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Today, in response to a question from one of my narcissistic abuse recovery coaching clients, I’m covering the differences – and similarities – between narcissistic personality disorder and bipolar disorder – and why psychologists and other medical professionals often confuse the two.

I’ve been writing and talking about narcissism, narcissistic personality disorder (NPD) and narcissistic abuse recovery for years, and one of the questions that I hear over and over again is actually related to another major issue – bipolar disorder.

The question: What are the differences between bi-polar disorder and NPD?

For example, one client told me her ex-narc has been diagnosed by a psychologist as bi-polar, but that she doesn’t believe this to be the case – and no one will listen to her. While I haven’t experienced this exactly, I can certainly relate to her pain – how about you?

Anyway.

Narcissists tend to be misread by many therapists, and generally in one of two ways – either the therapist doesn’t see an issue, or they are diagnosed with bipolar disorder.

Why does this happen? Well, there are a few reasons, so let’s talk about that.

First, a lot of therapists aren’t educated on NPD at all, and some don’t even recognize it. One of my clients told me the other day that she mentioned gaslighting, and her therapist told her that he not only hadn’t heard of it, but asked her how to SPELL it.

No, I’m not kidding.

Another reason this happens, quite honestly, is that so many of the symptoms overlap between these two disorders.

So, to put it in clinical terms, let me share this with you from a 2008 study published by the US Department of Health and Human Services, entitled Commonalities and differences in characteristics of persons at risk for narcissism and mania, written by
Daniel Fulford,* Sheri L. Johnson, and Charles S. Carver.

“Clinicians have long noted overlap in some of the key features of narcissism and bipolar disorder, including excessively high goals and impulsivity. In addition, empirical findings consistently document high levels of comorbidity between the two conditions. To better understand the similarities and differences in psychological qualities associated with mania- and narcissism-related vulnerabilities, we administered to 233 undergraduates a broad range of measures pertaining to goals and affects (both their experience and their dysregulation) and impulsivity. As hypothesized, tendencies toward both narcissism and hypomania related to elevations on measures of affective and goal dysregulation. In addition, hypomania tendencies were related to higher impulsivity, but that association did not appear for narcissistic tendencies. Results highlight key commonalities and differences between those at risk for mania versus narcissism. Future research should examine these relationships in clinically diagnosed samples.”

Putting it in layman’s terms, both someone with NPD and someone with bi-polar disorder will present with grandiose perceptions of themselves sometimes, and both will have unrealistic fantasies of power or success – plus, both may also feel a heightened sense of their own abilities or accomplishments.

This is most commonly misdiagnosed when a therapist believes that the person is experiencing a mild hypomania – elevated mood that hasn’t reached the full manic level yet – due to bipolar disorder. Of course, based on these symptoms alone, even a well-trained professional may misdiagnose their patient.

Now, as you know, I’m a certified life coach, NOT a psychologist – so I figured I’d bring some advice from a psychologist who IS qualified to offer it here.

According to psychiatrist Michael Peterson, who’s also an assistant professor at the University of Wisconsin School of Medicine and Public Health‘s school of psychiatry, one major distinguishing feature is the timing.

Peterson adds: “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.”

Of course, like I said, these symptoms can definitely overlap, and Peterson advises that other factors could play a part in the confusion.

He says: “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.

Bipolar Disorder Symptoms Vs NPD Symptoms

Let’s cover the basics here – bipolar disorder is mostly characterized by dramatic and overwhelming shifts in mood or energy – the bipolar person may hit the highest highs and the lowest lows, and these will alternate, often in a pattern. During the manic period, they’ll have lots of energy and be much more extroverted – while when the “down” side hits, they’ll find themselves exhausted, withdrawn and generally in despair.

Another big marker for bipolar disorder: those who are most seriously affected sometimes can’t function in normal day-to-day life. They can’t keep jobs or relationships due to their disorder.
Of course, when it comes to NPD, you’re dealing with someone who is self-absorbed to an unhealthy point, and who does not experience real empathy for the people around them.

So, in order to correctly diagnose or differentiate between the two disorders, psychologists must pay attention to the patterns in the ives of the disorder and be aware of the specific phases, if they believe the patient is bipolar.

A few more things to consider…

Sometimes the two CAN coexist: A recent study found that cluster B (which includes borderline, narcissistic, antisocial and histrionic personality disorders) features were evident in about one-third of bipolar patients, with possible associations to childhood emotional and/or physical abuse.

NPD SYMPTOMS:
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, the official list of symptoms is as follows.

