The manic phase of Bipolar I Disorder is often misdiagnosed as Narcissistic Personality Disorder (NPD).

Bipolar patients in manic phase exhibit many of signs and symptoms of pathological narcissism - hyperactivity, self-centeredness, lack of empathy, and control freakery. During this recurring chapter of disease, patient is euphoric, has grandiose fantasies, spins unrealistic schemes, and has frequent rage attacks (is irritable) if her or his wishes and plans are (inevitably) frustrated.

The manic phases of bipolar disorder, however, are limited in time - NPD is not. Furthermore, mania is followed by - usually protracted - depressive episodes. The narcissist is also frequently dysphoric. But whereas bipolar sinks into deep self-deprecation, self-devaluation, unbounded pessimism, all-pervasive guilt and anhedonia - narcissist, even when depressed, never forgoes his narcissism: his grandiosity, sense of entitlement, haughtiness, and lack of empathy.

Narcissistic dysphorias are much shorter and reactive - they constitute a response to Grandiosity Gap. In plain words, narcissist is dejected when confronted with abyss between his inflated self-image and grandiose fantasies - and 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 narcissists from depth of misery to heights of manic euphoria.

Not so with bipolar. The source of her or his mood swings is assumed to be brain biochemistry - not availability of Narcissistic Supply. Whereas narcissist is in full control of his faculties, even when maximally agitated, 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 manic phase. The narcissist does drugs, drinks, gambles, shops on credit, indulges in unsafe sex or in other compulsive behaviors both when elated and when deflated.

As a rule, bipolar's manic phase interferes with his/her social and occupational functioning. Many narcissists, in contrast, reach highest rungs of their community, church, firm, or voluntary organization. Most of time, they function flawlessly - though inevitable blowups and grating extortion of Narcissistic Supply usually put an end to narcissist's career and social liaisons.

The manic phase of bipolar sometimes requires hospitalization and - more frequently than admitted - involves psychotic features. Narcissists are never hospitalized as risk for self-harm is minute. Moreover, psychotic microepisodes in narcissism are decompensatory in nature and appear only under unendurable stress (e.g., in intensive therapy).

HOW IT’S SUPPOSED TO BE

We set out in our adult life with certain expectations about how things are supposed to be. It’s part of our upbringing, part of our culture, and part of values imparted to us by caring parents.

“You’re supposed to get your degree, then get a job, then get married,” says one parent. In another family formula may be “Follow your heart. If you love her, marry her. The rest will work out.” But behind these life rules passed down are certain assumptions, i.e., job, education, partner, marriage, children.

We learn it about little things as well as big. “He should have [was supposed to have] thanked you for that,” says your parent, or “He should’ve thought about that beforehand [that’s what he was supposed to have done].”

Basically we assume a natural order along with this. It may vary somewhat, but at midlife you’re supposed to find yourself (1) married, (2) with children, (3) with a good job, and (4) money in bank. Some time after that, we expect to have grandchildren, we expect to be able to retire well, and we expect to be OK financially. Behind these assumptions is fact that we’re supposed to have a good life if we do what we’re supposed to. 1 + 1 = 2.

When this natural order of things, and our sometimes unmindful expectations, are not met is when trouble occurs. We suffer when we are forced to retire sometimes more because of emotional affront than from actual deed.

I say “unmindful” because often we aren’t aware of what we assume to be our rights in life until they are violated. WE should never be burglarized, we assume, and are shocked when it happens. WE should never have a teenager in a rehab facility, we assume, until we find ourselves there. WE should get promotions, we assume, until we discover that corporation where we work values other qualities rather than fine ones we possess and ‘knew’ would take us far. WE should have grandchildren, because everyone does, we assume, until day our child informs us she plans to have no children.

RESILIENCE