Signs of bipolar disorder

What is bipolar disorder?

Bipolar disorder, also referred to as bipolar affective disorder and formerly as manic depression, is a mental health condition. It causes severe changes in mood that can stop people living their day-to-day lives.

Bipolar disorder is characterized by serious mood swings between depression and mania or hypomania that last several weeks or months. (See the Signs and symptoms section of this resource for information about the differences between mania and hypomania.)

These mood swings are more extreme than those experienced by most people.[1] Some people with bipolar disorder may experience stable moods between episodes.[2] Other people experience what is known as rapid cycling, where someone can experience four or more episodes a year.[3]

Bipolar disorder can affect anyone. The World Health Organization says that it currently affects 60 million people around the world.[4] This is approximately 1 in every 100 adults.[5] In the United States, 4.4 percent of the adult population is estimated to experience symptoms of bipolar disorder at some point during their lives.[1]

Men and women are equally likely to have bipolar disorder. It is most common for symptoms to begin during someone’s late teenage or early adult years, but children and older adults can also develop bipolar disorder.

Signs and symptoms of bipolar disorder

People with bipolar disorder experience episodes of mania or hypomania, and also commonly experience episodes of depression.

Mania

Mania, or experiencing an elevated or high mood, is the primary characteristic of bipolar disorder.[4]

A manic episode can feel like having a surge of energy, often accompanied by feelings of intense optimism and wellbeing. Someone having a manic episode may experience some of these feelings:[2][6][7][8][9]

  • Thoughts quickly jumping around
  • Thinking of new and interesting ideas
  • Intense happiness or euphoria
  • Irritability and annoyance
  • Increased sexual drive
  • An inflated sense of self-importance
  • Distraction
  • Exaggerated assessment of skills and abilities
  • Overconfidence

Some of the behaviors a person may exhibit during a manic episode are:

  • A lack of inhibition
  • Talking faster than usual
  • Not making sense while talking
  • Making lots of ambitious and unrealistic plans
  • Going on spending sprees
  • Drinking alcohol to excess or taking illicit drugs
  • Gambling
  • Making risky sexual decisions
  • Sleeping less than usual
  • Being critical of or over-familiar with other people

Someone experiencing a manic episode may not realise anything is wrong. They may enjoy feeling so positive and full of energy and be irritable or angry with other people for questioning their behavior. After a manic episode, people can feel embarrassed or ashamed about their behavior and unable to manage plans that were made while experiencing mania.

Symptoms of elevated mood, combined with other feelings and behaviors associated with mania that last at least one week, are considered an episode of mania. Without treatment, episodes often last between three and six months.[2]

Hypomania

Hypomania is similar to mania, but less extreme. Someone experiencing hypomania may appear to be managing day-to-day activities well, though it can still be disruptive. However, there is a risk of hypomania developing into mania.[7][10]

Symptoms and signs of hypomania can include:

  • Thoughts quickly jumping around
  • Feeling happy or euphoric
  • Having more energy than usual
  • Irritability and annoyance
  • Increased sexual drive
  • Distraction
  • Overconfidence

Some of the behaviors a person may exhibit during a hypomanic episode are:

  • A lack of inhibition
  • Talking faster than usual
  • Being more energetic than usual
  • Sleeping less than usual
  • Spending too much money
  • Willing to take risks

Depression

Depression is characterized by low mood that is more intense and longer-lasting than the feelings of sadness that everyone experiences from time to time.

Symptoms which interfere with day-to-day life and last for two weeks are considered an episode of depression. Symptoms can include:[6][7][8][11]

  • Low mood for most of the time
  • Not enjoying life and activities, even ones normally found pleasurable
  • Feeling upset or tearful
  • Not having energy and feeling sluggish
  • Lack of concentration or motivation
  • Feeling guilty or worthless
  • Not sleeping enough or sleeping too much
  • Lack of appetite or eating too much
  • Loss of interest in sexual activity and intimacy
  • Being irritable, agitated or tense
  • Suicidal thoughts and feelings

The contrast between the ‘high’ of mania or hypomania and depression may make an episode of depression even harder to cope with.

