NPD + Bipolar

[Pilpel]

I'm curious if anyone else has seen this combination? 

My NPD sister in law became part of the family when she was in her mid-20s.  As you all can imagine, she was difficult from the start.  Very much straight up NPD behaviors, high conflict, no empathy, attention seeking, bullying others, manipulative.  Then at some point after she turned 40, she was diagnosed as bipolar.  I had cut contact with her a couple years before she had her first bipolar episode.  Now we're limited contact.   I have known other people who have bipolar, but I have never seen someone else when they were in their bipolar mania.  But I'm guessing that it is more complicated when someone already has highly disordered NPD thinking.  The last two years, her manic episodes have been off the charts.  They seem less and less filtered.  And I have concerns that she could get into serious trouble with the police or from "harassing" the wrong people in future manic episodes.  I have always had some hope that she would one day wake up and realize how destructive her behaviors have been and genuinely want to change.  But that isn't going to happen.  It seems likely that she will just have manic episodes every year until she submits to having her meds readjusted.  Or worst case she self-harms during one of her episodes, or gets shot by police or she puts herself in a dangerous position by aggressively harassing the wrong stranger. 

[Pook075]

My daughter was diagnosed bipolar (unofficially) when she was 16 and BPD at 17.  Then they both made it to her charts when she turned 18.  Now at 26, her therapist is talking about a diagnosis of autism as well.

I mention that because my ex-wife also suffers from what out family doctor said appeared to be textbook BPD, but she also added that BPDs don't experience manic or depressive episodes.  And I was like, she is over the moon happy 24/7...she honestly appeared to be drugged those first few months.  Her diagnosis before this was major depressive disorder, so the manic behavior did not fit by any means and it didn't align with the thinking of BPD either.

So the short answer is yes, people can have multiple diagnosis for mental illness.

[CC43]

Hi there,

I don't know anyone with both NPD and bipolar.  I do know someone close to me with diagnosed BPD, and someone else with undiagnosed NPD.  Both have self-medicated with illicit/unprescribed substances, and I'm certain that the drugs exacerbated some of their more deleterious behaviors.  There have been times when more "psychotic" episodes from them have coincided with heavier drug use.  The "psychotic" behaviors seemed to go into "remission" when they were hospitalized and cut off from the drug source. 

I'm just mentioning this because, though I'm no expert, I understood that bipolar typically emerges in early adulthood.  That your SIL's bipolar behaviors emerged in her 40s seems unexpected.  I'm not saying it's not true, I'm just wondering if something else is going on, or is a triggering condition, such as a reaction to medications.

Having said that, the pwNPD in my life can exhibit extremely aggressive behaviors.  He has gotten into trouble with police for harassing-type behavior.  There was one incident where the police held him for several hours, and he became increasingly agitated and aggressive, but they couldn't figure out why he was acting so weirdly--he wasn't just drunk or high.  He made threats, but since he didn't actually follow through, the police couldn't book him.  The police called around to try to get someone to take him in, but nobody would.  They ended up taking him to the hospital, where he was treated for a few weeks.  Let's just say this wasn't an isolated incident--the police have a file on him, and that's why they were able to call around to ask someone to take him.  And the reason nobody would take him is that his NPD behavior is too much to handle.  He is in a bad way, and I wouldn't be surprised if he doesn't live much longer, cutting his life short by 30-40 years.  I don't know if he'll get in a fight, a car wreck, OD on drugs/alcohol or succumb to physical system failures (failing kidney, liver, heart attack, stroke?).  It is very sad.  But since he's NPD (in all likelihood), he thinks he's "special" and would never admit to having any sort of problem, whether a physical ailment, mental health issue or otherwise.  Though he loves the attention he gets at the hospital, he doesn't follow doctors' orders and reverts to bad habits when discharged.