Grandiose Delusions and Grandiosity in Bipolar Disorder

Grandiose ideations, or grandiosity, are an exaggerated sense of one's importance, power, knowledge, or identity—even with little evidence to support this. People with bipolar disorder (BD) may experience this symptom. Grandiosity can occur during both manic and hypomanic episodes.

Grandiosity vs. Delusions of Grandeur

Grandiosity is not the same as having delusions of grandeur. Grandiosity is more of a feeling of being superior to others, or inflated self-esteem. Conversely, delusions of grandeur are false beliefs or delusions of superiority not based in reality, such as someone believing that they have found the cure for a major disease.

Prevalence of Grandiosity

• The number of people with grandiose ideations is somewhat unclear, with research indicating that grandiosity is present in somewhere between 8% and 65% of the general population.
• In a 2015 study of 149 patients diagnosed with bipolar disorder, more than half had thought content disturbances that were mainly grandiose and persecutory in nature.
• Research published in the journal Bipolar Disorders suggests that around 57% of youth with BD experience grandiosity.
• Grandiose delusions occur in roughly two-thirds of people with bipolar disorder and one-half of people with schizophrenia.
• Grandiose thoughts are also common with substance use disorders, particularly in people who use cocaine and amphetamines.
• Additionally, grandiosity is thought to be a possible facet of personality disorders, particularly narcissistic personality disorder.

Causes of Grandiosity

• Grandiosity is one of the seven symptoms of a manic or hypomanic episode in bipolar disorder.
• Within the context of the disorder, grandiosity is considered a mood-congruent delusion consistent with a manic state.
• During manic or hypomanic episodes, the chemistry and activity of the brain change in complex ways. It is these changes that lead to symptoms.
• No one knows exactly why these changes happen. It's also not clear why some people experience severe symptoms and others do not.
• Although grandiosity is a common feature of bipolar mania and hypomania, it does not occur in everyone with the disorder.
• According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the presence of grandiosity can be used in combination with other manic or hypomanic symptoms to confirm a diagnosis of bipolar disorder.

Signs and Symptoms of Grandiosity

• The term "grandiosity" refers to an unrealistic sense of superiority in which someone believes themself to be unique and better than others.
• It also infers a disdain for people considered inferior (by way of class, intelligence, beauty, heritage, etc.).
• As a symptom, grandiosity exists on a spectrum. It can range from inflated self-esteem to sweeping delusions of grandeur.
• Grandiosity can be difficult to identify and pin down.
• Examples of grandiosity include:
• Exaggerating achievements
• Criticizing and dismissing the achievements or talents of others
• Constantly boasting and talking about oneself
• A belief that one is infallible or invulnerable
• A belief that one is more intelligent than others
• Thinking that rules don't apply to one
• Acting selfishly
• Treating others with disdain or contempt
• Not caring if one hurts someone with one's actions
• Being quick to anger if challenged
• An inability to see how one's behavior affects others
• An inability to see how unrealistic one's beliefs and actions are

Grandiosity in Narcissistic Personality Disorder

• At times, it can be difficult to distinguish between grandiose thinking during a manic or hypomanic mood and grandiosity as a facet of narcissistic personality disorder (NPD).
• NPD is broadly characterized by self-centeredness and an inability to have empathy for others.
• People with NPD manipulate others to get what they want.
• They consistently exhibit a pattern of grandiosity, a need for admiration, and a lack of empathy in a way that interferes with their relationships and well-being.
• One of the key ways to differentiate grandiosity in BD from grandiosity in NPD is the co-occurrence of mania symptoms.
• When grandiosity accompanies any of these abnormal behaviors, bipolar disorder should be explored as a possible cause.
• Grandiosity can also occur in hypomania (a less severe form of mania), but it is usually less problematic and easily missed in diagnosis.
• Another key differentiator is time. Personality disorders like NPD are pervasive patterns of interactions with others.
• By contrast, bipolar mania or hypomania typically lasts for weeks to months and is not always present.

Treatment

• People experiencing grandiosity as a feature of BD may suffer consequences in their personal and professional lives.
• Grandiosity can make someone seem unforgivably conceited and rude. This can affect relationships at home, with friends and family, and at work.
• Grandiose delusions can impair judgment and compromise the ability to keep or maintain employment.
• Grandiosity rarely occurs on its own in people with BD. They need medications, psychotherapy, and social support to effectively resolve symptoms,