alcohol misuse, eating disorders, and psychosis occur with bipolar disorder.
Psychosis may happen during a high or low mood. During a manic phase, a person may have delusions about being very important or having special powers. During a depressed phase, a person may fear that someone is after them or that they have done something wrong.
Narcissistic personality disorder
For a diagnosis of narcissistic personality disorder, a person must have some of the following symptoms, which must significantly interfere with relationships or the ability to function — at work, for example.
- a sense of entitlement
- seeking attention
- an exaggerated sense of self-worth or importance
- a disregard for the feelings or needs of others
- fantasies of grandiose success or power
- a belief that one is special or unique
- taking advantage of others to achieve one’s goals
- problems with self-esteem
- a sense of identity that depends on comparison with others
- relationships that remain superficial
A person might also regularly demonstrate antagonism toward others.
To diagnose bipolar disorder or a personality disorder, a doctor must be sure that another condition cannot better explain the person’s symptoms.
They will ask about the symptoms and may carry out a physical examination. The doctor might also perform tests to rule out a physical health problem. Next, they may use criteria from the DSM-5 to make a diagnosis.
People with narcissistic personality disorder often do not realize that they have a problem, and they may not seek help.
People with bipolar disorder may not seek help during a manic phase, but they may do so when they experience depression.
The treatments for narcissistic personality disorder and bipolar disorder are different.
Narcissistic personality disorder
People with this disorder tend not to seek treatment because they do not see a need for change.
However, they may experience underlying depression or anxiety, and a doctor can prescribe medication or recommend psychotherapy for these issues.
If a person seeks help specifically for traits of the personality disorder, a doctor may recommend counseling or psychotherapy. The person may have experienced trauma, and these interventions can often help.
Bipolar disorder is a chronic condition. There is no cure, but it is treatable. Many people learn to manage their symptoms and function well.
Doctors may recommend the following treatments, alone or in combination:
Mood stabilizers, such as lithium, can help people with bipolar disorder have fewer and less severe mood shifts. Some people also benefit from antidepressants, antipsychotic drugs, or antianxiety medications.
Therapy and lifestyle adjustments
Talking or behavioral therapies, such as cognitive behavioral therapy, can help people identify, understand, and better manage extreme emotions.
Therapy may also help people make healthy lifestyle changes. This might involve:
- getting regular exercise
- having a healthful diet
- having a regular sleep routine
Complementary remedies may help, although research is often mixed or inconclusive.
Herbal supplements, such as St. John’s wort, may not be safe to use with some medications for bipolar disorder, so it is important to discuss any alternative medicine with a doctor before trying it.
If a person’s symptoms do not improve with medication, talking therapy, and other treatments, electroconvulsive therapy may help.
It involves delivering a mild shock to the brain. Doctors are still not sure how it works, but it seems to reduce the symptoms of bipolar and some other mental health disorders.
Narcissistic personality disorder and bipolar disorder can be frustrating, for the people they affect and their loved ones.
Narcissistic traits — whether they occur with a personality disorder or with bipolar disorder — are not a choice. They are a symptom of a mental health condition.
Anyone who believes that they may have a mental health condition should see a doctor, who can help develop a treatment plan that supports the person in living a full, active life and maintaining healthy relationships.