Narcissism vs. Bipolar Disorder

Patients in the manic phase of bipolar disorder often exhibit many of the signs and symptoms of pathological narcissism. These symptoms include extreme control, hyperactivity, self-centeredness and lack of empathy. For this reason, the manic phase of Bipolar Disorder is often misdiagnosed as Narcissistic Personality Disorder (NPD).

During the manic phase of Bipolar Disorder the patient is euphoric, has grandiose fantasies, develops unrealistic schemes, and is irritated and provoked to anger very easily. The manic phases of bipolar disorder only last for a limited time however, and are usually followed by depressive phases marked by pessimism, self-devaluation and self-deprecation. The narcissist, even when depressed, never gives up their narcissism. Their grandiosity, sense of entitlement, haughtiness, and lack of empathy never go away.

Narcissists experience depression when confronted with the drab reality of their life (their failures, lack of accomplishments, disintegrating interpersonal relationships, and low status) as opposed to their high opinions of themselves. They can easily escape these depressions and return to manic euphoria with just one dose of Narcissistic Supply.

Bipolar patients can not escape their depression so easily however. Their moods are subject to brain biochemistry. While narcissists are in full control of their faculties, even when maximally agitated; bipolar patients often feel loss of control of their brains, speech, attention spans and motor functions.

The bipolar patient is prone to reckless behaviors and substance abuse only during the manic phase. The narcissist does drugs, drinks, gambles, shops on credit, indulges in unsafe sex or in other compulsive behaviors while manic and depressive.

The bipolar patient’s manic phase generally interferes with their social and occupational functioning. Many narcissists, on the other hand, reach the top of their community, work or church’s social or occupational ladder. Narcissists can function flawlessly; inevitable blowups and the grating extortion of Narcissistic Supply usually put an end to their career and social liaisons.

Narcissists’ risk for self-harm is minute while bipolar patients are often hospitalized during their manic phases. Bipolar patients regret their misdeeds following the manic phase and try to atone for their actions, while narcissists experience no guilt.

Both types of patients contend to give advice, carry out an assignment, accomplish a mission, or embark on an endeavor for which they are uniquely unqualified and lack the talents, skills, knowledge, or experience required. The bipolar patient’s pretentiousness is far more delusional than the narcissist's. Ideas of reference and magical thinking are common and, in this sense, the bipolar is closer to the schizophrenic than to the narcissistic.

When treating patients who display manic symptoms associated with NPD, doctors should closely evaluate them in order to discern whether it could be bipolar disorder.

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