Bipolar Disorder Symptoms Mania and Hypomania Grandiosity in Bipolar Disorder By 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 Marcia Purse Medically reviewed by Medically reviewed by Steven Gans, MD on February 09, 2020 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Review Board Steven Gans, MD Updated on March 02, 2020 Print Cavan Images/Stone/Getty Images Table of Contents View All Prevalence Causes Symptoms Narcissistic Personality Disorder Treatment 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, grandiosity is an exaggerated sense of one's importance, power, knowledge, or identity, even if there is little evidence to support the beliefs. Prevalence 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 people who are diagnosed with schizophrenia and a large number of people with substance use disorders also experience grandiosity as a manifestation of their illness. Grandiosity is thought to be a possible facet of personality disorders, particularly narcissistic personality disorder (NDP). Causes 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 changes in complex ways. It's 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 BD. Symptoms "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 people you consider to be inferior to you (by way of class, intelligence, beauty, or 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. People who are experiencing delusions of grandeur, as well as those around them, do not always recognize it as being anything more than pompousness, arrogance, or boastfulness. 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.The fact that the delusions occur during episodes is the main clue that bipolar disorder is involved. Grandiose delusions are one of the most common types of delusions in bipolar disorder. Examples of grandiosity include: Exaggerating your own achievementsCriticizing and dismissing other's achievements or talentsConstantly boasting and talking about yourselfBelieving yourself to be infallible or invulnerableBelieving that you are more intelligent than othersThinking that common rules don't apply to youActing selfishlyTreating others with disdain or contemptNot caring if you hurt someone with your actionsBeing quick to anger if you are challengedBeing unable to see how your behavior affects othersBeing unable to see how unrealistic your beliefs and actions are How to Recognize a Manic or Hypomanic Episode Bipolar vs. 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). Having NPD means that you consistently exhibit a pattern of grandiosity, need for admiration, and a lack of empathy 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 moodsIncreased energy and a decreased need for sleepRacing thoughtsPressured speech (excessive or frenzied speaking)Flight of ideas (rapidly jumping from topic to topic)Restlessness and increased goal-directed activityImpulsivity with poor judgment and reckless behaviors (including spending sprees, hypersexuality, and needless risk-taking) 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 that define one's interactions with others. By contrast, bipolar mania or hypomania typically lasts for weeks to months and is not always present. Consequences and Treatment 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 the ability to keep or maintain employment. Grandiosity rarely occurs on its own in people with BD and requires medications, psychotherapy, and social support to effectively resolve the symptoms. If you have symptoms of bipolar mania, your doctor 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 doctor will aim to resolve the abnormally heightened mood state that defines bipolar mania. By doing, behavioral extremes, like grandiosity, will also be tempered. The 9 Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Was this page helpful? Thanks for your feedback! Dealing with racing thoughts? Always feeling tired? Our guide offers strategies to help you or your loved one live better with bipolar disorder. Sign up for our newsletter and get it free. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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. Knowles, R, McCarthy-Jones, S, Rowse, G. Grandiose delusions: A review and theoretical integration of cognitive and affective perspectives. Clin Psychol Rev. 2011;31(4):684-696. doi:10.1016/j.cpr.2011.02.009 Muneer A. Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment. Chonnam Med J. 2017;53(1):1-13. doi:10.4068/cmj.2017.53.1.1 Picardi A, Fonzi L, Pallagrosi M, Gigantesco A, Biondi M. Delusional Themes Across Affective and Non-Affective Psychoses. Front Psychiatry. 2018;9:132. doi:10.3389/fpsyt.2018.00132 Additional Reading Severus, E. and Bauer, M. Diagnosing Bipolar Disorders in DSM-5. Int J Bipolar Dis. 2013;1:14. DOI: 10.1186/2194-7511-1-14.