  • Having an exaggerated sense of self-importance
  • Expecting to be recognized as superior even without achievements that warrant it
  • Exaggerating your achievements and talents
  • Being preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
  • Believing that you are superior and can only be understood by or associate with equally special people
  • Requiring constant admiration
  • Having a sense of entitlement
  • Expecting special favors and unquestioning compliance with your expectations
  • Taking advantage of others to get what you want
  • Having an inability or unwillingness to recognize the needs and feelings of others
  • Being envious of others and believing others envy you
  • Behaving in an arrogant or haughty manner

According to the DSM – 5, these are the basic symptoms for bipolar disorder – and please note this is a VERY high overview – bipolar disorder is far more complex than you’d expect.

Symptoms of Bipolar Disorder

First, you cannot self-diagnose bipolar disorder – the DSM5 requires a medical diagnosis. “Mania symptoms include periods of elevated mood or irritability. When experiencing a manic episode, a patient often has high energy levels with reduced need for sleep. Less often, people may experience psychosis. Depression symptoms include feeling sad, low energy, low motivation, or loss of interest in previously enjoyable activities.”

  • Mood: mood swings, sadness, elevated mood, anger, anxiety, apathy, apprehension, euphoria, general discontent, guilt, hopelessness, inability to feel pleasure, or loss of interest
  • Behavioral: irritability, risky behavior, disorganized behavior, aggression, agitation, crying, excess desire for sex, hyperactivity, impulsivity, or self-harm
  • Cognitive: unwanted thoughts, delusion, lack of concentration, racing thoughts, slowness in activity, or false belief of superiority
  • Psychological: depression, manic episode, agitated depression, or paranoia
  • Sleep: difficulty falling asleep or excess sleepiness
  • Whole body: fatigue or restlessness
  • Weight: weight gain or weight loss
  • Also common: rapid and frenzied speaking

A final thought on this – while people with bipolar disorder might have episodes of “remission” in which the disorder doesn’t dictate their lives, people with NPD are pretty consistent about their behavior. Sure, there ight be varying levels of intensity with the gaslighting and the manipulative behaviors with a narcissist, but it’s a character-type that doesn’t go away – and even when there is some success in treatment (rarely is the disorder even treated), it doesn’t usually go away. That fact, along with the fact that the narcissistic person can’t experience real empathy, are, in my opinion, the two most obvious differences between these disorders.

Now it’s your turn – what do you think? Do you know anyone who seems to be a narcissist but who was diagnosed as bipolar? How do you feel about it and what would you say to my suggestion that the easiest way to detect the difference lies in both the patterns and the empathy factor?

Share your thoughts and experiences in the comments below and let’s discuss it.

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6 Responses to Why Narcissists Are Often Misdiagnosed With Bipolar Disorder

  1. Wow. Yes. My father was diagnosed with bipolar disorder so, my whole life, I’ve given him empathy for his massively self-absorbed behavior and for leaving my brother and I to live in poverty with our mom when I was three years old while he went and got rich. I forgave him time after time after time for blatant abandonment, diminishing my accomplishments and basically never being there for me financially, emotionally or physically my whole life. He presented himself as a kindly man of peace but every interaction with him felt like an emotionally draining ordeal to get through. If I wanted anything or tried to share how he made me feel in any way, he grew smug and would tell me what’s wrong with me or offer advice as though he had nothing to do with the situation.

    Toward the end of his life, I finally stood up and adamantly asserted myself in a last ditch attempt at a heart to heart. He gave me nothing. Zero self reflection and his insults and dismissiveness were through the roof. After he died I finally got to read his memoirs he’d been writing…. oh… my… god… He got rich by secretly screwing over all of his business partners, he said I was an ugly baby, he cheated on my mom and blamed the divorce on her, he laid out how he manipulated his new wife (who hated kids) and revealed that he had spent seven years in Werner Erhard’s EST organization, where he was “enlightened” by learning that “man is a machine, life is a game, do whatever the hell you want”. There was so much shocking bizarre, weird and awful behavior in those memoirs but no remorse at all.

    He was the dictionary definition of a covert narcissist. Now that I see him for who he is, I’m dealing with a brother who refuses to acknowledge any of it. He can’t take dad off the pedestal. If I try to talk about him or sort through the rubble in any way, massive gas lighting and emotional manipulation begins. I’m starting to think that my brother has been a covert narcissist this whole time too, just waiting to take over the throne as king narcissist of the family or something.

    This is now affecting my relationship with the “good” side of the family, my deceased mom’s brother and sister who have always thought of my brother as a quiet, sensitive person. When I try to talk about the situation to them, they think I’m crazy. How do I protect that side of the family and myself from the toxic effects of narcissism without looking like the bad guy? It’s all so crazy making…

  2. Dear Son of a Narc.

    It could be that your father treated your brother as his golden child, the one he would put on a pedestal, maybe because your brother as a child was easier to manipulate and never fought back at your father. Maybe he even gave him some treats behind your and your mother’s back? It’s common amongst narcissistic parents to favor one kid and disregard or put down the other. I would guess that your brother looked up to your father and was treated much better than you by him and that your brother had learned to never start any argument with your father. On the other side, he might also have learned from early on, your father’s tricks on how to manipulate other people to have his own way. That doesn’t mean he uses these tricks in a calculated way, it could be subconscious and it doesn’t have to be a proof that your brother is a narcissist. Your brother might have picked up a learned behavior, while still being an empathetic person. I wouldn’t know since I don’t know him.

