Grandiosity refers to an exaggerated sense of one’s importance, power, knowledge, or identity, often to the point of arrogance or superiority, and sometimes without the basis in reality. It can be a symptom in various psychological disorders, including narcissistic personality disorder and bipolar disorder during manic episodes.
During manic episodes, individuals with bipolar disorder may exhibit grandiose delusions, such as believing they have special powers or abilities, or that they are destined for greatness. This sense of grandiosity can become problematic, leading to reckless behavior and impaired judgment.
Individuals with bipolar disorder should receive proper treatment and support to manage the signs of grandiosity and prevent potential negative consequences.
Grandiosity in bipolar disorder is not to be confused with feelings of self-confidence and self-esteem, which are healthy traits to develop. Grandiosity takes these traits to an extreme where individuals may consider themselves unstoppable, untouchable, or destined for great things, setting themselves above everyone else.
If these beliefs are noticeable only during manic or hypomanic episodes and not during the emotional lows of bipolar disorder, this is likely the symptom of grandiosity.
Not everyone diagnosed with bipolar disorder will experience grandiosity, but many do. It is thought that around two-thirds of people with bipolar I disorder experience grandiose delusions at some point during the course of their condition (Knowles, McCarty-Jones, & Rowse, 2011).
The trait of grandiosity is not thought only to be experienced by those with bipolar disorder. Many people with conditions such as schizophrenia and substance-use disorders also experience grandiosity as a symptom of these disorders.
Grandiosity is also considered a possible trait of personality disorders, particularly narcissistic personality disorder (NPD). Unlike grandiosity, which occurs during manic or hypomanic episodes in bipolar disorder, grandiosity in NPD tends to persist over time and in most situations.
Grandiosity Vs. Delusions Of Grandeur
Grandiosity is not the same as grandiose delusions, also known as delusions of grandeur. Grandiosity is thought to exist on a spectrum, ranging from an exaggerated sense of self to delusions of grandeur.
A delusion is a false belief held by a person, contradicting what is considered true. Grandiose delusions are one of the most common types of delusions people with bipolar disorder experience.
A delusion of grandeur is a person’s belief that they are someone other than who they are or the belief that they have special abilities or powers.
Delusions can also become unsafe when someone may take risks because they feel protected by their special abilities.
Delusions have the following characteristics:
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The belief the delusion is true, even when others know it to be untrue.
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The person will not listen to other viewpoints about the belief despite contradicting evidence to challenge the delusion.
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The content of the delusion is impossible or implausible.
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The delusion impacts the person’s daily life.
People who experience delusions of grandeur may have beliefs such as the following:
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Believing they have a specific ability, object, or talent that no one else knows about.
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The belief that they are a famous person and that the real famous person is an imposter.
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The belief is that they have secret connections, sometimes to someone important, or that they are working as a spy.
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Religious-themed delusions of grandeur that they are a religious leader or have been chosen by a religious entity for a greater purpose.
Signs
It is important to note that the symptoms of grandiosity in bipolar disorder can vary significantly from person to person. It is possible for someone experiencing grandiosity to exhibit some, but not all, of the symptoms listed in this article.
However, it is crucial to emphasize that experiencing one or two symptoms alone is not sufficient to self-diagnose bipolar disorder. A proper diagnosis can only be made by a qualified mental health professional after a comprehensive evaluation.
Below are some of the signs of grandiosity in bipolar disorder:
- An inflated sense of self-importance or superiority
- Believing one has special abilities or powers
- Feeling that one is above the rules or laws that govern others
- Overestimating one’s accomplishments or talents
- Having an unrealistic belief in one’s potential
- Making grandiose plans or unrealistic goals
- Spending money extravagantly or engaging in reckless behavior
- Talking excessively about oneself and one’s accomplishments
- Interrupting others or dominating conversations
- Being easily irritated or angered when one’s grandiose beliefs are challenged or questioned.
Grandiosity can lead to someone displaying behaviors such as only doing things for their own gain, rushing into activities, making decisions without considering the negative consequences, or disregarding those close to them they consider to be inferior.
It may result in someone quitting their job or spending all their money because they believe they are too talented for their job and will get a better, higher-salaried one soon.
