Relationships: Bipolar or Narcissism?

Manic episodes of bipolar resemble twelve out of fourteen identifying criteria for narcissistic personality disorder (NPD), with only admiration-seeking and devaluation specific to narcissism. Chronic substance abuse can also mimic the characteristics of somebody with NPD, making differential diagnosis difficult.

“Bipolar patients in the manic phase exhibit many of the signs and symptoms of pathological narcissism; hyperactivity, self-centeredness, lack of empathy, and control freakery” — The Giraffe Eater.

Many mood and personality disorders overlap, and a person can have a comorbid diagnosis with one or more other conditions. Mental health clinicians use either the Diagnostic Statistical Manual of Mental Disorders (DSM-V) or the International Classification of Diseases (ICD-11) to diagnose bipolar or NPD.

NPD is a personality disorder consisting of personality traits that adversely affect their lives, notably their ability to maintain healthy, stable, and fulfilling work, family, and personal relationships.

NPD is diagnosed when five or more of nine criteria in the DSM are present as outlined in the table below:

TABLE 1. DSM-5 Criteria for Narcissistic Personality Disorder

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectation of especially favorable treatment or automatic compliance with his or her expectations.
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors and attitudes.

Source: The American Journal of Psychiatry.

The most common identifiers are a pervasive need for admiration, lack of empathy, heightened sense of entitlement, grandiose fantasies, and interpersonal exploitativeness.

The two types of NPD, grandiose and vulnerable, almost led to the removal of narcissism from the DSM-V because the criteria mostly depict the grandiose types.

Grandiose types are overtly grandiose, and vulnerable types are more covert, hiding their need for admiration and lack of empathy, often behind a mask that presents entirely differently.

“Individuals with NPD may be grandiose or self-loathing, extraverted or socially isolated, captains of industry or unable to maintain steady employment, model citizens or prone to antisocial activities”.

People with NPD may suffer depression and anxiety, particularly when their needs and expectations are not met. The vulnerable types are more susceptible to depression, anxiety, self-injury, and suicide attempts due to chronic envy, hypersensitivity to the evaluation of others, and impaired emotional processing.

Relationships with narcissists are renowned for causing CPTSD in the people close to them. Children raised by narcissists can suffer considerable effects from the trauma of existing solely to satisfy their parent’s needs and become their scapegoats. There is particular interest in the adverse effects on the children of mothers with narcissism.

The causes of NPD range from neurobiological to genetic, with significant research suggesting either abusive or overly involved parents and childhood trauma, contribute to the development of NPD.

My father was diagnosed with schizophrenia and bipolar, so I feel more familiar with bipolar, despite mainly writing about narcissism.

Bipolar is a mood disorder that presents with episodes of extreme manic and depressive moods. There are four types of bipolar; bipolar 1, bipolar 2, cyclothymic, and unspecified bipolar. The most common types of bipolar are 1 and 2.

Bipolar 1 describes those who experience mania so noticeable and intense that it can lead to hospitalization and may or may not experience depressive episodes. Bipolar 2 describes those who experience depressive episodes for two weeks or longer with one or more episodes of hypomania (a less intense form of mania).

Manic episodes include obvious signs of extreme euphoria, high energy, heightened self-esteem, restlessness, fast and uninterruptible speech, inability to focus, impulsivity, irrational or risky behaviours, and insomnia.

It is difficult to steady a manic episode, and they typically last from around a week to three months; untreated, an episode could last months.

Less severe hypomania is still noticeably out of character, though it may or may not be more extreme than typical euphoric or high energy episodes. Hypomania may look like the person has taken a stimulant or appear simply as highly energetic or driven.

As mentioned above, where bipolar and NPD merge is during the manic phases of bipolar. In this way, the more grandiose types are more likely to be mistaken for bipolar than the vulnerable type.

During a manic episode, a person with bipolar will behave in narcissistic ways; they’re high energy, act overconfident, lack insight, are entitled and grandiose, act without thinking about how their behaviour affects others, can not take criticism, become exploitative and volatile, may believe they’re special or unique and can go into a fantasy world type of mindset.

A person in a bipolar 1 manic episode might only sleep 2–3 hours a night or have noticeably fast and even incoherent speech, so those with hypomanic episodes or bipolar 2 might more closely resemble a person with NPD.

The use of devaluation and the need for admiration in NPD are the only two traits that do not relate to people with bipolar in a manic phase; this makes sense considering interpersonal relationships do not influence bipolar behaviour as heavily as they do people with NPD.

People with bipolar can maintain stable, healthy, and happy lives with proper treatment that includes medication and therapy; this is not so for people with NPD. As a result, people with well-managed bipolar disorder are more likely than those with NPD to hold down a steady job or secure relationships and parent without causing significant trauma to their children.

Consequently, those in a relationship with a bipolar person may be less affected than someone in a relationship with a person with NPD.

People in relationships with a person with NPD frequently suffer distress and even trauma from the effects of the diagnosis.

Therefore, it would be helpful to have a rough idea of your significant other’s relationship history to distinguish one from the other. However, NPD’s are renowned for distorting the facts, particularly when it comes to their relationships.

Both people with bipolar and NPD are susceptible to depression, except that the tendency to seem disinterested and insensitive is an NPD devaluation tactic while the same traits can present during bipolar depressive episodes.

Bipolar is a mood disorder primarily attributed to an imbalance in neurotransmitters such as noradrenaline, serotonin, dopamine, and oxytocin.

NPD is a personality disorder most often associated with parenting and childhood trauma, though some neurobiological, genetic, environmental, and personality links have been demonstrated in research.

Although cold therapy shows some promise in treating NPD, further research, larger samples, and peer reviews are needed. Some temporary success in treating NPD has come from medications for symptoms such as depression, anxiety, and psychotic episodes, and psychotherapy using cognitive behavioural therapy (CBT) or dialectical behaviour therapy (DBT).

People with NPD often think they don’t have a problem and will only seek help if absolutely necessary or they’ve been referred to therapy by an authority such as the courts.

Bipolar is manageable through medication and therapy. Mood stabilizers, anti-depressants, anti-anxiety medication, and anti-psychotics are well tolerated and help regulate mood, reducing the severity and duration of episodes.

Hospitalization may be necessary during extreme episodes, though medication, healthy lifestyle changes, and therapy can support reintegration into a happy, healthy, and stable life.

Whether you are in a relationship with a person with bipolar or NPD, having a good understanding of the disorders and a mental health professional supporting you both can significantly improve how you each manage the symptoms and strengthen your relationship.

If you are struggling in a relationship with a person with bipolar or NPD, and the situation has become toxic or abusive, you should consider going no contact and leaving the process up to a professional.

Best of luck, and thank you for reading.❤