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.


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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My step-daughter didn’t want me to marry her father: How I Survived

My step-daughter didn’t want me to marry her father: How I Survived

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Oh boy! Oh boy! I was in for a morning like I had never thought possible a few weeks ago. I woke up as normal and went about my morning routine, starting with getting the kids awake and in the shower.

Then I’m making breakfast and packing lunches.

And making beds and answering the every day question.

“Do I have to go to school today?”

So, while putting away the clean dishes from the dishwasher, I was talking to the smallest of my bunch, my youngest daughter and my new step-daughter, who were both being very engaging that morning.

We were laughing and getting ready for our day.

The Planner Incident

Every school day the kids bring home a planner that you are supposed to sign saying you saw it and read the information it gives you from school. I have never been a step-mother before.

I have signed many planners before this one, and still do so daily though. I had just recently married and we were starting to blend our families together. My step-daughter is with us half of the time and her mother the other half. I never signed her school planner before we were married because I did not think it was my place to do so.

However, after the wedding my husband suggests to me that I sign my step-daughter’s planner now that we were married and I had a new name. I thought it would be a good way to become more of an integrated part of her life so I proudly signed my new married name in my new step-daughter’s planner feeling happy and proud of my new beginnings. I even signed her planner the next day as well. Yay for new right? Not so much.

I did not think of the implication my actions of signing her planner would cause. It’s just signing a planner right? No… no, no it is not just that. It was so much more and I had no clue.

My smiley morning of oatmeal, kids, and cleaning up stopped when I opened my step-daughter’s planner. Upon flipping to the correct date I noticed the week before and stopped.

You know that week of Yay, you are all fantastic and life is fantastic and everyone loves everyone?

Yeah,  all of that came to a very abrupt halt.

I saw my name. That new name I had just gotten and was so proud of…scratched out. My step-daughter scratched out my new married name. Then again on the next day she scratched it out and her mother wrote her name over mine….. *sigh*

I died just a little inside. Here I was only married for 8 days and THIS was happening?

Holy sheesh, I wanted to cry. I didn’t understand. Weren’t we just joking and laughing and eating breakfast and getting along fine 5 seconds ago?

Had I ever noticed my step-daughter display anything but love and acceptance over the past year and a half before I married her father? I couldn’t recall anything that would cause her to do this. I was stunned.

What I Did Next

Turning around I flipped the planner over showing the kids what happened and asked what was this scribbling on the page?

My new step-daughter instantly starts crying into her Cheerios and I realize that was the wrong thing to do. My youngest just looks at me and I leave the room immediately feeling confused and knowing there was a better way I should have handled the situation.

I texted my husband at work. I told him what was going on and asked if he knew anything about it. I have to admit I freaked out a little bit with him.

He immediately called me and said that he had no idea and acted shocked this was happening. I did not know where to turn next.

In the meantime, my youngest daughter comes downstairs and says that she knows why my new step-daughter is upset and my daughter wants to talk. She says that my step-daughter always wanted her parents to get back together and so she did not want me to marry her father.

She said she told her mother and her grandmother (mother’s mother) about this and they had both previously told her father about her feelings and discouraged him from marrying me a few days before the wedding. I quickly thanked her for the information and then ushered her back upstairs so I could process all of this.

I was grateful that I had a starting point. If you know what the problem is then you have a better shot at fixing it. I was worried why my husband didn’t tell me all of this but deep down I totally understood too.

I didn’t even have to ask him to know that he was only trying to protect me. So, I texted him back at work and he told me that yes, he had known and that we were going though everything with the wedding and he didn’t want me to worry about something I didn’t need to worry about, how he wanted to be with me, and how he had talked to his daughter about this and thought it was all resolved.

Very apparent this was not resolved by the morning I was having.

I quickly tapped into my resources at home and called my oldest teenage daughter downstairs to ask her opinion. I told her about what had just happened in the kitchen and asked her what she thought would be best.

Love this kid of mine…


My Daughter’s Advice

She said that if she was in the same position and the same age she would want someone to sit her down and tell her like it is. Not to sugar coat anything because that’s not how life is. Don’t treat her with kid gloves, I am helping to raise another mature and responsible adult now. I need to treat my step-daughter like I would treat my own children. My daughter has such wisdom for a young adult.

