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(The use of gender pronouns in this article reflects theclinical facts: most narcissists are men.)

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

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

The manic phases of the bipolar disorder, however, are limitedin time - NPD is not. Furthermore, the mania is followed by -usually protracted - depressive episodes. The narcissist is alsofrequently dysphoric. But whereas the bipolar sinks into deepself-deprecation, self-devaluation, unbounded pessimism,all-pervasive guilt and anhedonia - the narcissist, even whendepressed, never forgoes his narcissism: his grandiosity, senseof entitlement, haughtiness, and lack of empathy.

Narcissistic dysphorias are much shorter and reactive - theyconstitute a response to the Grandiosity Gap. In plain words,the narcissist is dejected when confronted with the abyssbetween his inflated self-image and grandiose fantasies - andthe drab reality of his life: his failures, lack ofaccomplishments, disintegrating interpersonal relationships, andlow status. Yet, one dose of Narcissistic Supply is enough toelevate the narcissists from the depth of misery to the heightsof manic euphoria.

Not so with the bipolar. The source of her or his mood swings isassumed to be brain biochemistry - not the availability ofNarcissistic Supply. Whereas the narcissist is in full controlof his faculties, even when maximally agitated, the bipolaroften feels that s/he has lost control of his/her brain ("flightof ideas"), his/her speech, his/her attention span(distractibility), and his/her motor functions.

The bipolar is prone to reckless behaviors and substance abuseonly during the manic phase. The narcissist does drugs, drinks,gambles, shops on credit, indulges in unsafe sex or in othercompulsive behaviors both when elated and when deflated.

As a rule, the bipolar's manic phase interferes with his/hersocial and occupational functioning.

Many narcissists, incontrast, reach the highest rungs of their community, church,firm, or voluntary organization. Most of the time, they functionflawlessly - though the inevitable blowups and the gratingextortion of Narcissistic Supply usually put an end to thenarcissist's career and social liaisons.

The manic phase of bipolar sometimes requires hospitalizationand - more frequently than admitted - involves psychoticfeatures. Narcissists are never hospitalized as the risk forself-harm is minute. Moreover, psychotic microepisodes innarcissism are decompensatory in nature and appear only underunendurable stress (e.g., in intensive therapy).

The bipolar's mania provokes discomfort in both strangers and inthe patient's nearest and dearest. His/her constant cheer andcompulsive insistence on interpersonal, sexual, andoccupational, or professional interactions engenders unease andrepulsion. Her/his lability of mood - rapid shifts betweenuncontrollable rage and unnatural good spirits - is downrightintimidating. The narcissist's gregariousness, by comparison, iscalculated, "cold", controlled, and goal-orientated (theextraction of Narcissistic Supply). His cycles of mood andaffect are far less pronounced and less rapid.

The bipolar's swollen self-esteem, overstated self-confidence,obvious grandiosity, and delusional fantasies are akin to thenarcissist's and are the source of the diagnostic confusion.Both types of patients purport to give advice, carry out anassignment, accomplish a mission, or embark on an enterprise forwhich they are uniquely unqualified and lack the talents,skills, knowledge, or experience required.

But the bipolar's bombast is far more delusional than thenarcissist's. Ideas of reference and magical thinking are commonand, in this sense, the bipolar is closer to the schizotypalthan to the narcissistic.

There are other differentiating symptoms:

Sleep disorders - notably acute insomnia - are common in themanic phase of bipolar and uncommon in narcissism. So is "manicspeech" - pressured, uninterruptible, loud, rapid, dramatic(includes singing and humorous asides), sometimesincomprehensible, incoherent, chaotic, and lasts for hours. Itreflects the bipolar's inner turmoil and his/her inability tocontrol his/her racing and kaleidoscopic thoughts.

As opposed to narcissists, bipolar in the manic phase are oftendistracted by the slightest stimuli, are unable to focus onrelevant data, or to maintain the thread of conversation. Theyare "all over the place" - simultaneously initiating numerousbusiness ventures, joining a myriad organization, writingumpteen letters, contacting hundreds of friends and perfectstrangers, acting in a domineering, demanding, and intrusivemanner, totally disregarding the needs and emotions of theunfortunate recipients of their unwanted attentions. They rarelyfollow up on their projects.

The transformation is so marked that the bipolar is oftendescribed by his/her closest as "not himself/herself". Indeed,some bipolars relocate, change name and appearance, and losecontact with their "former life". Antisocial or even criminalbehavior is not uncommon and aggression is marked, directed atboth others (assault) and oneself (suicide). Some biploarsdescribe an acuteness of the senses, akin to experiencesrecounted by drug users: smells, sounds, and sights areaccentuated and attain an unearthly quality.

As opposed to narcissists, bipolars regret their misdeedsfollowing the manic phase and try to atone for their actions.They realize and accept that "something is wrong with them" andseek help. During the depressive phase they are ego-dystonic andtheir defenses are autoplastic (they blame themselves for theirdefeats, failures, and mishaps).

Finally, pathological narcissism is already discernible in earlyadolescence. The full-fledged bipolar disorder - including amanic phase - rarely occurs before the age of 20. The narcissistis consistent in his pathology - not so the bipolar. The onsetof the manic episode is fast and furious and results in aconspicuous metamorphosis of the patient.

More about this topic here:

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

Roningstam, E. (1996), Pathological Narcissism and NarcissisticPersonality Disorder in Axis I Disorders. Harvard Review ofPsychiatry, 3, 326-340

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