BIPOLAR I DISORDER
Bipolar patients in the manic phase have many signs and symptoms of pathological narcissism – hyperactivity, self-centeredness, lack of empathy and control freak. During this recurring chapter of the disease, the patient is euphoric, has grandiose fantasies, makes unrealistic plans, and has frequent fits of anger (being irritable) when her wants and plans are (inevitably) frustrated.
However, the manic phases of bipolar disorder are temporary – NPD is not. In addition, the mania – usually protracted – is followed by depressive episodes. The narcissist is also often dysphoric. But while the bipolar sinks into deep self-devaluation, self-devaluation, unlimited pessimism, omnipresent guilt and anhedonia, the narcissist, even when he is depressed, never renounces his narcissism: his grandiosity, his sense of pretension, his arrogance and his lack of empathy.
Narcissistic dysphorias are much shorter and reactive – they are a reaction to the grandiosity gap. In simple terms, the narcissist is dejected when faced with the abyss between his inflated self-image and grandiose fantasies – and the dreary reality of his life: his mistakes, poor performance, the breakdown of interpersonal relationships, and low status. However, one dose of narcissistic care is enough to lift the narcissist from the depths of misery to the height of manic euphoria.
Not so with the bipolar. It is believed that the cause of her or his mood swings is the biochemistry of the brain – not the availability of narcissistic supplies. While the narcissist has full control over his abilities, even when he is maximally aroused, the bipolar often feels that he has lost control of his brain (“flight of ideas”), language and attention span (distractibility) and his / her motor functions.
The bipolar is only susceptible to reckless behavior and substance abuse during the manic phase. The narcissist takes drugs, drinks, gambling, shops on credit, indulges in unsafe sex or other compulsive behaviors, both when excited and when depleted.
As a rule, the manic phase of the bipolar affects his social and professional functioning. In contrast, many narcissists reach the highest levels in their community, church, company, or volunteer organization. Most of the time, they work just fine – although the inevitable explosions and blatant extortion of the narcissistic offer usually end the narcissist’s career and social relationships.
The manic phase of bipolar sometimes requires hospitalization and, more often than not admitted, involves psychotic features. Narcissists are never hospitalized because the risk of self-harm is low. In addition, psychotic micro-episodes in narcissism are decompensatory in nature and only occur under unbearable stress (e.g. during intensive therapy).
Bipolar mania causes discomfort to strangers as well as to the patient’s nearest and dearest. His constant cheering and compulsive insistence on human, sexual, and professional or professional interactions lead to discomfort and repulsion. His / her mood of weakness – rapid changes between uncontrollable anger and unnaturally good spirits – is downright intimidating. In comparison, the sociability of the narcissist is calculated, “cold”, controlled and goal-oriented (extraction of the narcissistic offer). Its mood and affect cycles are far less pronounced and less rapid.
The bipolar’s puffy self-esteem, overrated self-confidence, overt grandiosity, and delusions are similar to those of the narcissist and are the source of diagnostic confusion. Both types of patient pretend to provide advice, carry out an assignment, serve a mission, or start a business for which they are uniquely unqualified and lack the required talent, skills, knowledge or experience.
But the bombast of the bipolar is far more delusional than that of the narcissist. Reference ideas and magical thinking are common, and in this sense the bipolar is closer to the schizotype than the narcissistic.
There are other differentiating symptoms:
sleep disorders – especially acute insomnia – are common in the manic phase of bipolar and uncommon in narcissism. This is what “manic language” is like – pressurized, uninterrupted, loud, fast, dramatic (including vocals and humorous side effects), sometimes incomprehensible, incoherent, chaotic, and lasting for hours. It reflects the bipolar’s inner turbulence and his inability to control his frenzied and kaleidoscopic thoughts.
In contrast to narcissists, bipolar people in the manic phase are often distracted by the slightest stimulus, cannot concentrate on relevant data or maintain the thread of the conversation. They are “everywhere” – simultaneously initiating numerous business activities, joining a variety of organizations, writing countless letters, contacting hundreds of friends and complete strangers, acting in a dominant, demanding and intrusive manner, completely ignoring the needs and emotions of the unfortunate recipients their unwanted attentions. They rarely pursue their projects any further.
The transformation is so pronounced that the bipolar is often described by his / her neighbor as “not himself”. Indeed, some bipolar people move, change names and appearances, and lose touch with their “previous life”. Antisocial or even criminal behavior is not uncommon, and aggression is pronounced and directed against others (assault) as well as against yourself (suicide). Some bipolar people describe a sharpness of the senses, similar to the experiences told by drug users: smells, sounds and sights are accentuated and achieve a supernatural quality.
Unlike narcissists, bipolar people regret their misdeeds after the manic phase and try to atone for their actions. They recognize and accept that “something is wrong with them” and seek help. During the depressive phase, they are ego-dystonic and their defenses are autoplastic (they blame themselves for their defeats, failures, and mishaps).
After all, pathological narcissism can already be recognized in early adolescence. Full-fledged bipolar disorder – including a manic phase – rarely occurs before the age of 20. The narcissist is consistent in his pathology – not so the bipolar. The beginning of the manic episode is quick and furious, leading to a noticeable metamorphosis in the patient.
More on this topic here:
Stormberg, D., Roningstam, E., Gunderson, J. & Tohen, M. (1998) Pathological Narcissism in Patients with Bipolar Disorder. Journal of Personality Disorders, 12, 179-185
Roningstam, E. (1996), Pathological Narcissism and Narcissistic Personality Disorder in Axis Disorders I. Harvard Review of Psychiatry, 3, 326-340
Labels: bipolar, cold, compulsiveness, cycling, mental disorder, mood swings, narcissism
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