Grandiosity in Bipolar Disorder

Grandiosity is a symptom experienced by people with bipolar disorder during manic and hypomanic episodes. People experiencing grandiosity, or grandiose delusions, often describe larger-than-life feelings of superiority. In short, it's an exaggerated sense of your importance, power, knowledge, or identity, even though there is evidence that these beliefs are inaccurate.

Prevalence of Grandiose Delusions

It's estimated that around two-thirds of people with bipolar disorder will experience grandiose delusions. About half of people with schizophrenia, a large number of people with substance use disorders, and more than 10 percent of the general population experience grandiose delusions as well, though in the general population, these thoughts don't meet the criteria for delusions.

The Causes of Grandiose Delusions

In the case of bipolar disorder, grandiose delusions are considered “mood-congruent delusions” in that they manifest from the manic or hypomanic state. During manic or hypomanic phases, brain activity appears to change,  brain waves speed up, and neurotransmitter concentrations change, particularly levels of dopamine.

Examples of Grandiose Delusions

Grandiose delusions are one of the most common types of delusions. Some examples include:

• Believing you're capable of finding the cure for cancer

• Thinking you're someone famous or related to someone famous
• Believing you can communicate directly with God
• Thinking you're particularly lucky or special
• Believing you've created or developed something that can save the world or that's worth millions of dollars

Distinguishing Between Narcissism and Bipolar Disorder

At times it can be difficult to distinguish between bipolar patients experiencing grandiose thinking during a manic or hypomanic mood and patients with a different personality disorder known as narcissistic personality disorder.

 One key to distinguishing whether grandiosity is part of narcissistic personality disorder or bipolar disorder is to identify other features of mania or hypomania the patient may be experiencing at the same time.

For example, a patient with bipolar disorder who's experiencing grandiose thinking would also be expected to experience other symptoms at the same time, such as requiring less sleep, spending reckless amounts of money, or becoming suddenly hypersexual.

In the American Psychiatric Association's Diagnostic and Statistical Manual, the presence of grandiosity in mania or hypomania is used in combination with several other symptoms to confirm a diagnosis of bipolar. This symptom also occurs in children with early-onset bipolar disorder.

Consequences of Grandiosity

Bipolar patients experiencing grandiose thinking may suffer consequences in their personal and professional lives. To those who don't understand the symptoms of bipolar disorder, grandiosity can make someone seem conceited and rude. This can affect interpersonal relationships, such as friendships and romantic relationships. Grandiose delusions can also impair your judgment and make it difficult to be productive in your day-to-day work activities, compromising your career success.

And, finally, when grandiose ambitions involve a financial stake, you may experience significant financial loss and strain.

Sources:

Knowles R, McCarthy-Jones S, Rowse G. Grandiose Delusions: a Review and Theoretical Integration of Cognitive and Affective Perspectives. Clinical Psychology Review. June 2011;31(4):684-696. doi:10.1016/j.cpr.2011.02.009.

Severus E, Bauer M. Diagnosing Bipolar Disorders in DSM-5. International Journal of Bipolar Disorders. 2013;1:14. doi:10.1186/2194-7511-1-14.