Have you known someone with narcissist red flags who say they’ve bipolar disorder? This seems quite common, and there’s good reason why…
Mental health diagnoses are difficult. Human behaviour is complicated, context dependent, and often contradictory.
A common areas of confusion is the overlap between narcissism and bipolar disorder. While these are different conditions, they can look strikingly similar. Which leads to misdiagnosis.
Kernberg & Yeomans (2013) observed that “about 50% of patients who enter the personality disorders unit of our hospital with the diagnosis of bipolar disorder or major depression turn out to present neither, but rather a severe personality disorder… particularly borderline personality disorder… [or] severe narcissistic personality disorder.”
If you want to know why narcissists get misdiagnosed with bipolar disorder, then we need to look at both conditions, the nature of their symptoms, and the challenges doctors face evaluating them…
Please Watch This Short Video To Aid Your Understanding…
Similarities That Cause Confusion
At first glance, narcissism and bipolar disorder can appear almost identical. Especially during the manic or hypomanic episodes of bipolar disorder.
Both may involve…
- Elevated confidence and grandiosity
- Increased talking
- Risk taking behaviour
- A strong need for attention or admiration
- Impulsivity
During a manic phase, someone with bipolar disorder may feel unusually powerful, important, or invincible. Similarly, a narcissist may present themselves as superior or uniquely gifted.
To an untrained eye, or even a doctor with limited experience, these behaviours can blur together. The key issue is that they come from completely different psychological mechanisms. So whilst the traits may be similar, the root causes aren’t.
Consistency Over Time
One of the key differences between narcissism and bipolar disorder is the consistency over time…
- Bipolar disorder is episodic. Symptoms fluctuate depending on mood states. These are mania, hypomania, depression, and periods of relative stability.
- Narcissistic personality traits are enduring. They’re a consistent pattern of thinking, feeling, and behaving over long periods of time. It’s who they are.
A person experiencing mania may suddenly become grandiose and impulsive. But this represents a departure from their usual self. In contrast, narcissistic behaviours are long standing, and woven into their identity.
Misdiagnosis often occurs when doctors see someone during a high energy, attention seeking period. Because with limited contact, it’s difficult to know whether it’s temporary, or a lifelong pattern.
The Role of Emotional Regulation
Another source of confusion is emotional intensity. People with bipolar disorder experience mood shifts driven by internal neurobiological changes. These shifts can happen without clear external triggers.
On the other hand, narcissists often show emotionally reactive behaviour tied to external validation…
- Praise can lead to exaggerated confidence.
- Criticism can trigger anger, defensiveness, or withdrawal.
This can look like the rapid mood changes, as seen in bipolar disorder. But the cause is different.
Overlapping Risk Taking And Impulsivity
Impulsivity is another major overlap…
- In bipolar mania, impulsivity may include excessive spending, risky sexual behaviour, or reckless decision making. But this is due to elevated mood and reduced inhibition.
- In narcissism, similar behaviours can occur. But these are driven by a desire for status, admiration, or entitlement.
Without careful assessment, the motivation behind the behaviour can be overlooked, leading to wrongful diagnosis.
The Problem Of Limited Clinical Context
Misdiagnosis usually comes from incomplete information. A doctor may…
- See a patient during a dramatic or high energy period.
- Rely on self reported symptoms, without accurate history.
- Have limited time to assess long term behavioural patterns.
If someone presents as charismatic, confident, and impulsive, it may be tempting to interpret this as hypomania. Especially if the person also reports periods of low mood. However, without understanding the broader personality structure, this diagnosis can completely miss the mark.
The Narcissists Facade
Narcissists operate behind a false facade – a mask. This is because they want to fit in, and be liked and admired.
Narcissists know no one would go near them if they constantly displayed their full narcissism. So they hold their narcissism back most of the time. Particularly the more high functioning narcissists.
A narcissist might retreat into “nice mode” if they realise they’ve pushed someone too much. Because they don’t want them to walk away. Plus they don’t want to damage their reputation.
So this creates the impression that the narcissist is having episodes of narcissistic and erratic behaviours. Just like someone with bipolar disorder. But really they’re having episodes of “nice behaviour” to disguise their narcissism.
Cultural And Social Influences
Modern culture can further complicate things…
Traits associated with narcissism, such as confidence, ambition, and self promotion, are rewarded or even encouraged in some environments. This normalises behaviours that might otherwise raise alarm bells.
At the same time, awareness of bipolar disorder has increased, making it a more commonly thought of explanation for mood and behavioural changes. This creates a bias toward diagnosing bipolar disorder when dramatic behaviours are observed.
Why The Right Diagnosis Matters
Confusing narcissism with bipolar disorder has real consequences…
- Treatment approaches significantly differ
Bipolar disorder is often treated with mood stabilisers and medication. Whereas narcissism is usually helped with long term psychotherapy. - Misdiagnosis can delay effective help
A narcissist may not benefit from medication. Whereas someone with bipolar disorder may struggle without it. - Stigma and misunderstanding increase
The wrong labels can shape how people see themselves, and how others respond to them.
Moving Towards Better Understanding
Accurate diagnosis requires…
- Long term observation.
- A detailed personal history.
- Attention to patterns, rather than isolated behaviours.
- Exploration of underlying motivations, not just outward symptoms.
Mental health is complex, and no single symptom tells the whole story. By distinguishing between long term personality traits and episodic mood disturbances, doctors can gain a more precise understanding. However, this isn’t easy to do in practice…
Final Thoughts
A big problem when diagnosing narcissism is time. Doctors don’t have the time to observe how people behave in day-to-day life. They can’t follow them around for weeks on end, observing their behaviours. They must rely on quick judgements, patient testimony, and questionnaires.
The problem with this is that narcissists aren’t known for their honesty. So there’s a good chance their testimonies and questionnaires contain “mistruths”.
Narcissists don’t want to admit there’s anything “wrong” with them. Because this would shatter their delusions of superiority. So they may downplay their behaviours. Or claim they only flair up at certain times. Which gives the impression they have bipolar disorder.
Narcissists also operate behind a mask. This can create the impression that they only have temporary symptoms. Just like someone with bipolar disorder.
Narcissists often prefer a bipolar diagnosis over a narcissist diagnosis. So they may be more geared to accept this. And can you blame them?
There’s less stigma attached to bipolar disorder. Plus it gives them a ready made excuse to avoid accountability. Because when they’re confronted over their narcissistic behaviours, they can blame their “bipolar”, and usually all’s forgiven.
Please CLICK HERE For Why It Seems Like Narcissists Are Everywhere