Bipolar Disorder Symptoms Mania and Hypomania Grandiosity in Bipolar Disorder By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on May 29, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Cavan Images / Stone / Getty Images Table of Contents View All Table of Contents Prevalence Causes Signs and Symptoms Grandiosity in NPD Treatment 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. Grandiosity vs. Delusions of Grandeur Grandiosity is not the same as having delusions of grandeur. Grandiosity is more of a feeling of being superior to others, or inflated self-esteem. Conversely, delusions of grandeur are false beliefs or delusions of superiority not based in reality, such as someone believing that they have found the cure for a major disease. 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 delusions occur in roughly two-thirds of people with bipolar disorder and one-half of people with schizophrenia. 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. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the presence of grandiosity can be used in combination with other manic or hypomanic symptoms to confirm a diagnosis of bipolar 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 achievementsCriticizing and dismissing the achievements or talents of othersConstantly boasting and talking about themselfA belief that they are infallible or invulnerableA belief that they are more intelligent than othersThinking that rules don't apply to themActing selfishlyTreating others with disdain or contemptNot caring if they hurt someone with their actionsBeing quick to anger if challengedAn inability to see how their behavior affects othersAn inability to see how unrealistic their beliefs and actions are Grandiosity may not be recognized until it becomes extreme. Often, it's the friends or family members of the person who realize that the behavior is inconsistent with the person's usual demeanor. 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. How to Recognize a Manic or Hypomanic Episode 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. Another key differentiator is time. Personality disorders like NPD are pervasive patterns of interactions with others. By contrast, bipolar mania or hypomania typically lasts for weeks to months and is not always present. 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. 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Sheffield JM, Brinen AP, Freeman D. Paranoia and grandiosity in the general population: Differential associations with putative causal factors. Front Psychiatry. 2021;12:668152. doi:10.3389/fpsyt.2021.668152 Nascimento M, Marinho M, Sobreira G, et al. Bipolar disorder: What kind of disturbances of thought content and perception are observed?. Eur Psychiatry. 2015;30(S1)820. doi:10.1016/S0924-9338(15)30641-6 Van Meter AR, Burke C, Kowatch RA, Findling RL, Youngstrom EA. Ten-year updated meta-analysis of the clinical characteristics of pediatric mania and hypomania. Bipolar Disord. 2016;18(1):19-32. doi:10.1111/bdi.12358 Isham L, Griffith L, Boylan AM, et al. 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