Grandiosity is not always recognized by the individual. It will often take someone close to the person to realize that the patterns of grandiose thinking and behaviors do not match their usual self.
Grandiosity may be more noticeable during manic episodes and more easily missed in hypomania. It may not be recognizable in individuals until grandiosity becomes extreme, such as having grandiose delusions.
The feelings of grandiosity usually disappear in bipolar disorder once the manic or hypomanic episode has ended.
Experiences of Grandiose Thinking
Below are some individual accounts to illustrate people’s experiences with grandiosity:
“My grandiose thoughts were really focused on making things perfect. Like Stepford wife level, cooking, cleaning and errand runner. I could also go to school, teach my kid and earn money, while being a ‘good’ wife. I often got really aggressive when things didn’t come out. Followed by tears and exhaustion.”
‘Mina’
“I think often it’s just that you see things from an altered perspective. Often, that perspective will be hard to understand if you haven’t thought of it that way before and because the way your mind might try to interpret it, it might either sound/be grand. On the other hand, however, because of the new perspective sometimes you might just be able to understand something which is already there in an extremely insightful way if your mind thinks about in the right way.”
‘David’
“I would also have quite grandiose career ideas. I almost applied to be a nanny during one mania despite having almost zero childcare experience.”
‘Elle’
“I feel godlike almost. Incapable of being harmed. I often go to bars and pick fights… I deeply struggle with this sense of being untouchable when manic, not only in being a bully but also in terms of doing extremely dangerous things.”
‘Sam’
Causes
Since grandiosity is a trait of bipolar disorder, the causes of this disorder would also be the cause of grandiosity. The exact causes of bipolar disorder are not fully understood, but research suggests that a combination of genetic, environmental, and neurobiological factors may play a role in its development.
Genetics
Bipolar disorder may have a genetic component since, according to the Depression and Bipolar Support Alliance (DBSA), it has been found that around two-thirds of people diagnosed with the condition have a close relative with either bipolar or major depressive disorder.
Likewise, someone with a parent or sibling with bipolar disorder has a 4-6 times higher risk of developing the condition compared to someone who doesn’t, according to the American Academy of Child and Adolescent Psychiatry (AACAP).
The AACAP also states that an identical twin has a 70% chance of being diagnosed with bipolar disorder if their twin has it, implying that genetics may play a big role in causing the condition.
However, it’s important to note that not everyone with a family history of bipolar disorder will develop the condition, and individuals without a family history can still develop bipolar disorder.
Environmental
Another potential cause for bipolar disorder is environmental and lifestyle factors that could trigger the onset of the condition, such as extreme stress. Triggers that can increase the body’s stress levels include:
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Life events, whether positive or negative
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Disruption in regular sleep patterns
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A change in routine
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Too much stimulation
Traumatic experiences could also trigger the onset of bipolar disorder, such as:
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A breakdown in a relationship
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Physical, sexual, or emotional abuse
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The death of a close family member or loved one
Moreover, other environmental factors such as alcohol or substance abuse, financial worries, work problems, and the diagnosis of a physical illness could also be potential triggers for bipolar disorder.
Biological
There is evidence that if there is an imbalance in the levels of one or more neurotransmitters (chemical messengers in the brain), then a person may develop some of the symptoms of bipolar disorder.
For instance, there is evidence that episodes of mania may occur when levels of noradrenaline and too high, and episodes of depression may result from noradrenaline levels becoming too low (National Health Service, 2019).
Likewise, a loss of brain cells (neurons) in certain areas of the brain may be a cause of bipolar disorder.
The loss or damage of neurons in the hippocampus, part of the brain associated with memory which also indirectly affects mood and impulses, has been found to contribute to the development of mood disorders such as bipolar disorder (Anacker & Hen, 2017).
Age
Age could be a risk factor associated with someone developing bipolar disorder. This disorder usually develops around the age of 25 but often between the ages of 15 and 25.
While bipolar disorder can be diagnosed later or earlier in life, someone may be more at risk of the disorder developing for them around this age.
Gender
Bipolar II disorder appears to be more prevalent in women than in men, suggesting that women may be more at risk of developing this type of disorder than men.
However, there seem to be no differences between men and women developing bipolar I disorder, so perhaps gender is not a risk for this type of disorder (Parial, 2015).
