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, 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.

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.

Grandiose delusions are one of the most common types of delusions in bipolar disorder. 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

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.

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)
• Flight of ideas (rapidly jumping from topic to topic)
• Restlessness and increased goal-directed activity
• Impulsivity 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.

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.