Grandiosity in Bipolar Disorder

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Grandiosity is a symptom experienced by people with bipolar disorder during manic and hypomanic episodes. People experiencing grandiosity often describe larger-than-life feelings of superiority. In short, it is an exaggerated sense of one's importance, power, knowledge or identity, which often has religious overtones. 

It is estimated that more than half of people with bipolar disorder will experience grandiose thinking.

In the case of bipolar disorder, grandiose delusions are considered “mood-congruent delusions” in that they manifest from the manic (or hypomanic) state. During manic or hypomanic phases, it is believed that brain activity changes, brain waves speed up, and neurotransmitter concentrations change, particularly levels of dopamine.

Distinguishing Between Narcissism and Bipolar Disorder

At times it can be difficult to distinguish between bipolar patients experiencing grandiose thinking during a manic or hypomanic mood and patients with a different personality disorder known as narcissism. One key to distinguishing whether grandiosity is part of narcissistic personality disorder or bipolar disorder is to identify other features of mania or hypomania the patient may be experiencing concurrently. For example, a patient with bipolar disorder who is experiencing grandiose thinking would also be expected to experience other symptoms at the same time, such as requiring less sleep, spending reckless amounts of money, or becoming suddenly hypersexual.

In the American Psychiatric Association's Diagnostic and Statistical Manual, the presence of grandiosity is used in combination with several other symptoms to confirm a diagnosis of bipolar. This symptom also occurs in children with early onset bipolar disorder.

Consequences of Grandiosity

Bipolar patients experiencing grandiose thinking may suffer consequences in their personal and professional lives.

To those who don't understand the symptoms of bipolar disorder, grandiosity can make someone seem conceited and rude. This can affect interpersonal relationships, such as friendships and romantic relationships. It can also impair judgment and make it difficult to be productive in day-to-day work activities, compromising a person's career success. And, finally, when grandiose ambitions involve a financial stake, a patient may experience significant financial loss and strain. 

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