Complications
Grandiosity in bipolar disorder can become problematic in many different ways. It can affect a person’s ability to think rationally, preventing someone from considering more realistic perspectives.
Suppose someone experiencing grandiosity believes they are superior and more intelligent than everyone else. In that case, they may find it difficult to see themselves for who they truly are and cannot see the qualities of those around them.
Relationships with others
Grandiosity may also negatively affect someone’s relationships with others. To those who do not fully understand the symptoms, grandiosity can make someone seem conceited and rude.
People may not want to spend time with the person expressing grandiose patterns, which could result in a breakdown of relationships, especially the relationships the individual may rely on for social support.
Thus, grandiosity could also result in people becoming or feeling isolated once their manic or hypomanic episode has ended.
Employment
Grandiosity could also affect the individual’s relationships with those at work. If the individual reacts with anger when criticized, dismisses others’ accomplishments, and believes they are above the rules, this can create a negative work environment.
This may also compromise the ability to maintain employment if their condition is undiagnosed or unrecognized by their workplace.
Putting themselves at risk
Grandiosity could also create the potential for physical harm, such as getting into fights if they react angrily and then are confronted or criticized.
It could also result in more risk-taking behaviors if the person believes they are above the rules and have impaired judgment about their vulnerability.
For instance, they may abuse substances if they believe that these cannot cause them harm or that they are protected by an outside force.
Treatment Options
Grandiosity is not likely to occur on its own in people who have bipolar disorder; therefore, getting treatment for this disorder may help to prevent episodes of mania and hypomania and some of the related signs, including grandiosity.
Sometimes, a combination of medications, psychotherapy, and social support is most effective for managing these symptoms.
The type of treatment for bipolar disorder can depend on the person and the signs being experienced, taking into consideration the impact on a person’s life.
Some of the treatments will be discussed below but note that this is not an exhaustive list and should not be taken in place of professional advice. Seek advice from a healthcare professional if you are considering treatment for bipolar disorder.
Medications
To treat mania and its symptoms, including grandiosity, the following medications are usually the most common to help balance out an individual’s mood:
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Antipsychotics – these work by blocking a type of dopamine receptor in the brain. Dopamine is a neurotransmitter that plays a vital role in mood, so blocking these receptors should work to balance out someone’s mood.
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Mood stabilizers – this medication is usually used to manage manic or hypomanic episodes, one type being lithium. Lithium is often used in the long-term treatment of mania and reduces the frequency and severity of the episodes being experienced. This works by stimulating the glutamate receptor NMDA to increase glutamate availability, which is essential for the brain’s normal functioning.
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Antidepressants – sometimes, a person may be prescribed antidepressants such as selective serotonin reuptake inhibitors (SSRIs) to help manage the depressive symptoms associated with bipolar disorder.
However, since antidepressants can sometimes trigger a manic episode, these are usually prescribed alongside a mood stabilizer or antipsychotic.
It is worth noting that medications come with their own side effects and may not be the first response for someone with bipolar disorder. It’s always important to consult a professional about the use of medications for this disorder.
Psychotherapy
Often, therapy is recommended for people with bipolar disorder, and some researchers have found it to be as effective as medications for treating symptoms of bipolar disorder.
While medications are useful for balancing moods, psychotherapy can target the underlying cause of the disorder, and the skills learned can be useful for preventing a relapse of symptoms in the future.
Some types of psychotherapy for bipolar disorder can include:
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Interpersonal and social rhythm therapy (IPSRT) – a type of psychotherapy that stabilizes daily rhythms such as sleeping, waking, and mealtimes.
The reasoning behind this therapy is that a consistent routine is thought to allow for better mood management. Thus, people with bipolar disorder may benefit from establishing a daily routine, specifically for sleep, diet, and exercise.
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Cognitive behavioral therapy (CBT) – a type of psychotherapy that is used for many mental health conditions. The focus of CBT is on challenging unhealthy, negative beliefs and behaviors and identifying more healthy and realistic ones.
CBT can be used for people who experience mania or hypomania to help identify what triggers these episodes. CBT can also give people the tools to help deal with their moods in the moment and to learn effective strategies to manage stress and cope with upsetting situations.