Without treatment, depressive episodes usually last longer than episodes of mania.[2]

Psychosis

Psychosis can occur during a severe episode of mania or depression. A psychotic episode is when a person loses touch with reality. They may see, hear or believe things that the people around them do not.[12][13]

Around 50 percent of people with bipolar disorder will experience a psychotic episode in their lifetime.[14]

Common symptoms of psychosis are:[12][15][16]

  • Hallucinations, such as hearing voices, seeing things that others don’t or feeling sensation without an obvious cause
  • Delusions, such as being convinced of having special powers or believing people are trying to cause one harm

A person experiencing psychosis that has developed from mania may feel or show the following signs:[12][16][17]

  • Hearing voices encouraging them in risky behaviors
  • Believing they are being followed or that someone is trying to control their thoughts
  • Seeing visions, such as of deceased relatives or religious figures
  • Becoming convinced they have powers, such as being able to manipulate the weather or being able to fly
  • Having difficulty communicating, because thoughts and words become jumbled

Although psychosis is commonly linked with mania, it can also occur during an episode of depression. Signs of psychosis, which a person with depressive psychosis may present, include:[9][18][19]

  • Hearing voices saying negative things
  • Hallucinations, such as seeing things that aren’t there
  • Believing they have committed a crime
  • Thinking they are financially ruined
  • Becoming convinced they have a serious physical illness

Mixed states

Mixed states, or mixed episodes or features, are when a person experiences symptoms of depression and mania or hypomania at the same time.[6]

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), which is the universal authoritative work for psychiatric diagnoses, categorizes mixed features as someone experiencing either:[20]

  • Three symptoms of mania or hypomania during a major depressive episode
  • Three symptoms of depression during an episode of mania or hypomania

People experiencing a mixed state may find their emotional state highly confusing as it can be difficult to identify what is happening.

Mixed states also pose a greater risk of attempted suicide, as the person may feel the sadness and hopelessness of depression while in an energized state.[9][20]

Postpartum illnesses

Women with bipolar disorder are at higher risk of developing postpartum depression or postpartum psychosis.

For more information, see the Pregnancy and bipolar disorder section of the bipolar disorder resource.

Signs of postpartum illnesses linked to bipolar disorder are similar to the usual symptoms of mania, psychosis and depression, but can also include:

  • Thoughts of harming the baby
  • Difficulty bonding with the baby

Types of bipolar disorder

There are various types of bipolar disorder, so people may present different symptoms depending on the variant.

Bipolar I disorder

Someone with bipolar I disorder may experience:[2][5][21][22]

  • Manic episodes that last at least seven days
  • It is common to also experience periods of depression, though not in every case
  • Manic episodes may be severe enough to require hospitalization
  • People may experience episodes of stable mood between episodes

Hospitalization may become necessary if a person stops being able to take care of themselves or others, is hallucinating, is threatening to harm themselves or others, or if other treatments are not working.[23]

Bipolar II disorder

Someone with bipolar II disorder may experience:[9][22][24]

  • At least one episode of severe depression
  • Episodes of hypomania, rather than mania
  • People may experience episodes of stable mood between episodes

Signs of bipolar disorder in children and teenagers

The early signs of bipolar disorder usually appear around the late teenage years, though symptoms can appear in children younger than this.

