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Grandiosity in Bipolar Disorder

By Olivia Guy-Evans, published March 10, 2022

by Saul Mcleod, PhD

What is grandiosity?

Grandiosity is a symptom experienced by individuals who have bipolar disorder, during manic and hypomanic episodes. With bipolar disorder, this causes individuals to have extreme mood swings that include emotional lows (depression), and highs (mania or hypomania).

When depressed, the individual may feel sad or hopeless, but when the mood shifts to mania or hypomanic, they may feel euphoric, full of energy or irritable. Mania and hypomania are distinct types of episodes, but with the same symptoms.

Mania is more severe from hypomania and can cause more noticeable problems or result in hospitalization for some. 

People who are experiencing mania or hypomania may have grandiosity symptoms. This is categorized as an exaggerated sense of superiority, power, knowledge, or identity, even if there is little evidence to support this belief.

This is not to be confused with feelings of self-confidence and self-esteem, which are both healthy traits to develop. Grandiosity takes these traits to an extreme where the individual 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 who is 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 symptom of grandiosity is not thought to only be experienced by those with bipolar disorder. Many people with conditions such as schizophrenia and substance-use disorders also experience grandiosity as their condition manifests.

Grandiosity is also thought to be 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. 

How does grandiosity differ from 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 to be 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:

  • The belief the delusion is true, even when others know it to be untrue.

  • The person will not listen to any other viewpoints about the belief despite contradicting evidence to challenge the delusion.

  • The content of the delusion is impossible or implausible.

  • The delusion impacts the person’s daily life.

People who experience delusions of grandeur may have beliefs such as the following:

  • Believing they have a specific ability, object, or talent that no one else knows about.

  • Belief that they are a famous person, and that the real famous person is an imposter.

  • The belief that they have secret connections, sometimes to someone important, or that they are working as a spy.

  • Religious-themed delusions of grandeur that they are a religious leader or have been chosen by a religious entity for a greater purpose.

Symptoms of grandiosity

Grandiosity is a common symptom of manic and hypomanic episodes in bipolar disorder. It is the development of an unusually positive view of the self, the future, and the world at large.

People may feel self-confidence and experience a sense of well-being, but sometimes this can progress to the point where the person’s thinking becomes grandiose and delusional.

Below are some of the symptoms of grandiosity:

  • A sense of being special

  • Boasting about real or imagined accomplishments 

  • Feeling more talented or intelligent than others

  • Dismissing others’ achievements

  • Trying to one-up others’ achievements 

  • A belief of being above the rules

  • Failure to recognise that their actions can harm others

  • Lashing out in anger when criticized

  • Constantly talking about themselves

  • Acting selfishly

  • Being unable to see how unrealistic their beliefs and actions are

Grandiosity can lead to someone displaying behaviours such as only doing things for their own gain, rushing into activities, or 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 of the belief that they are too talented for their job and will get a better, higher-salaried one soon. 

In bipolar disorder, grandiosity can show up alongside other symptoms of manic and hypomania including:

  • An expansive or euphoric mood

  • Talkativeness, pressured speech, and racing thoughts

  • Increased activity and energy such as starting new projects

  • Impulsive behaviour

When grandiosity accompanies any of the above symptoms, bipolar disorder should be explored.

Grandiosity is not always recognised by the individual and will often take someone close to the person to realise that the patterns of grandiose thinking and behaviours do not match their usual self.

Grandiosity may be more noticeable during manic episodes, and more easily missed in hypomania. It may not be recognisable in individuals until grandiosity becomes extreme such as having grandiose delusions.

The feelings of grandiosity will usually disappear in bipolar disorder, once the manic or hypomanic episode has ended. Manic episodes tend to last 1 week or longer, whereas hypomanic tends to last 4 days or longer.


Since grandiosity is a symptom of bipolar disorder, the causes of this disorder would also be the cause of grandiosity. There is not a specific known cause for the development of bipolar disorder, and it may be that it develops due to a combination of multiple factors.


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 state 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. 


Another potential cause for bipolar disorder is environmental and lifestyle factors which could trigger the onset on the condition, such as extreme stress. Triggers which can increase the body’s stress levels include:

  • Life events, whether positive or negative

  • Disruption in regular sleep patterns

  • A change in routine

  • Too much stimulation

Traumatic experiences could also trigger the onset of bipolar disorder, such as:

  • A breakdown in a relationship

  • Physical, sexual, or emotional abuse

  • 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 a potential trigger for bipolar disorder. 


There is evidence that if there is an imbalance in the levels of one or more neurotransmitters (chemical messengers), 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 be the result of 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 could be a risk factor associated with someone developing bipolar disorder. This disorder usually tends to develop around the age of 25, but usually between the ages of 15 and 25.

