Bipolar with narcissistic personality disorder

Bipolar or Narcissistic Personality Disorder?

Delusions of grandeur, a heightened sense of your own abilities or accomplishments, unrealistic fantasies of power or success: If you are plagued by these beliefs or if you recognize them in a loved one, you may wonder whether you are facing the manic phase of bipolar disorder, narcissistic personality disorder, or something else. Even trained professionals have a hard time distinguishing between some mental illnesses and personality disorders, based on these symptoms alone.

Determining which condition or conditions you are facing is key to getting the right treatment. With bipolar disorder in particular, pay attention not just to the symptoms but their pattern.

“One distinguishing feature is the timing,” says psychiatrist Michael Peterson, MD, PhD, an assistant professor in the department of psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison. “Personality disorders are pervasive patterns of relating to others and situations that are long-standing. In bipolar, manic or depressed periods typically last weeks to months, but are not always present.”

Meanwhile, several of the symptoms of bipolar disorder can overlap with other conditions and lifestyle choices — leading to confusion. “Many of the core symptoms of bipolar can be confused with normal variability in mood, changes associated with personality disorders — including narcissistic or borderline personality disorder — or changes associated with alcohol or drug use,” says Dr. Peterson.

A little bit of detective work may be required before a final diagnosis can be made.

Bipolar Disorder Symptoms

Bipolar disorder is characterized by dramatic, intense shifts in mood. When in a down cycle, withdrawal, sadness, and despair are hallmarks of the depression many bipolar people face. On an upswing, extroversion, high energy, and intense joy may accompany what is called the manic period. Different people cycle at different rates — some moods can last weeks or months, others just a few days. At times, symptoms and mood shifts may be so severe that the individual cannot carry out normal daily activities or relationships. Most people with bipolar disorder experience more depression than mania, says Peterson, but all eventually experience both. Symptoms of a depressive period include:

  • Loss of interest in activities that were once enjoyed
  • Long periods of worry, sadness, or emptiness
  • Tiredness or fatigue
  • Difficulty concentrating or focusing
  • Changes in appetite or sleep
  • Restlessness
  • Irritability
  • Suicidal thoughts, plans, or attempts

Symptoms of a manic period include:

  • Feeling jumpy or wired
  • Extreme irritability
  • Long period of feeling very energetic, outgoing, and upbeat
  • Racing thoughts
  • Talking very fast
  • Not needing much (or a normal amount) of sleep
  • Excessive/irrational confidence in one’s own abilities
  • Poor impulse control (which may lead to overindulgence in sex, shopping, investments, and other high risk decisions.)

Narcissistic Personality Disorder Symptoms

The hallmark of narcissistic personality disorder is an apparent absorption with yourself (narcissism). Because this is a personality disorder, the symptoms are always present to some degree.

Symptoms include:

  • Love of self/great self-interest
  • Preoccupation with success and power
  • Attention seeking
  • Boasting or bragging about one’s own achievements often
  • Exaggeration of abilities and achievements
  • Having unrealistic goals
  • Fantasies of success beyond what is likely or possible
  • Hypersensitivity to possible slights and insults from others (coupled with what could be an aggressive or angry response)
  • Arrogant behavior
  • Belief in one’s own uniqueness/entitlement to special treatment
  • Difficulty understanding another’s emotions or perspective

“These symptoms could easily be confused with similar patterns that can emerge during manic phases of bipolar disorder,” explains Peterson.

Paying close attention to symptoms and the patterns that emerge over time may help distinguish between narcissistic personality disorder and bipolar disorder.

Narcissistic Personality Disorder

The symptoms of narcissistic personality disorder include: grandiose sense of importance, preoccupation with unlimited success, belief that one is special and unique, exploitative of others, lack of empathy, arrogance, and jealousy of others. These symptoms cause significant distress in a person’s life.

Narcissistic personality disorder is characterized by a long-standing pattern of grandiosity (either in fantasy or actual behavior), an overwhelming need for admiration, and usually a complete lack of empathy toward others. People with this disorder often believe they are of primary importance in everybody’s life — and to anyone they meet. While this pattern of behavior may be appropriate for a king in 16th century England, it is generally considered inappropriate for most ordinary people today.

People with narcissistic personality disorder often display snobbish, disdainful, or patronizing attitudes. For example, an individual with this disorder may complain about a clumsy waiter’s “rudeness” or “stupidity,” or conclude a medical evaluation with a condescending evaluation of the physician.

In layperson terms, someone with this disorder may be described simply as a “narcissist” or as someone with “narcissism.” Both of these terms generally refer to someone with narcissistic personality disorder.

