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Misdiagnosing Personality Disorders as Bipolar I Disorder

By Sam Vaknin,Author of "Malignant Self Love - Narcissism Revisited"


The manic phase of the Bipolar I Disorder is often misdiagnosed as a Personality Disorder. In the manic phase of Bipolar Disorder, patients exhibit many of the signs and symptoms of certain personality disorders, such as the Narcissistic, Borderline, Histrionic, or even Schizotypal Personality Disorders: they are hyperactive, self-centered, lack empathy, and are control freaks.

The manic patient is euphoric, delusional, has grandiose fantasies, spins unrealistic schemes, and has frequent rage attacks (is irritable) if her or his wishes and plans are (inevitably) frustrated.


The Bipolar Disorder got its name because the mania is followed by - usually protracted - depressive attacks. A similar pattern of mood shifts and dysphorias occurs in many personality disorders such as the Borderline, Narcissistic, Paranoid, and Masochistic. But whereas the bipolar patient sinks into deep self-deprecation, self-devaluation, unbounded pessimism, all-pervasive guilt and anhedonia - patients with personality disorders, even when depressed, never lose the underlying and overarching structure of their primary mental health problem.

The narcissist, for instance, never foregoes his narcissism, even when down and blue: his grandiosity, sense of entitlement, haughtiness, and lack of empathy remain intact.

From my book "Malignant Self Love - Narcissism Revisited":

"Narcissistic dysphorias are much shorter and reactive - they constitute a response to the Grandiosity Gap. In plain words, the narcissist is dejected when confronted with the abyss between his inflated self-image and grandiose fantasies - and the drab reality of his life: his failures, lack of accomplishments, disintegrating interpersonal relationships, and low status. Yet, one dose of Narcissistic Supply is enough to elevate the narcissists from the depth of misery to the heights of manic euphoria."


The etiologies (the causes) of the Bipolar Disorder and of personality disorders differ. These disparities explain the different manifestations of mood swings. The source of the Bipolar's mood shifts is assumed to be brain biochemistry. The source of the transitions from euphoric mania to depression and dysphorias in the Cluster B personality disorders (Narcissistic, Histrionic, Borderline) is the fluctuations in the availability of Narcissistic Supply. Whereas the narcissist is in full control of his faculties, even when maximally agitated, the bipolar often feels that s/he has lost control of his/her brain ("flight of ideas"), his/her speech, his/her attention span (distractibility), and his/her motor functions.


The bipolar is prone to reckless behaviors and substance abuse only during the manic phase. In contrast, people with personality disorders do drugs, drink, gamble, shop on credit, indulge in unsafe sex or in other compulsive behaviors both when elated and when deflated.


More about this topic here:

Roningstam, E. (1996), Pathological Narcissism and Narcissistic Personality Disorder in Axis I Disorders. Harvard Review of Psychiatry, 3, 326-340

Stormberg, D., Roningstam, E., Gunderson, J., & Tohen, M. (1998) Pathological Narcissism in Bipolar Disorder Patients. Journal of Personality Disorders, 12, 179-185

Vaknin, Sam - Malignant Self Love - Narcissism Revisited - Skopje and Prague, Narcissus Publications, 1999-2006

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Author Bio

Sam Vaknin ( http://samvak.tripod.com ) is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He served as a columnist for Central Europe Review, Global Politician, PopMatters, eBookWeb , and Bellaonline, and as a United Press International (UPI) Senior Business Correspondent. He was the editor of mental health and Central East Europe categories in The Open Directory and Suite101.

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This content was written by Sam Vaknin. If you wish to use this content in any manner, you need written permission. Contact Dr. Jonice Webb for details.



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