Research suggests that dysfunctional attitudes are elevated in bipolar disorder, especially during depressive episodes, suggesting targeting attitudes in treatment may help prevent mood episodes (Woods et al., 2023). -
Family-focused therapy – getting the family involved in the therapy of someone with bipolar disorder can provide the support and communication needed to help stick to treatment plans.
This can also help the individual and their loved ones to recognize and manage the warning signs of a manic or hypomanic episode coming on.
Lifestyle
Making some healthier lifestyle changes may also prove to be effective at helping to treat grandiosity and the other symptoms of bipolar disorder. These can include:
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Quitting drinking or using recreational drugs – since a big concern during manic and hypomanic episodes is the negative consequences of risk-taking behavior, quitting drinking and drugs completely could limit the temptation to use these substances during an episode.
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Form healthy relationships – it can be beneficial to be surrounded by people with a positive influence. Friends and family can support and help watch for warning signs of mood shifts.
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Creating a healthy routine – having a routine for sleeping, eating, and physical exercise can help to balance moods.
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Keeping a mood chart – keeping a record of daily moods, sleep, activities, and feelings can be useful for identifying triggers for when a manic or hypomanic episode may be coming on.
This can also be useful for seeing how effective the treatment is and for identifying when treatment needs to be adjusted.
How To Be Supportive
There are many ways in which you can support someone who is experiencing a manic episode:
Build trust
Having an open and honest conversation with the person experiencing mania or hypomania and discussing how it affects them.
You can ask them questions about what they have experienced and engage well in what they are saying to feel heard. This can also help to improve their understanding of what things are like for them.
Ask how you can help
It is likely that the person who experiences manic or hypomanic episodes already has an idea of what they do to help themselves, as well as knowing what does not help.
If they are unsure of how to help themselves, then you can offer to help by exploring their options.
Offer to help with self-management
People who experience manic or hypomanic episodes may find it useful to develop a self-management plan to help them manage their symptoms better.
You could help them to complete this plan by identifying any triggers or warnings signs you may have noticed that the individual may not have. You can make suggestions but remember that the final decision is down to the individual.
The self-management plan can also be useful to review together when the individual experiences another episode.
Don’t make assumptions
It is normal for people with bipolar disorder to have good and bad moods without it necessarily being a manic episode. The person may find it frustrating if they are questioned, or you start worrying about them whenever they are having a good day.
Instead, it may help to look for consistent signs and patterns that they are approaching an episode and discuss what this presents.
Be gentle in your approach
If the person’s behavior is becoming worrying, it is important to gently let them know you are worried about them without criticizing or accusing them.
Staying calm and non-confrontational may make them more likely to discuss what they are experiencing.
You can gently explain that you have noticed changes in their behavior and why it concerns you. Sometimes, people may not notice they are experiencing a manic or hypomanic episode until it is brought up to them by someone who knows the behavior is different from their typical behavior.
Discuss challenging behavior
It can be a challenge to be around someone who is experiencing a manic or hypomanic episode, especially if they are displaying grandiose signs such as being selfish or quick to anger.
The individual may not realize that their behavior is causing tension, so it is ok to set boundaries in a non-confrontational, calm manner.
For instance, you could explain that you will end the conversation with them if they are rude or that you will not participate in their grand ideas if you feel these will have negative consequences.
Offer reassurance
When the manic or hypomanic episode is over, the person may feel ashamed or embarrassed about their behavior. They may feel like they want to isolate themselves away from their loved ones if they do not like how they act in front of them.
They may really benefit from you reassuring them that you still care and understand that their behavior is a part of their condition.
Help them find the support they need
People may find it difficult to find the right care and support for themselves. If they agree, you can help them research treatment options, attend appointments with them, or help them find suitable coping strategies.
Plan for a crisis
In extreme cases, manic or hypomanic episodes can become so intense that the individual may need to be hospitalized. To account for this, it can be useful to devise a crisis plan with the individual.
This can include information about who to contact, what to do, and when would be an acceptable time to consider hospital treatment.
Do you need mental health help?
USA
Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/
1-800-273-8255
UK
Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; email jo@samaritans.org .
Available 24 hours a day, 365 days a year (this number is FREE to call):
116-123
Rethink Mental Illness: rethink.org
0300 5000 927
Further Information
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