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Symptoms of Narcissistic Personality Disorder

In order for a person to be diagnosed with narcissistic personality disorder (NPD) they must meet five or more of the following symptoms:

  • Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
  • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
  • Requires excessive admiration
  • Has a very strong sense of entitlement, e.g., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
  • Is exploitative of others, e.g., takes advantage of others to achieve his or her own ends
  • Lacks empathy, e.g., is unwilling to recognize or identify with the feelings and needs of others
  • Is often envious of others or believes that others are envious of him or her
  • Regularly shows arrogant, haughty behaviors or attitudes

Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is fairly uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes, and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.

Narcissistic personality disorder is more prevalent in males than females and is thought to occur in around 6 percent of the general population, according to research.

Like most personality disorders, NPD typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in their 40s or 50s.

Learn more: Symptoms of narcissistic personality disorder

How is Narcissistic Personality Disorder Diagnosed?

Personality disorders such as NPD are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood, or genetic tests that are used to diagnose personality disorder.

Many people with this disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis for narcissistic personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Causes of Narcissistic Personality Disorder (NPD)

Researchers today don’t know what causes NPD. There are many theories, however, about the possible causes of narcissistic personality disorder.

Most professionals subscribe to a biopsychosocial model of causation — that is, the causes are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important.

If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children. While some of this has to do with genetics, some of is also likely due to the child’s personality, as well as the parenting behavior of one or both of the parents.

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Treatment of Narcissistic Personality Disorder

Treatment of narcissistic personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms.

Learn more: Narcissistic personality disorder treatment

References

What is the prognosis of narcissistic personality disorder (NPD)?

  1. American Psychiatric Association. Personality disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Publishing, Inc; 2013.

  2. American Psychiatric Association. Alternative DSM-5 model for personality disorders. Fifth Edition. Washington, DC: American Psychiatric Publishing, Inc; 2013. 761-81.

  3. Akhtar S, Thomson JA Jr. Overview: narcissistic personality disorder. Am J Psychiatry. 1982 Jan. 139(1):12-20. .

  4. Torgersen, S. Epidemiology. Oldham JM, Skodol AE, Bender DS. The American Psychiatric Publishing Textbook of Personality Disorders. Washington, DC: American Psychiatric Publishing; 2005. 129-141.

  5. de Ruiter C, Greeven PG. Personality disorders in a Dutch forensic psychiatric sample: convergence of interview and self-report measures. J Pers Disord. 2000 Summer. 14(2):162-70. .

  6. Ronningstam E. Narcissistic Personality Disorder: Facing DSM-V. Psychiatric Annals. 2009 Mar. 39:111-121.

  7. Crosby RM, Hall MJ. Psychiatric evaluation of self-referred and non-self-referred active duty military members. Mil Med. 1992 May. 157(5):224-9. .

  8. Bourgeois JA, Hall MJ, Crosby RM, Drexler KG. An examination of narcissistic personality traits as seen in a military population. Mil Med. 1993 Mar. 158(3):170-4. .

  9. Maffei C, Fossati A, Lingiardi V, Madeddu F, Borellini C, Petrachi M. Personality maladjustment, defenses and psychopathological symptoms in non-clinical subjects. J Pers Disord. 1995 Apr. 9:330-345.

  10. Rebecca J. Frey, Ph.D. Narcissistic Personality Disorder. Encyclopedia of Mental Disorders. Available at http://www.minddisorders.com/Kau-Nu/Narcissistic-personality-disorder.html. Accessed: September 8, 2008.

  11. Ronningstam E, Gunderson J, Lyons M. Changes in pathological narcissism. Am J Psychiatry. 1995 Feb. 152(2):253-7. .

  12. Waller G, Sines J, Meyer C, et al. Narcissism and narcissistic defences in the eating disorders. Int J Eat Disord. 2007 Mar. 40(2):143-8. .

  13. Ronningstam E. Pathological narcissism and narcissistic personality disorder in Axis I disorders. Harv Rev Psychiatry. 1996 Mar-Apr. 3(6):326-40. .

  14. Ronningstam EF, Maltsberger JT. Part X: Personality Disorders. Gabbard GO. Gabbard’s Treatments of Psychiatric Disorders. Fourth Edition. Washington DC: American Psychiatric Publishing; 2007. Chapter 52: Narcissistic Personality Disorder, pages 791-804.

  15. David Bienenfeld, MD. Personality Disorders. Medscape Reference. Available at http://emedicine.medscape.com/article/294307-overview. Accessed: July 1, 2008.

  16. Simon RI. Outpatients. Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk Management. Washington DC: American Psychiatric Publishing; 2004. 89-90.

