Bipolar vs. Narcissistic Personality Disorder: Key Differences - Verywell Health

Bipolar disorder (BPD) and narcissistic personality disorder (NPD) are different mental disorders. These two conditions can have some overlapping traits. At times, it may be hard to tell them apart.

BPD features distinct mood shifts that may last weeks or longer. These include:

• Manic episodes: Extreme energy, elation, or irritability
• Depressive episodes: Sadness, hopelessness, and lack of interest
• Mixed episodes: Symptoms of both moods at the same time

Key NPD symptoms are:

• An inflated sense of their own importance
• An extreme preoccupation with themselves
• A lack of empathy

Narcissism and NPD aren't the same. Narcissism is an inflated sense of your importance. NPD takes this to an extreme and includes other symptoms.

This article will compare the symptoms and causes of BPD and NPD, as well as how they're diagnosed and treated.

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Symptoms: Similarities and Differences

Not everyone with BPD has narcissistic traits. Most people with BPD or NPD don't have the other disorder. Research suggests 4.5% of people with BPD have NPD.

On the surface, BPD and NPD look quite different. When you dig deeper, though, you find some similarities.

In particular, the manic phase of bipolar disorder can make a person feel that they're especially powerful, important, or talented. That's a key trait of narcissism. (Not everyone with BPD has this symptom.)

Other symptoms BPD and NPD have in common include:

• Setting high, often unachievable goals
• Impulsivity and risky behavior (excessive spending, drinking, drugs, sex, etc.)
• Relationship problems
• Appearing to be insensitive or dismiss the needs of others

The nature of BPD can help you distinguish between garden-variety narcissism and the pathological symptoms of NPD. 

• In NPD, narcissistic personality traits are always present (although the person may try to mask them.)
• In BPD, narcissistic traits only tend to surface during manic episodes.

It also helps to look at other symptoms. That may help you rule out one of these disorders.

BPD Manic Symptoms

• Elation or feeling "high"

• Jumpiness

• Irritability 

• Inflated belief in importance, talent
  

• Short temper

• Racing thoughts

• Talking fast

• Needing less sleep

• Risky behavior and poor judgment

NPD Symptoms

• Rage, shame, or humiliation in response to criticism

• Taking advantage of other people

• Excessive feelings of importance

• Exaggerating talents and achievements

• Preoccupation with fantasies of power, and intelligence

• Unreasonable expectations of special treatment

• Constant need for attention, admiration

• Lack of empathy

• Obsessive self-interest

In NPD, what appears as arrogance is an attempt to hide deep-seated fears and insecurities. This can lead to depression and other traits that may be similar to depressive symptoms of bipolar disorder.

Suicidal thoughts and behaviors are common in both disorders.

Recap

Some people with bipolar disorder display narcissistic traits during manic episodes. The two conditions also have some overlapping symptoms. Very few people have both bipolar and narcissistic personality disorder, though.

What Causes BPD and NPD?

Medical science doesn't yet fully understand the causes of BPD or NPD. But some progress has been made toward a better understanding them.

Bipolar Disorder Causes

Experts believe bipolar disorder is caused by a combination of: 

• Genetics
• Brain structure and function
• Stressful or traumatic events

You're at a higher risk of BPD if you have a close relative who has it.

Narcissistic Personality Disorder Causes

Experts believe NPD may be caused by:

• Genetics
• Childhood trauma
• Early relationships

Your risk is higher if you had:

• Excessive praise or judgment by parents
• Overindulgent or unreliable parents
• Childhood trauma or abuse
• Problems with childhood relationships
• Childhood hypersensitivity to texture, light, or noise
• Childhood behavioral disorders

Understanding the Diagnostic Processes

BPD and NPD have similar diagnostic processes. It may begin with your healthcare provider, who will give you a physical exam and look at your medical and family histories.

Depending on your symptoms, your healthcare provider may order blood work or other tests to rule out other conditions.

You will then undergo a mental health evaluation. Your primary care provider may perform this themselves or refer you to a mental health specialist.

How BPD and NPD Are Treated

Some of the treatments for bipolar disorder and narcissistic personality disorder are the same. These include psychotherapy and medication. There are no specific medications to treat NPD, but medications may be used to treat symptoms of the anxiety and depression that commonly accompany the disorder. Treatment involves:

• Psychotherapy: Traditional talk therapy, psychodynamic psychotherapy, and cognitive behavioral therapy (CBT)
• Medication: Mood stabilizers, antipsychotics, and antidepressants

Other treatment approaches are different.

What is CBT?

Cognitive behavioral therapy is a type of psychotherapy that focuses on changing behavior or mood problems by addressing negative thought patterns.

Bipolar Disorder Treatments

Additional treatments for bipolar include:

• Electroconvulsive therapy (ECT): Controlled electric currents pass through the brain. They cause a brief seizure that can change brain chemistry and the function of neurons (brain cells).
• Transcranial magnetic stimulation (TMS): Magnetic fields stimulate neurons linked to depression.
• Other types of psychotherapy: Interpersonal and social rhythm therapy, dialectical behavior therapy (a type of CBT), and family-focused therapy.
• Self-management: Regular exercise, meditation, education about BPD, and learning to recognize and manage episode triggers.

ECT and TMS are primarily used when psychotherapy and medications don't provide enough relief.

Narcissistic Personality Disorder Treatments

NPD is difficult to treat, as it's common for people with NPD to reject therapy or refuse to admit they have a problem.

A type of therapy called individual psychodynamic psychotherapy is believed to be effective for NPD. However, it's generally a lengthy and difficult process. 

Recap

The causes of BPD and NPD aren't fully understood. It's suspected that brain differences, genetics, and environmental/lifestyle factors play a role. Both are diagnosed through a mental health evaluation. Treatment can involve different types of talk therapy and medications.

Can These Conditions Be Prevented?

There's no known way to prevent bipolar disorder or narcissistic personality disorder. However, because childhood trauma is linked to both, it may help to get therapy for issues as soon as possible.

If you're a parent who's concerned about narcissism or NPD in your child, parenting classes or therapy may help you improve your parenting style so it doesn't contribute to narcissistic traits.

Summary

Some bipolar mania symptoms mimic narcissistic traits. True NPD alongside BPD is rare.

Genetics, brain chemistry, and childhood trauma may all contribute to the development of these disorders. They're diagnosed through mental health evaluations and treated with medications and psychotherapy.

Prevention of NPD in children may be possible through psychotherapy for childhood trauma and improved parenting skills. However, there's no proven way to prevent either disorder.

A Word From Verywell

If you or someone close to you has BPD or NPD, know that a proper diagnosis and treatment are essential. It can be scary, and those with NPD may be especially reluctant.

It may take a long time to find the right mix of medications and a therapist and therapy style that work well. But between treatments and lifestyle management strategies, it is possible to have a full life and fulfilling relationships with BPD and NPD.

Frequently Asked Questions

• Bipolar disorder comes in three main types:

  • Bipolar 1: "Classic" bipolar, it often involves the characteristic manic episodes alternating with depressed mood.
  • Bipolar 2: This type involves depressive and hypomanic episodes. Hypomania is a milder version of mania.
  • Cyclothymic disorder: It involves less intense symptoms and more rapid mood swings.

• While there's only one diagnosis for NPD, several types of narcissism exist. The most harmful to others is malignant narcissism. It can include:

  • Antisocial behavior
  • Sadism
  • Tendency toward paranoia
  • Chronic lying

  Malignant narcissists tend to be very manipulative.

• In the United States, about 2.4% of people have bipolar disorder.

  Although estimates vary, about 5% of people have narcissistic personality disorder.

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