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?
Why Are Narcissists Are Often Misdiagnosed by Psychotherapists?
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.
Psychology schools haven’t taught about NPD.
First, many schools didn’t teach psychologists a lot about narcissistic personality disorder, so a lot of therapists aren’t educated on NPD at all. Others just don’t even recognize it as a possible diagnosis. One of my clients told me that she mentioned gaslighting during a therapy session, 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.
Bi-polar and NPD symptoms overlap.
Another reason this happens 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 bipolar 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 mild hypomania – an 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.
Psychologist on Bi-Polar and NPD Diagnosis Confusion
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, as 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 lives of the disorder and be aware of the specific phases, if they believe the patient is bipolar.
Cluster B and Bi-Polar Can Be Co-Morbid Conditions
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.
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.
Bipolar Disorder Symptoms
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
Bipolar Disorder Has Periods of Remission, NPD Does Not
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 might 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?
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