  17. Holdwick DJ Jr, Hilsenroth MJ, Castlebury FD, et al. Identifying the unique and common characteristics among the DSM-IV antisocial, borderline, and narcissistic personality disorders. Compr Psychiatry. 1998 Sep-Oct. 39(5):277-86. .

  18. Gunderson JG, Ronningstam E. Differentiating narcissistic and antisocial personality disorders. J Personal Disord. 2001 Apr. 15(2):103-9. .

  19. Stormberg D, Ronningstam E, Gunderson J, et al. Brief communication: pathological narcissism in bipolar disorder patients. J Personal Disord. 1998. 12(2):179-85. .

  20. Clarkin JF, Howieson DB, McClough J. The Role of Psychiatric Measures in Assessment and Treatment. Hales RE, Yudofsky SC, Gabbard GO. The American Psychiatric Publishing Textbook of Psychiatry. 5th Edition. Arlington, VA: American Psychiatric Publishing; 2008. Chapter 3.

  21. Roth BE. Narcissistic patients in group therapy: containing affects in the early group. Ronningstam E. Disorders of Narcissism: Diagnostic, Clinical, and Empirical Implications. Washington DC: American Psychiatric Press; 1998. 221-238.

  22. Alonso A. The shattered mirror: treatment of a group of narcissistic patients. Group. 1992 Dec. 16:210-219.

  23. Young J, Flanagan C. Schema-focused therapy for narcissistic patients. Ronningstam E. Disorders of Narcissism: Diagnostic, Clinical, and Empirical Implications. Washington DC: American Psychiatric Press; 1998. 239-268.

  24. Young J, Klosko JS, Weishaar ME. Schema Therapy. A Practitioner’s Guide. New York: Guilford; 2003.

  25. Links PS, Gould B, Ratnayake R. Assessing suicidal youth with antisocial, borderline, or narcissistic personality disorder. Can J Psychiatry. 2003 Jun. 48(5):301-10. .

  26. Links PS, Kolla N. Assessing and Managing Suicide Risk. Oldham JM, Skodol AE, Bender DS. The American Psychiatric Publishing Textbook Of Personality Disorders. Washington DC: American Psychiatric Publishing; 2005. 459.

Bipolar and Narcissism: What’s the Connection?

Bipolar disorder is a lifelong mental health condition. It causes severe mood shifts from highs (mania or hypomania) to lows (depression). These mood shifts interfere with a person’s quality of life and ability to carry out daily tasks.

There are several types of bipolar disorder, each with its own characteristic symptoms. These include:

Bipolar I disorder: With this type, a person must have experienced at least one manic episode, which may be followed by a hypomanic or major depressive episode. This sometimes triggers a break from reality (psychosis).

Bipolar II disorder: The person has had at least one major depressive episode and at least one hypomanic episode. They’ve never had a manic episode.

Cyclothymic disorder: Adults with this disorder have experienced many episodes of hypomania symptoms and periods of depressive symptoms over a two-year period. For young people, the symptoms have to have occurred over only one year. These symptoms are less severe than major depression.

Treatment for bipolar disorder involves medication and psychotherapy to regulate mood.

Narcissism is a lifelong personality disorder. A person with this disorder has these traits:

  • high sense of their own self-importance
  • desire for admiration from others
  • lack of empathy for others

People with narcissism may seem very confident. But in reality, they have a problem with self-esteem. This makes them vulnerable to even the smallest criticism. This condition can cause problems in many areas of a person’s life, such as work, relationships, schools, or finances.

A person with this disorder may feel unhappy and disappointed when others don’t pay special attention to them or do them special favors. Often, others don’t enjoy spending time with those exhibiting narcissistic personality disorder. People with the condition don’t have fulfilling relationships.

What is the connection between bipolar disorder and narcissism?

Mental health experts have found that some key features of bipolar disorder and narcissism overlap. These include setting high, sometimes unattainable, goals and being very impulsive. As a result, people with bipolar disorder often also have narcissistic personality disorder.

But there is a debate over how much the conditions overlap or if they’re actually occurring separately. Most experts say both conditions occur separately, but that people with bipolar disorder may present narcissistic personality traits.

For example, a person may present signs of narcissism during mild to moderate hypomania. They may particularly show grand perceptions of self. The person with bipolar disorder experiencing such a mood probably doesn’t have narcissistic personality disorder. Instead, they display narcissism during one or some of their moods.

