Grandiosity in Bipolar Disorder

Grandiose ideations, or grandiosity, are an exaggerated sense of one's importance, power, knowledge, or identity—even with little evidence to support this. People with bipolar disorder (BD) may experience this symptom. Grandiosity can occur during both manic and hypomanic episodes.

Prevalence of Grandiosity

The number of people with grandiose ideations is somewhat unclear, with research indicating that grandiosity is present in somewhere between 8% and 65% of the general population. That's a different question that how common grandiosity is in people with bipolar disorder.

In a 2015 study of 149 patients diagnosed with bipolar disorder, more than half had thought content disturbances that were mainly grandiose and persecutory in nature. Research published in the journal Bipolar Disorders suggests that around 57% of youth with BD experience grandiosity.

Grandiose thoughts are also common with substance use disorders, particularly in people who use cocaine and amphetamines. Additionally, grandiosity is thought to be a possible facet of personality disorders, particularly narcissistic personality disorder.

Causes of Grandiosity

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 change in complex ways. It is these changes that lead to symptoms.

No one knows exactly why these changes happen. It's also not clear why some people experience severe symptoms and others do not. Although grandiosity is a common feature of bipolar mania and hypomania, it does not occur in everyone with the disorder.

Signs and Symptoms of Grandiosity

The term "grandiosity" refers to an unrealistic sense of superiority in which someone believes themself to be unique and better than others. It also infers a disdain for people considered inferior (by way of class, intelligence, beauty, heritage, etc.).

As a symptom, grandiosity exists on a spectrum. It can range from inflated self-esteem to sweeping delusions of grandeur. Grandiosity can be difficult to identify and pin down.

Examples of grandiosity include:

• Exaggerating achievements
• Criticizing and dismissing the achievements or talents of others
• Constantly boasting and talking about themself
• A belief that they are infallible or invulnerable
• A belief that they are more intelligent than others
• Thinking that rules don't apply to them
• Acting selfishly
• Treating others with disdain or contempt
• Not caring if they hurt someone with their actions
• Being quick to anger if challenged
• An inability to see how their behavior affects others
• An inability to see how unrealistic their beliefs and actions are

Delusions of Grandeur

There is a subtle difference between grandiose delusions and delusions of grandeur. Grandiose delusions are less exaggerated than delusions of grandeur. For instance, a grandiose delusion may involve thinking you have more musical talent than you do, whereas a delusion of grandeur would be that you are the only one who can keep world leaders safe.

People who experience delusions of grandeur, as well as those around them, do not always recognize it as being anything more than pompousness, arrogance, or boastfulness. If delusions occur during manic episodes, this is a clue that bipolar disorder is involved.

Grandiosity in Narcissistic Personality Disorder

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). 

NPD is broadly characterized by self-centeredness and an inability to have empathy for others. People with NPD manipulate others to get what they want. They consistently exhibit a pattern of grandiosity, a need for admiration, and a lack of empathy in a way that interferes with their relationships and well-being.

One of the key ways to differentiate grandiosity in BD from grandiosity in NPD is the co-occurrence of mania symptoms. When grandiosity accompanies any of these abnormal behaviors, bipolar disorder should be explored as a possible cause. Grandiosity can also occur in hypomania (a less severe form of mania), but it is usually less problematic and easily missed in diagnosis.

Treatment

People experiencing grandiosity as a feature of BD may suffer consequences in their personal and professional lives. Grandiosity can make someone seem unforgivably conceited and rude. This can affect relationships at home, with friends and family, and at work.

Grandiose delusions can impair judgment and compromise the ability to keep or maintain employment. Grandiosity rarely occurs on its own in people with BD. They need medications, psychotherapy, and social support to effectively resolve symptoms, including grandiosity.

If you have symptoms of bipolar mania, your healthcare provider may treat you with a mood stabilizer and sometimes an antipsychotic drug to control your symptoms. If the behaviors are extreme or potentially harmful, hospitalization may be needed until your mood symptoms are under better control.

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