    All I know from personal experience is that it’s easy to ‘partner up with’ a narcissist and start to think and behave in a similar manner, especially if you are an emotionally sensitive person that are afraid to go against the narcissist out of fear of retaliation. I lived with one for many years and we had two children together. My children are not narcissists, but one of them has picked up some of the manipulation tricks from their father. The difference is that my child (now 16 years old) is very empathetic and also has a good sense of self-awareness.

    My suggestion to you would be to focus on yourself and your own life without taking the responsibility of your brother. He has to find his own way in life. The only thing you can do is to try to find true happiness in your life regardless of your family history and your brother. Even if this means that he might manipulate his way to better favors than you are able to retrieve. Just let it go. Let him go. Let your past go. Focus on yourself and all the good things life has to offer you.

    Wish you all the best.

  3. I am dealing with my ex, the father of my 11yo daughter. He is semi-present, when he feels like it, and the damage he is causing to my daughter, I fear, is becoming irreparable. He has indicated to me that he is BPD, but says he was diagnosed and is treated by, his GP. I find that difficult to believe, much like everything else he says. Seems his interest in his daughter ebbs and flows with his lovelife, he likes to keep her in his back pocket for the times he is lonely or bored. When I attempt to rationally/irrationally/calmly/angrily/you name it, address my concerns, he always responds with “You’re so mean, your words are hurtful to me, woe is me, me, me, me, meeeeeeeeee”

    He claims to be BPD but I see shades of NPD, he literally is incapable of showing empathy or taking ownership, and is incapable of prioritizing his child, and I am continually picking up the pieces. I am trying to accept that he will not change, and I am trying to find ways to empower my daughter to express her feelings to him but I feel I need to be careful not to promise change if she does. This has been my struggle since the day she was born. I am at a loss.

  4. I have a feeling my ex was both. I knew he was diagnosed with BPD when he was young, but never does treatment. Risk seeker, depressive episodes, jail time, cheating, lies, instability with money, life instability, grandiose self worth, I think lack of empathy (if you cried in front of him he didn’t respond), he’d run away from problems, drug user, tattoos, treated his kid well, used people to get what he thought he needed/survival (home, money etc), manipulative especially through guilt (I’ve you love me….), known for hoovering (disappeared and randomly would come back then disappear again), a lot about him and if it wasn’t about him it was projected onto his kid. I loved him and his kid so much I went through the roller coasters, didn’t make anything about the BPD but eventually said I can’t do this, I want you and your kid but… (and I fought for it but he just never responded). I still love him and his kid, that never changed but he went onto the next person.

  5. My ex always would tell me I was a narcissist, I was so frightened of this I asked my psychiatrist and counselor. They assured me I wasn’t but I fear if I ever do anything it might seem like I am. I’m diagnost with sever depression, ADHD 1&2, Anxiety and PTSD. He for some reason decided to go see a psychiatrist, I thought he finally wanted help. He said he was ADHD and bipolar. He even justifies his actions due to his bipolar and adhd. Then he takes these notebooks he writes in to his psychiatrist whom he just loves and I found out he was writing about me and how I was abusing him and a narcissist he even said that’s what his psychiatrist said. He often says I have antisocial personality and he thinks I’m bipolar. One time when I went to a domestic violence shelter. He bought a book about emotional abuse. I thought finally he sees what he does to me he finally understands, boy was I wrong he flipped the script on me and bought me a book and I seen in his book that he underlined and wrote notes indicating that that’s what I do to him. I still feel so worried he may be right. I know he is not I’m very empathetic. It’s just hard

  6. Was in a 3 year relationship with a man I am just figuring out is a somatic narcissist. He recently served me a final – and brutal – discard. He dumped me and proposed to his new victim a week later. After 3 weeks of consuming everything I could on NPD, in conjunction with my personal experiences with him, family stories and first-hand experience with his mother – it is clear his mother also suffered from NPD. She was/is a classic NPD with other possible mental illness issues as well. My ex narc, her younger son, is the golden child. Her older son moved all the way across the country years ago to get away from her toxic behavior. She split her own family (siblings) apart and worked tirelessly to split her sons and their families apart. Although I know it’s too late to try and convince my ex narc of his condition (he wouldn’t believe me anyway) it helps to know that truly – there is nothing I can do but move on and heal myself. At least I know now what I was dealing with. Thank you for this post.

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