Comparing the symptoms

To get a better idea of the connections between bipolar and narcissistic personality disorder, it’s a good idea to compare the symptoms of both. As mentioned before, the symptoms of bipolar disorder vary, but generally include:

  • mania and hypomania:
    • abnormally upbeat attitude
    • wired or jumpy energy level
    • increased activity or energy level
    • easily agitated
    • an exaggerated sense of well-being and self-confidence (euphoria)
    • a decreased need for sleep
    • extreme talkativeness
    • racing thoughts
    • easily distracted
    • poor decision-making
  • major depressive episodes:
    • depressed mood
    • loss of interest or pleasure in almost all activities
    • significant weight loss or gain, or decrease in appetite
    • insomnia or sleeping too much
    • restlessness or slowed-down behavior
    • loss of energy
    • feeling worthless or guilty
    • lack of concentration
    • indecisiveness
    • thinking about, planning, or attempting suicide
  • other signs:
    • anxious distress
    • melancholy
    • psychosis

Those with narcissistic personality disorder may display these symptoms:

  • an abnormally large sense of self-importance
  • expecting to be recognized as superior without reason to warrant that treatment
  • exaggerating talents and past achievements
  • feeling preoccupied by fantasies about success and power, intelligence, good looks, or the perfect mate
  • thinking they’re superior and can only be associated and understood by people with equal superiority
  • need for constant admiration
  • feeling entitled
  • expecting others to give special favors and comply with expectations
  • taking advantage of others to get what they want
  • having an inability or being unwilling to recognize the needs and feelings of others
  • being jealous of others and believing that other people envy them
  • acting arrogant or haughty

How can people who have bipolar disorder with narcissism control their narcissism?

Everyone has a different personality. That personality usually doesn’t change much over a lifetime. Your personality may be less or more intense some days, but it doesn’t change.

This is the same for people with bipolar disorder and narcissism. They may display their narcissism more at certain times, especially during manic or hypomanic episodes. So those around them may not notice their narcissism all the time.

There are ways to cope with both conditions. Psychotherapy is an effective treatment for both bipolar disorder and narcissistic personality disorder. The focus of therapy should be to:

  • help manage moods and narcissistic tendencies
  • reduce the intensity of manic and hypomanic episodes
  • work on narcissism in therapy when symptom-free

It’s especially important for those with both conditions to understand the causes of their emotions. It can also help for people with both conditions to learn to relate better to others. This may lead to forming and maintaining more rewarding and intimate relationships.

The bottom line

It’s not always possible to change personality traits. But psychotherapy can help people with both conditions control the expression of their narcissistic traits. Seeking treatment can improve your quality of life, so it’s important to do so if you need help. See your doctor or mental health expert for more information.

Jump to: Signs & Symptoms Causes Treatment

What is Narcissistic Personality Disorder?

It’s a nice feeling to be admired. It naturally makes us feel good and feel important. And, yes, we sometimes boast and brag on ourselves as well. But, if people start describing you as cocky, manipulative, and demanding, you might be suffering from a more serious condition. It is disorder is a mental disorder affecting approximately 1% of the population1, with a greater prevalence in men than women. Narcissistic personality disorder is defined as an inflated sense of self-importance, a lack of empathy for others, and a great need for admiration. The hallmark definition of narcissistic personality disorder is grandiosity – the exaggerated sense of self-importance. If you are living with this disorder, you may be preoccupied with power, prestige, vanity, and may think you deserve special treatment and fame.

Narcissistic personality disorder should not be confused with high self-confidence and self-esteem. Those with high self-esteem are still humble. If you are living with narcissistic personality disorder, you are likely selfish, boastful, and ignore others’ feelings and needs. It was once thought that individuals suffering from narcissistic personality disorder have high self-esteem on the surface, but deep down are insecure. This theory was supported by the defensive state these individuals enter when provoked. Recent research discounts the earlier theory and now indicates that if you are suffering from narcissistic personality disorder, you likely also have high self-esteem – both on the surface and below the surface.

If you are living with narcissistic personality disorder, it is probably affecting your everyday life. . . in a negative way. In general, you may be unhappy with life in general and disappointed when others are not admiring you or giving you special treatment and attention. Your work, personal, and social relationships are likely suffering, though, you are unable to see your own role in these occurrences. Individuals with narcissistic personality disorder are unable to realize the damaging effects their behavior is causing themselves and others. If you have this condition, people likely will not enjoy being around you and you may feel unfulfilled at work, home, and in your social life.

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Concerned that you or a loved one has Narcissistic Personality Disorder?

Take our 2-minute Narcissistic Personality Disorder quiz to see if you may benefit from further diagnosis and treatment.

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What are the Symptoms?

Monopolizing conversations? Feelings of entitlement? Belittling others? These are all classic signs of narcissistic personality disorder. Do you know of someone who knows the “right” way and all other ways are wrong? Are they cocky, lack empathy, and think they are largely important? Then it’s possible they might be suffering from this condition.