I knew my oldest daughter was right that I had to tell my step-daughter the truth but with compassion, understanding, and love. I can “tell it like it is” all day to my own kids but they know me.

Telling It Like It Is


With this being the first time I had to help raise another person’s child I thought maybe she should know where my messages come from… the heart. I needed her to know that when I say something it’s not because I want to be bossy or take her mother’s place. It is because I love her and I want her to become a successful adult.

I found my confidence again with being a mother and a part of this family. I texted my husband one more time and told him that I was going to have a chat with my step-daughter regarding what happened this morning. He totally supported my decision to do so.

A Resolution: The Talk

I decided that since she was the last person to be dropped of at school each morning that gave us a normal time we are alone together every day to talk. She won’t feel like I am singling her out or pulling her aside.

Since she is the last one out of the car she sits behind me in the car. This allowed us to have our chat and her not to see me, I thought she might be more comfortable talking if she wasn’t staring directly at my face.

The plan of attack and time of occurrence had been decided so I was ready to go back upstairs and face life once again.

I walked up with a basket of clean laundry to put away acting like I was just doing my normal thing in the basement. I sneaked a peek at my step-daughter to see if there were anymore tears and thankfully there were not.

I got my kids all in jackets and ushered them out to the car on our way to school. My heart was racing and I didn’t know what I would say. I knew I had minutes before this big life changing conversation with a child was supposed to start and I felt like I needed to puke.

All of a sudden everyone was out of the car and only my step-daughter and I were left. I pulled out of the high school parking lot and onto the road heading to the next school.

I stumbled. I sat quiet. I knew I had to talk. By the time we hit the light I told myself that I was counting to 3 and then starting because the words were not willing to come out on their own. 1… 2… 3…

What I Said

I opened with, “I thought maybe we should talk about this morning and your feelings.”

Great start, good job, keep going, I told myself – a quick pep-talk I gave myself when the next sentence wouldn’t come out.

However, as soon as I got the courage to start talking it was easy. I told her I knew why she scratched my name out of her planner.

I said I understood how she feels about wanting her parents to get back together. I explained to her that I felt the same way when I was a kid. That when my mom and dad got divorced I wanted so much for them to get back together.

Even when my mom remarried a terrific guy who became my step-dad, even though I really liked that guy and his kids, even though I saw my mom was happy and I was happy, I still wanted my parents to get back together.

That doesn’t mean I didn’t love my new family or my old family. That simply meant I wanted my mom and dad. Because I do love my step-dad and I think he is great. But I just wanted my mom and dad.

I told her that I wanted my mom and dad to get back together all the way until I was an adult because it is hard to understand the “why” when you are a kid. Why some relationships just don’t work out.

Sometimes two people don’t get along no matter how much they love each other. That unfortunately relationships can end and the best things that came out of them are the beautiful children.

Then I took a deep breath and continued. We were pulling onto the street of her school so I had to make it quick.

I continued.

I told her that it’s perfectly normal to feel the way she feels and that no one loves her less because of it. That we know she doesn’t love us less because of this either. I told her that I love her and her dad.

I said that I will be there for the two of them for the rest of my life and that will never change. I stressed that her mother and her father and myself we all love her and understand her feelings and only want her to be happy.

I wanted her to understand I was not mad at all. That I was empathetic to the situation and related to her directly. I wanted her to know that I was supportive of her feelings as well. I was afraid that she thought the way she felt was not normal.

I needed her to know that her feelings were normal but her father and I were married now. I am a part of her life, not as a replacement parent but as a friendly guide with a mothering hand. I had to know that she knew I loved her and I wasn’t ever going to punish her for the way she felt even if it hurt me.

I support her and her feelings.

When she got out of the car I hugged her and told her I loved her. She was quiet during the ride but she looked at me while we were standing there in those few short seconds and said she understood and she thanked me for talking to her. She was smiling.


I have never been a step-mother. I have no clue how to start, where to start, and what not to do. I am learning this new role in my life each and every day. However, I am going to trip and fall and have to pick myself back up I’m sure.

But that little girl, my NEW DAUGHTER, will see nothing but me trying as hard as I can to do what’s right for her and for us. I am excited to have another little life to help gently guide. I will not fail her.

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