Children and adolescents experience bipolar disorder as mania, hypomania and depression. The standard diagnostic symptoms are likely to be applicable to young adults of 15 to 19 years of age, which is the typical age that bipolar disorder first develops. Symptoms in younger children may be atypical and harder to identify.[25]

The American Academy of Child and Adolescent Psychiatry notes that mania in children can be more changeable and erratic than in adults, with incidences of ultrarapid cycling.[26]

Children and teenagers may also have other conditions, such as ADHD, anxiety disorders or issues with substance abuse, which may delay a diagnosis of bipolar disorder.[27]

Some specific behaviors by younger children during a manic episode can include:[28][27]

  • Temper tantrums
  • Acting inappropriately silly for the child’s age
  • Being physically aggressive
  • Talking very quickly and jumping from topic to topic
  • Not sleeping enough, but not feeling tired

Some specific behaviors in older teenagers during a manic episode can include:[28][27]

  • Being highly focused on sex
  • Substance abuse
  • Taking physical risks

Specific behaviors which children and adolescents with bipolar disorder may exhibit during a depressive episode can include:[28][27][29]

  • Being very sad and tearful
  • Thinking about death and suicide
  • Change in eating habits
  • Sleeping a lot or having insomnia
  • Experiencing aches and pains
  • Lack of energy and interest in previously pleasurable activities
  • Complaining of being bored

There appears to be a genetic link, as the chance of developing bipolar disorder is greater if a family member is also affected. If one parent has bipolar disorder, there is a 25 percent chance a child will develop it. If both parents have bipolar disorder, there is an up to 50 percent chance of a child developing bipolar disorder.[30]

The excessive mood swings associated with bipolar disorder can make it difficult for children to do well in school. Lack of inhibitions and poor decision making may increase the chances of a child or teenager smoking, drinking or taking drugs.[27]

There is an increased risk of suicidal ideation and suicide attempts in children and teenagers with bipolar disorder. For this reason, it is important to obtain a diagnosis and begin an appropriate treatment regime.[31]

The American Academy of Child and Adolescent Psychiatry urges caution in looking for signs of bipolar disorder in toddlers and children under six years old. This is because of the difficulty of applying adult diagnostic criteria to very young children.[26]

Identifying bipolar disorder

There is an understandable desire for people to know the early signs of bipolar disorder, particularly early signs of bipolar disorder in children and young adults. Bipolar disorder can take years to be diagnosed, and as the condition often appears in the mid-to-late teenage years, it is reasonable to want to obtain a diagnosis and begin treatment in order to allow the person who has the condition to experience stability.[32]

It is important to appreciate that bipolar disorder is not a progressive condition in the way that some other conditions are progressive. There are no early warning signs of bipolar disorder, such as the way that beginning to experience episodes of coughing or wheezing can indicate the development of childhood asthma.

It is also important to note that, while mania and depression can progress into psychosis, psychosis is not an inevitable result of remaining untreated. Similarly, while it is possible for people diagnosed with bipolar II disorder to progress to bipolar I disorder, it is not inevitable.[33]

Early signs of a person starting to display symptoms of bipolar disorder will be those of an episode of hypomania, mania or depression.

New bipolar episodes

Each person with bipolar disorder will experience the condition differently. The key is to gain insight into what may trigger a new episode of mania or depression and to understand what each person’s early warning signs may be to indicate a new episode is beginning. For example, one person may stop sleeping, whereas another person may lose the ability to focus.[34]

It can be helpful to keep a mood diary to track changing emotion and behavior. A person can learn from old entries and compare current feelings and actions with those from the past.[35]

When to seek medical advice

Anyone at risk of harming themselves or others, because of severe depression, mania or psychosis, should be brought to the attention of a medical professional immediately.

Some people find it takes a long time to receive an accurate diagnosis of bipolar disorder. A doctor will take a history of symptoms, perhaps over several years. It may help to keep track of mood and behavior changes in a diary to provide evidence.[32][35]

See this resource on bipolar disorder for more information about treating and managing the condition.