Signs & Symptoms

Included below is a list of some well-recognized symptoms of narcissistic personality disorder.

  • Preoccupied with fantasies of unlimited success
  • Belief of great self-importance; only understood and should only associate with individuals of high-status
  • Expectations of being realized as superior
  • In need of and requiring constant admiration
  • Exaggeration of achievements and talents
  • Possessing a sense of entitlement
  • Being envious of others and the exaggerated belief that others are envious of you
  • Thinking about oneself the majority of the time and talking about oneself a lot; self-promotion
  • Setting of unrealistic goals
  • Expectation that others should do special favors for you
  • Belief that nobody should question your motives and should have unwavering compliance with your requests
  • Taking advantage of others to move forward in life and/or to get what you want, with no remorse toward the ones you stepped on to get there
  • Arrogance, haughtiness
  • Easily rejected, hurt
  • Unemotional
  • Power seeking
  • Demonstrates superiority
  • Responds to criticism with shame, anger, and humiliation
  • Easily jealous

Oftentimes, individuals are initially attracted toward people with narcissistic personality disorder. You may find yourself attracted to the confidence, assertiveness, and excitement that surrounds a person with narcissistic personality disorder. However, getting to know the person in depth, you may start to despise the very same traits that initially attracted you to the person. This, of course, after realizing their unemotional response to relationships, the unattractiveness of their lack of empathy for others, and the grandiose belief they are greatly important and you should treat them as such.

What Causes Narcissistic Personality Disorder and How is it Diagnosed?

There is not a single defined cause of narcissistic personality disorder. But, researchers agree that both genetic and environmental causes are at play. Individuals with narcissistic personality disorder have been found to have less volume of gray matter in the left anterior insula, the part of the brain related to empathy, emotional regulation, compassion, and cognitive functioning.

Many of the traits of narcissistic personality disorder occur during normal stages of development. Scientists believe that full onset of narcissistic personality disorder may occur when interpersonal development during these phases is conflicted. Examples of types of negative or destructive interpersonal environments interacting with developmental phases include:

  • Being born with an oversensitive temperament
  • Learning manipulative behavior from parents or peers
  • Being excessively praised for good behaviors and excessively criticized for bad behaviors
  • Suffering from severe childhood abuse
  • Inconsistent parental care giving – unreliable or unpredictable care
  • Being overindulged by parents, peers, or family members
  • Being excessively admired with no realistic feedback to balance you with reality
  • Receiving excessive praise from parents or others over your looks or abilities

If you are suffering from narcissistic personality disorder, you might never head to the doctor for a diagnosis. Studies have shown that people suffering from this condition rarely enter treatment. If you do enter treatment, progress will be slow. However, if you or a loved one is suffering from narcissistic personality disorder, it’s important to get treatment. Prepare for your appointment by taking note of symptoms, personal experiences, medications, and your medical history. Your doctor will conduct a physical examination to rule out any underlying conditions and will then refer you to a mental health provider. A mental health provider will ask you a number of questions to gather information about your symptoms and the effects they are having on your life.

What are the Treatment Options?

Psychotherapy is the key approach in the treatment of narcissistic personality disorder. Psychotherapy, also known as talk therapy, is used to help you learn how to relate to others better to encourage more functional interpersonal relationships and to gain a better understanding of your emotions and why you feel the way you do.

As noted above, the treatment prevalence for individuals living with narcissistic personality disorder is low and slow going. Because treatment is focused on personality traits, which are pretty steady over time, it may take many years of psychotherapy before realizing a break through. Change behaviors are focused on accepting responsibility for your actions and learning ways to engage inter personally in a more appropriate manner. These include:

  • Accepting and maintaining relationships with co-workers and family
  • Tolerating criticisms and failures
  • Understanding and regulating your feelings
  • Minimizing your desire to attain unrealistic goals and ideal conditions

There are no known medications to treat narcissistic personality disorder. But, oftentimes if you are living with this condition, you might also be living with depression and anxiety. Medications are helpful for these conditions and may be used to treat those. Individuals living with narcissistic personality disorder are also at a greater likelihood of abusing drugs and alcohol – so treatment for addiction problems is also beneficial in treating this condition.

Keep an open mind toward treatment, stick to treatment plans, educate yourself about your condition, and stay focused on your goal. You may feel negative toward treatment, but know that it can help.

Article Sources Last Updated: Oct 22, 2019

Bipolar Disorder

Also known as manic depression, bipolar disorder causes swings in mood, energy, and the ability to function throughout the day.