Whilst it is possible for bipolar disorder to be diagnosed later or earlier in life, someone may be more at risk of the disorder developing for them around this age.


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 over men.

However, there seems 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). 


Grandiosity in bipolar disorder can become problematic in many different ways. It an affect a person’s ability to think rationally, preventing someone from considering more realistic perspectives.

If someone experiencing grandiosity believes that they are superior and more intelligent than everyone else, they may find it difficult to see themselves for who they truly are, as well as being able to see the qualities of those around them. 

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, and this could result in the breakdown of relationships, especially the relationships the individual may rely on for their social support.

Thus, grandiosity could also result in people becoming or feeling isolated once their manic or hypomanic episode has ended. 

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. 

Grandiosity could also create the potential for physical harm, such as getting into fights if they react angrily then confronted or criticized.

It could also result in more risk-taking behaviours if the person believes they are above any rules and have impaired judgement about their vulnerability.

For instance, they may abuse substances if they have the belief that these cannot cause them harm or that they are protected by an outside force. 


Grandiosity is not likely to occur on its own in people who have bipolar disorder, therefore getting treatment for this disorder should help to prevent episodes of mania and hypomania, and all related symptoms, including grandiosity.

Typically, a combination of medications, psychotherapy and social support is most effective for resolving these symptoms. 


To treat mania and its symptoms, including grandiosity, the following medications are usually the most common to help balance out an individual’s mood:

  • Antipsychotics – these work by blocking a type of dopamine receptor in the brain. Dopamine is a neurotransmitter which plays a vital role in mood, so blocking these receptors should work to balance out someone’s mood. 

  • Mood stabilizers – this type of medication is usually used to control manic or hypomanic episodes, a popular type being lithium. Lithium is often used in the long-term treatment of mania and is used to reduce the frequency and severity of the episodes being experienced. This works by stimulating the glutamate receptor NMDA in order to increase glutamate availability, which is essential for the normal functioning of the brain.

  • 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. 


Often, therapy is a choice for many people and has proved to be as effective as medications for treating symptoms of bipolar disorder.

Whilst medications are useful for balancing moods, psychotherapy can target the underlying cause of the disorder, and the skills learnt can be useful for preventing a relapse of symptoms in the future. 

  • Interpersonal and social rhythm therapy (IPSRT) – is a type of psychotherapy that focuses on the stabilization of 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. 

  • Cognitive behavioural therapy (CBT) – this is a highly popular type of psychotherapy for many mental health conditions. The focus of CBT is in identifying unhealthy, negative beliefs and behaviours, replacing them with healthy, 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.

  • Family-focused therapy – getting 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 recognise and manage the warning signs of a manic or hypomanic episode coming on. 


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:

  • Quitting drinking or using recreational drugs – since a big concern during manic and hypomanic episodes is the negative consequences of risk-taking behaviour, quitting drinking and drugs completely could limit this temptation to use these substances during an episode. 

  • Form healthy relationships – it can be beneficial to be surrounded by people with a positive influence. Friends and family can provide support and help watch for warning signs of mood shifts.

  • Creating a healthy routine – having a regular routine for sleeping, eating, and physical exercise can help to balance moods.

  • 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 help someone who may be experiencing a manic or hypomanic 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 so they feel heard. This can also help to improve 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 have 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 put together a self-management plan to help them manage they 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. 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 being a manic episode. The person may find it frustrating if they are questioned or if you start worrying about them whenever they are having a good day.

Instead, it may help to look for consistent sign and patterns that they are approaching an episode and discuss together what this presents as. 

Be gentle in your approach

If the person’s behaviour is becoming worrying, it is important to gently let them know you are worried about them without criticising 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 behaviour and why it concerns you. Sometimes, people may not notice they are experiencing a manic or hypomanic episode until it is brought up with them by someone who knows the behaviour is different from their normal behaviour.

Discuss challenging behaviour

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 realise that their behaviour is a problem, 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 behaviour. They may feel like they want to isolate themselves away from their loved ones if they did not like how they acted in front of them.

They may really benefit from you reassuring them that you still care, and you understand that their behaviour 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 that is right for them. If they agree to it, 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 bad that the individual may need to be hospitalized. To account for this, it can be useful to come up with 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?


Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger:



Contact the Samaritans for support and assistance from a trained counselor:; email [email protected].

Availiale 24 hours day, 365 days a year (this number is FREE to call):


Rethink Mental Illness:

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About the Author

Olivia Guy-Evans obtained her undergraduate degree in Educational Psychology at Edge Hill University in 2015. She then received her master’s degree in Psychology of Education from the University of Bristol in 2019. Olivia has been working as a support worker for adults with learning disabilities in Bristol for the last four years.

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