Why Narcissists Are Often Misdiagnosed With Bipolar Disorder

Why Narcissists Are Often Misdiagnosed With Bipolar Disorder

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.

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.

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?

Get help with narcissistic abuse recovery right now.

 

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Symptoms and Risk Factors of Narcissistic Personality Disorder

Symptoms and Risk Factors of Narcissistic Personality Disorder

You might already be aware of everything you need to know about identifying toxic relationships and how to spot a narcissist – or someone who suffers from narcissistic personality disorder (NPD). Today, we’re going to discuss WHY people become narcissists.

How and Why People Become Narcissists

What are the symptoms of narcissistic personality disorder?

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


Today, let’s dive a little deeper and discuss symptoms and risk factors of NPD.

Identifying Narcissistic Personality Disorder

How do you know it’s NPD?

As you can guess from the official list of symptoms above, a diagnosis of NPD would typically be made when five or more of the characteristics are identified – but generally, the condition goes undiagnosed because narcissists see nothing wrong with their behavior.

People who are involved with narcissists and those who have NPD typically report the following kinds of behaviors and characteristics – do we see a pattern?

  • The belief that he or she is “special” and the desire to only associate with people he or she perceives are on their wavelength or who will “appreciate” them.
  • The need for excessive admiration from those around him or her.
  • The expectation of especially favorable treatment and automatic agreement by people around him or her.
  • The exploitation of others around them for their own benefit or advancement.
  • Inability to empathize with others.
  • Feels envious of others, but also feels that others are envious of him or her.
  • Acts arrogant, and may try to disguise arrogance with ethics.
  • Displays an exaggerated sense of self-importance and is typically extremely judgmental.

How to Identify Narcissistic Personality DIsorder

People with NPD are good at making those around them, especially people who don’t know them intimately, believe that they are something special. Family members of people dealing with NPD will typically find themselves trying to please him or her, and feeling guilty if they fail. They may even be afraid of how the person with NPD will react if their desires can’t be met or if they are defied in some way.

Risk Factors for NPD: Why People Become Narcissists

People always ask how narcissistic personality disorder develops in a person. They want to know: how are narcissists created? How do narcissists become narcissists? Does narcissism develop as a result of nurture or nature? 

According to some researchers, NPD may be developed when a parent fails to act empathetically toward the sufferer during his or her infancy. This is common among those born to very young parents or those born to mothers who suffer from postpartum depression or psychosis.

Kids who don’t feel safe during childhood or who suffered from a lack of affection and parental praise may also develop NPD, as can those who were neglected and emotionally abused.

Related: Researchers Blame Mom for Narcissistic Kids

Those who live in unpredictable situations and who feel they cannot rely on their parents are also at risk, as are those who are learning manipulative behavior from their parents.

When this happens, the child gets sort of emotionally “stuck” at an early stage of development and while they may later understand logically that others exist and have real feelings and needs, they may not ever fully embrace it emotionally. While a “normal” child will usually develop feelings of empathy for others around them by the time they hit kindergarten, those suffering from NPD never do–leaving them to become adults with the empathic capacity of an infant.

Want to know more? Get a more detailed explanation of attachment theory and how attachment style creates narcissists (as well as codependents) in this video. 

Here are some other videos you might like to watch to better understand narcissism and narcissistic personality disorder:

More on Narcissistic Signs and Traits: The Truth About Narcissists & NPD – Understanding the psychology of narcissists and self-help for those who have been in relationships with narcissists.

Learn how narcissistic personality disorder is diagnosed. 

Are you dealing with narcissistic abuse in a toxic relationship?

Need support in your recovery from narcissistic abuse? If you’re dealing with a malignant narcissist or someone with narcissistic personality disorder, you’ll definitely heal faster with the right kind of support. Which one is right for you? Here are a few options.

Still not sure? Take our narcissistic abuse recovery program test and find out which option is best for you!

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