Symptoms: Bipolar disorder is known for alternating periods of depression and mania that can last from days to months. During a manic, hypomanic, or depressed episode with “mixed features,” symptoms of depression and mania happen at the same time. Unlike borderline personality disorder, the mood swings of bipolar disorder are not triggered by interpersonal conflicts, last for days to weeks rather than minutes to hours, and episodes are, by definition, accompanied by changes in sleep, energy, speech, and thinking

During times of mania, symptoms might include:

  • An excessively happy or angry, irritated mood
  • More physical and mental energy and activity than normal
  • Racing thoughts and ideas
  • Talking more and faster
  • Making big plans
  • Risk taking
  • Impulsiveness (substance abuse, sex, spending, etc.)
  • Less sleep, but no feeling of being tired

During periods of depression, symptoms might include:

  • Drop in energy
  • Lasting sadness
  • Less activity and energy
  • Restlessness and irritability
  • Problems concentrating and making decisions
  • Worry and anxiety
  • No interest in favorite activities
  • Feelings of guilt and hopelessness; suicidal thoughts
  • Change in appetite or sleep patterns

Treatment: Most people with bipolar disorder need lifelong treatment to keep their condition managed. This usually includes medicine — usually mood stabilizers, and sometimes also antipsychotics or antidepressants. Therapy can also help people with bipolar disorder understand it and develop skills to handle it.

How are DSM axis I disorders differentiated from narcissistic personality disorder (NPD)?

  1. American Psychiatric Association. Personality disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Publishing, Inc; 2013.

  2. American Psychiatric Association. Alternative DSM-5 model for personality disorders. Fifth Edition. Washington, DC: American Psychiatric Publishing, Inc; 2013. 761-81.

  3. Akhtar S, Thomson JA Jr. Overview: narcissistic personality disorder. Am J Psychiatry. 1982 Jan. 139(1):12-20. .

  4. Torgersen, S. Epidemiology. Oldham JM, Skodol AE, Bender DS. The American Psychiatric Publishing Textbook of Personality Disorders. Washington, DC: American Psychiatric Publishing; 2005. 129-141.

  5. de Ruiter C, Greeven PG. Personality disorders in a Dutch forensic psychiatric sample: convergence of interview and self-report measures. J Pers Disord. 2000 Summer. 14(2):162-70. .

  6. Ronningstam E. Narcissistic Personality Disorder: Facing DSM-V. Psychiatric Annals. 2009 Mar. 39:111-121.

  7. Crosby RM, Hall MJ. Psychiatric evaluation of self-referred and non-self-referred active duty military members. Mil Med. 1992 May. 157(5):224-9. .

  8. Bourgeois JA, Hall MJ, Crosby RM, Drexler KG. An examination of narcissistic personality traits as seen in a military population. Mil Med. 1993 Mar. 158(3):170-4. .

  9. Maffei C, Fossati A, Lingiardi V, Madeddu F, Borellini C, Petrachi M. Personality maladjustment, defenses and psychopathological symptoms in non-clinical subjects. J Pers Disord. 1995 Apr. 9:330-345.

  10. Rebecca J. Frey, Ph.D. Narcissistic Personality Disorder. Encyclopedia of Mental Disorders. Available at http://www.minddisorders.com/Kau-Nu/Narcissistic-personality-disorder.html. Accessed: September 8, 2008.

  11. Ronningstam E, Gunderson J, Lyons M. Changes in pathological narcissism. Am J Psychiatry. 1995 Feb. 152(2):253-7. .

  12. Waller G, Sines J, Meyer C, et al. Narcissism and narcissistic defences in the eating disorders. Int J Eat Disord. 2007 Mar. 40(2):143-8. .

  13. Ronningstam E. Pathological narcissism and narcissistic personality disorder in Axis I disorders. Harv Rev Psychiatry. 1996 Mar-Apr. 3(6):326-40. .

  14. Ronningstam EF, Maltsberger JT. Part X: Personality Disorders. Gabbard GO. Gabbard’s Treatments of Psychiatric Disorders. Fourth Edition. Washington DC: American Psychiatric Publishing; 2007. Chapter 52: Narcissistic Personality Disorder, pages 791-804.

  15. David Bienenfeld, MD. Personality Disorders. Medscape Reference. Available at http://emedicine.medscape.com/article/294307-overview. Accessed: July 1, 2008.

  16. Simon RI. Outpatients. Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk Management. Washington DC: American Psychiatric Publishing; 2004. 89-90.

  17. Holdwick DJ Jr, Hilsenroth MJ, Castlebury FD, et al. Identifying the unique and common characteristics among the DSM-IV antisocial, borderline, and narcissistic personality disorders. Compr Psychiatry. 1998 Sep-Oct. 39(5):277-86. .

