Grandiosity in Bipolar Disorder

Grandiosity is a symptom experienced by people with bipolar disorder (BD) during manic and hypomanic episodes. People experiencing grandiose delusions often describe larger-than-life feelings of superiority and invulnerability. In short, it is an exaggerated sense of one's importance, power, knowledge, or identity, even though there may be little evidence to support the beliefs.

It is estimated that around two-thirds of people with bipolar I disorder will experience grandiose delusions at some point in their illness. About half of the people diagnosed with schizophrenia and a large number of people with substance use disorders will experience grandiosity as a manifestation of their illness.

Grandiose delusions may also be a facet of personality disorders, most especially narcissistic personality disorder (NDP).

Grandiosity is one of the seven symptoms of a manic or hypomanic episode in bipolar disorder. Within the context of the disorder, grandiosity is considered a mood-congruent delusion consistent with a manic state.

During manic or hypomanic episodes, the chemistry and activity of the brain will begin to change, causing nerve signals to speed up and neurotransmitter concentrations to rise, especially dopamine (the so-called "pleasure" neurotransmitter).

No one knows exactly why this happens, or why the symptoms are severe in some people but not in others. While grandiosity is a common feature of bipolar mania and hypomania, it doesn't occur in everyone with BD.

"Grande" in French means grand. As such, grandiosity refers to an unrealistic sense of superiority in which you consider yourself unique and better than others. It also infers a disdain for those you consider inferior to you, either by way of class, intelligence, beauty, or heritage.

As a symptom, grandiosity exists on a spectrum, ranging from inflated self-esteem to sweeping delusions of grandeur. Grandiosity can be difficult to pin down because the people experiencing the symptom, as well as those around them, may not recognize it as anything more than pompousness, arrogance, or boastfulness.

Grandiose delusions are one of the most common types of delusions in BD. Examples of grandiosity include:

• Exaggerating your own achievements
• Criticizing and dismissing other's achievements or talents
• Constantly boasting and talking about yourself
• Believing yourself to be infallible or invulnerable
• Believing that you are more intelligent than others
• Thinking that common rules don't apply to you
• Acting selfishly
• Treating others with disdain or contempt
• Not caring if you hurt someone with your actions
• Being quick to anger if you are challenged
• Being unable to see how your behavior affects others
• Being unable to see how unrealistic your beliefs and actions are

At times, it can be difficult to distinguish between grandiose thinking during a manic or hypomanic mood and grandiosity as a facet of narcissistic personality disorder (NPD). 

Having NPD means that you consistently exhibit traits of self-adoration in a way that interferes with your relationships and well-being. NPD is broadly characterized by self-centeredness, the inability to have empathy for others, and the manipulation of others to get what you want.

One of the key ways to differentiate grandiosity in BD from grandiosity in NPD is the co-occurrence of mania symptoms. Bipolar mania is a set of mood symptoms characteristic of bipolar I disorder that appears in episodes and can include:

• Euphoric, elevated, expansive, or irritable moods
• Increased energy and a decreased need for sleep
• Racing thoughts
• Pressured speech (excessive or frenzied speaking)
• Tangential speech (constantly changing unrelated topics)
• Restlessness and increased goal-directed activity
• Impulsivity with poor judgment and reckless behaviors (including spending sprees, hypersexuality, and needless risk-taking)

If grandiosity accompanies any of these abnormal behaviors, bipolar disorder should be explored as a possible cause. While grandiosity can accompany hypomania, a less severe form of mania, it is usually less problematic and easily missed in diagnosis.

People experiencing grandiosity as a feature of BD may suffer consequences in their personal and professional lives. To those who don't understand the symptoms, grandiosity can make someone seem unforgivably conceited and rude. This can affect interpersonal relationships at home, with friends and family, or at work.

Grandiose delusions can impair your judgment and compromise ability to keep or maintain employment. Grandiosity rarely occurs on its own in people with BD and may require medications, counseling, cognitive behavioral therapy (CBT), and social support to effectively resolve the symptoms.

If suffering from bipolar mania, your doctor may treat you with a mood stabilizer and sometimes an antipsychotic drug to quickly control hyperactivity, sleeplessness, hostility, and irritability. If the behaviors are extreme or potentially harmful, hospitalization may be needed to help bring your moods under control.

There is no one drug or psychotherapeutic approach that treats grandiosity on its own. Instead, your doctor will aim to resolve the abnormally heightened mood state that defines bipolar mania. By doing, behavioral extremes, like grandiosity, will also be tempered.