Grandiosity is one of the seven symptoms of a manic or hypomanic episode in bipolar disorder, though it is also present in several mental illnesses including schizophrenia and psychotic disorders. About half of people with bipolar I disorder experience delusions of grandeur. Much like other symptoms, it exists on a spectrum, in this case from inflated self-esteem to delusions of grandeur. Grandiosity can be difficult to pin down in bipolar disorder not only because of the scale of the symptom, but also because the people experiencing it can lack insight into their illness and may not realize its happening.

Grandiose thoughts and actions can fall anywhere on the scale from somewhat problematic to extreme. It depends on the episode. Because grandiose delusions are the most apparent presentation of grandiosity, it may be difficult to overlook the more subtle symptom of inflated self-esteem. In hypomania, inflated self-esteem may come off as just being more self-centered or boastful. Its possible that the person experiencing the hypomania may be able to hide what they are truly feeling.

People with signs of grandiosity often feel superior to others or that everyone around them is simply incompetent. This can lead to frustration and irritability in manic or hypomanic episodes when people dont behave exactly as the person expects or wants them to. The person can come off as condescending, entitled and ungrateful.

Grandiosity on a larger scale may relate to other symptoms of mania such as increased goal-directed activity or engagement in risky behavior. A person may suddenly decide to quit their job to write the Great American Novel or become an artist when they have neither any artistic experience nor have expressed interest in art before. In school they may suddenly change their course of study or sign up for a double class load and fully expect that not only will they be able to accomplish it, but they will perform better than anyone else.

These feelings and actions may be based on a smaller-scale desire for something new and different. Perhaps the person really would prefer to be an artist or they just want to be a better student. Grandiosity in bipolar disorder can bring these small thoughts out and distort them into something baffling or intolerable to those who dont understand the illness.

The most extreme and potentially dangerous form of grandiosity is delusions of grandeur. These delusions are symptoms of a psychotic episode. More than simply running away with an idea, delusions have no basis in reality, and any facts presented hold no sway. In extension to wanting to write a novel, the person may think they have been contacted by a publisher who has offered them millions of dollars for their unique and superior talent.

Some grandiose delusions are religious in nature. A person may think that they are a messenger from God or a god themselves. They may think they have super powers straight out of a comic book. Another delusion may be related to friendships or relationships. Patients may think they are being pursued by someone or that they are in a relationship they are clearly not in, such as with a celebrity or fictional character.

Any type of grandiose thinking should be closely monitored. Delusions of grandeur especially can lead to potentially illegal or dangerous actions. Patients who have awareness of their symptoms should speak with a doctor.

For those who are not aware enough of their illness to seek help, there is little a loved one can do in cases of psychosis and delusional behavior. As difficult as it may be, remaining calm and patient is incredibly helpful. The best action, if the person is not a danger to themselves or others, is to attempt to convince them to go with you to a psychiatric emergency room.

If a person is a threat to themselves or others, emergency personnel like police officers can take action to get the person under control and get the help they need. Just make sure to describe the behavior and emphasize the fact that the person has a mental illness. This requires a different and more challenging protocol from first responders and will make sure the patient and those around them are kept as safe as possible.

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Image credit:Jo Jakeman