  18. Gunderson JG, Ronningstam E. Differentiating narcissistic and antisocial personality disorders. J Personal Disord. 2001 Apr. 15(2):103-9. .

  19. Stormberg D, Ronningstam E, Gunderson J, et al. Brief communication: pathological narcissism in bipolar disorder patients. J Personal Disord. 1998. 12(2):179-85. .

  20. Clarkin JF, Howieson DB, McClough J. The Role of Psychiatric Measures in Assessment and Treatment. Hales RE, Yudofsky SC, Gabbard GO. The American Psychiatric Publishing Textbook of Psychiatry. 5th Edition. Arlington, VA: American Psychiatric Publishing; 2008. Chapter 3.

  21. Roth BE. Narcissistic patients in group therapy: containing affects in the early group. Ronningstam E. Disorders of Narcissism: Diagnostic, Clinical, and Empirical Implications. Washington DC: American Psychiatric Press; 1998. 221-238.

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From: MHM Journal – Volume 6, Issue1

ARE THEY CAUSED BY A MANIC STATE?

A heightened sense of one’s achievements and abilities, lack of empathy, driven and goal directed behaviour are features common to both Narcissistic Personality Disorder and Bipolar Mood Disorder.

Clinically both conditions may look similar, even to the trained observer. Narcissism is not a symptom of bipolar, and neither are all bipolar patients narcissistic but narcissistic tendencies can manifest during a manic or hypomanic episode of a Bipolar Mood Disorder.

A narcissistic PD and the manic/hypomanic bipolar might both display grandiose self perceptions, a pre-occupation with themselves and their own interests, impulsiveness, mood disturbances, and an increase in goal directed behaviour.

Disregard for the differences in these conditions can lead to misdiagnosis and improper management that can be harmful, particularly in the case of the bipolar patient.

Bipolar Mood Disorder is identified primarily by severe shifts in mood.

A bipolar patient will cycle between feelings of elation and euphoria, known as mania, and depressive symptoms.

These interfere with a person’s relationships and ability to carry out day to day functions.

Although the condition may be life-long, the symptoms are episodic.

Bipolar I disorder is differentiated from Bipolar II disorder by manic episode in the former and less severe hypomanic episodes in the latter.

Adults with Cyclothymic Disorder will experience many episodes of hypomania and depressive symptoms over a two year period.

Symptoms of a manic period include:

  • An expansive mood and feelings of euphoria that is out of character
  • Feeling jumpy or wired
  • Extreme irritability
  • Period of feeling increased energy
  • Racing thoughts
  • Talking very fast; pressured speech
  • Sometimes uninhibited behaviour, such as striking up a conversation with a stranger in a supermarket.
  • Reduced need for sleep
  • Excessive/irrational confi dence in one’s own abilities
  • Increase in goal directed activity
  • General impulsiveness evidence by spending sprees, engaging in risky behaviour or getting involved in poorly thought out business ventures
  • Symptoms of a depressive period include:
  • Loss of interest in activities that were once enjoyed
  • Long periods of worry, sadness, or emptiness
  • Tiredness or fatigue
  • Difficulty concentrating or focusing
  • Changes in appetite or sleep
  • Restlessness
  • Irritability
  • Suicidal thoughts, plans, or attempts

Personality refers to what makes us who we are.

An amalgamation of coping skills, ways of interacting, strengths and weaknesses, psychological defences and genetic characteristics.

Essentially the skills and tools we meet the world with.

A personality disorder results when one’s way of interacting with the world is markedly different from cultural norms or expectations.

Certain aspects of personality may result in continuous interpersonal problems or functionally impairs social and occupational functioning.

A personality disorder isn’t a sudden onset but rather an enduring pattern of behaviours and inner experiences emerging in adolescence or early adulthood.

Narcissistic Personality Disorder is one of ten personality disorders identified in the DSM V.

A person with this disorder will display a high sense of their own self-importance, have an excessive need for admiration and praise and shows a marked lack of empathy towards others. They’re boastful of their achievements, often to the extent of an over evaluation of normal accomplishments.

A narcissist might come across as overly confident, and perhaps even arrogant. However, this over-confident external self is a remarkable early developmental adaptation to protect a very fragile self-esteem that easily damaged under even the slightest criticism.

Symptoms include:

  • Love of self/great self-interest
  • Feelings of grandiosity
  • Often sees himself being the ideal in beauty, intelligence, ambition and talents
  • Preoccupation with success and power
  • Attention seeking
  • Boasting or bragging about one’s own achievements often
  • Exaggeration of abilities and achievements
  • Having unrealistic goals
  • Fantasies of success beyond what is likely or possible
  • Hypersensitivity to possible slights and insults from others (coupled with what could be an aggressive or angry response)
  • Generally showing arrogant or haughty behaviour
  • Belief in one’s own uniqueness/entitlement to special treatment
  • Lack of empathy
  • Manipulative or exploitative behaviour

Perhaps one of the most marked areas of overlap between BMD and NPD are the heightened self-perceptions observed in both. However similar they look, the clinician should look for subtle differences.

The bipolar individual will have more transient moments of grandiosity. It’s mood-phase specific and fuelled by elated and euphoric feelings accompanying the mania. It doesn’t last and isn’t present during a depressive episode. In extreme cases bipolar grandiosity takes on a delusional quality, such as belief in prophetic or supernatural abilities.

Narcissistic grandiosity is more enduring. Overinflated self-appraisals occur and one might not know the narcissist without the accompanying overinflated self perceptions. Narcissistic grandiosity is also unlikely to take on a bizarre or delusional quality. Bipolar patients and Narcissistic PD’s have a tendency towards impulsivity and increased goal directed behaviour.

Clinically it can be diffi cult to differentiate between a narcissist and a manic bipolar. Both the external and internal experience might look and feel the same, but underlying these experiences are different forces.

The narcissist is driven by a need to constantly be “better than”, and the manic bipolar is essentially driven by a chemical imbalance. Also, the narcissist may have the drive and ambition associated with goal directed behaviour, but lacks the increased energy evident during mania.

Depression or depressive features are common to both. Bipolar is often accompanied by at least one Major Depressive Episode. A narcissistic individual may also be at risk for developing Depression, particularly at around middle age.

Feelings of shame and embarrassment could result from their objective, measurable achievements not matching up to their idealised self leading to depression or dysthymia.

If depression is present, the bipolar individual will have transient depressive symptoms or a depressive episode. An individual with Narcissistic Personality Disorder will more likely develop a Major Depressive Disorder or more enduring depressive features.

The timing of symptoms is key to distinguishing the two conditions. Narcissism associated with Bipolar will manifest during a manic phase and may not be present when the individual is not symptomatic or controlled on medication. Bipolar symptoms are episodic and are labile.

A Narcissistic PD is less likely to have fluctuating moods associated with BMD and will have a more pervasive presentation of symptoms, manifesting in adolescence or early adulthood. Narcissistic symptoms don’t go into remission; they’re enduring and without extensive therapy they are lifelong.

Treatment of the two conditions is different. Treatment of BMD is primarily medication. Therapy aims to help the bipolar individual gain insight into their condition, psycho-educate and assist in recognising the start of a manic episode. Treatment of NPD is primarily long term therapy.

Medication is needed in the treatment of NPD to the extent there is a co-morbid condition requiring medication, such as Major Depressive Disorder.

The Narcissists behaviour is deeply embedded in their psychological defence making therapy difficult and lengthy.

Essentially, treatment and therapy should aim to alleviate symptoms, help people with to understand the causes of their emotions; and with time and commitment lead to improved relationships and overall improved wellbeing.

Mathew is a very driven and ambitious individual and was among the top achievers in one of the best universities. He’s highly qualified but currently unemployed. He recently resigned from his first job saying the job wasn’t worth his abilities. He’d rather wait until a more suitable job comes along rather than waste his talents in the wrong environment. Whilst working he didn’t get along with his supervisor and colleagues, some of whom referred to him as “arrogant, egotistical and manipulative.” “It’s really hard working with people who are not as capable as I am. I never got the recognition I deserved, even when I pointed out my achievements to others. My work was superior to the others and I think my supervisor was just too threatened by me to say so. I’m far too talented to waste my time in just any company”

Sally is an administrator at a law firm and studying towards her LLB. She was brought to the clinical psychologist by her concerned boyfriend who complained she hadn’t slept for days; she stays up all night working and seems not to get tired during the day. Her boyfriend also reported recent uncharacteristically reckless behaviour, such as her sudden resignation from her job. Sally complied with her boyfriend’s request to see a psychologist but admitted that she saw no reason why. She said she felt fantastic and didn’t understand her boyfriend’s concern. “I was depressed before, but without medication I just got out of it. I work all night because there’ s important work to be done. I spend my nights writing to leaders of corporations and countries about how we can solve global problems. I know I have a special gift and it’s up to me to make a difference. I was wasting valuable time in my job”

Mathew was diagnosed with Narcissistic Personality Disorder and Sally was diagnosed with Bipolar Mood Disorder.

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