Signs of bipolar disorder FAQs

Q: What are the signs of bipolar disorder in adults?
A: Bipolar disorder is a condition, where people’s moods and emotions swing between manic highs and depressive lows, usually with stable periods in between. These moods are more extreme than those experienced by most people. (See Signs and symptoms of bipolar disorder)

Q: What are the signs of bipolar disorder in young adults and children?
A: Bipolar disorder generally appears at around 15 to 19 years of age, and the symptoms are those of mania, hypomania and depression. Younger children may display signs of mania that are more erratic and highly changeable. The American Academy of Child and Adolescent Psychiatry stresses the difficulty of making a diagnosis of mania in children under six years old, who are already prone to distraction and disrupted sleep patterns.[26] (See Signs of bipolar disorder in children and teenagers)

Q: What are the signs of bipolar disorder in women?
A: The signs of bipolar disorder are the same for women as for men, though women are more likely to experience rapid cycling. Women with bipolar disorder are also at higher risk of postpartum illnesses than women without bipolar disorder. (See Postpartum illnesses)


  1. National Institute of Mental Health. “Bipolar Disorder.” November 2017. Accessed April 5, 2018.

  2. Royal College of Psychiatry. “Bipolar disorder.” April 2015. Accessed April 5, 2018.

  3. John Hopkins Medicine. “Bipolar I Disorder.” October 2017. Accessed April 5, 2018.

  4. World Health Organization. “Mental disorders.” April 2017. Accessed April 5, 2018.

  5. Mental Health Foundation. “Bipolar disorder.” 2018. Accessed April 5, 2018.

  6. Mind. “What are bipolar mood states?” October 2015. Accessed April 5, 2018.

  7. Patient Info. “Bipolar Disorder.” August 2017. Accessed April 5, 2018.

  8. HeretoHelp. “Bipolar Disorder: What does it feel like?” 2008. Accessed April 5, 2018.

  9. National Institute of Mental Health. “Bipolar Disorder.” April 2016. Accessed April 5, 2018.

  10. Mind. “Hypomania and mania.” August 2016. Accessed April 5, 2018.

  11. National Institute of Mental Health. “Depression.” February 2018. Accessed April 5, 2018.

  12. Rethink Mental Illness. “About psychosis.” Accessed April 5, 2018.

  13. National Institute of Mental Health. “What is Psychosis?” Accessed April 5, 2018.

  14. US National Library of Medicine. “Prevalence and description of psychotic features in bipolar mania.” August 2000. Accessed April 5, 2018.

  15. Mind. “About psychosis.” August 2016. Accessed April 5, 2018.

  16. Royal College of Psychiatrists. “Psychosis.” March 2017. Accessed April 5, 2018.

  17. Mind. “What types of psychosis are there?” August 2016. Accessed April 5, 2018.

  18. MedlinePlus. “Psychosis.” February 2016. Accessed April 5, 2018.

  19. MedlinePlus. “Major depression with psychotic features.” December 2016. Accessed April 5, 2018.

  20. US National Library of Medicine. “Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment” January 2017. Accessed April 5, 2018.

  21. Patient Info. “Bipolar Disorder.” May 2016. Accessed April 5, 2018.

  22. Bipolar UK. “Are there different types of bipolar?” April 5, 2018.

  23. Depression and Bipolar Support Alliance. “Psychiatric Hospitalization: A Guide for Families.” 2004. Accessed April 5, 2018.

  24. Mind. “What types of bipolar are there?” October 2015. Accessed April 5, 2018.

  25. Boston Children’s Hospital. “Bipolar Disorder.” 2011. Accessed April 5, 2018.

  26. American Academy of Child and Adolescent Psychiatry. “Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder.” 2007. Accessed April 5, 2018.

  27. National Institute of Mental Health. “Bipolar Disorder in Children and Teens.” 2015. Accessed April 5, 2018.

  28. Medscape. “Pediatric Bipolar Affective Disorder.” March 2018. Accessed April 5, 2018.

  29. American Academy of Child and Adolescent Psychiatry. “Bipolar Disorder in Children and Teens.” March 2015. Accessed April 5, 2018.

  30. Deister, Arno; Laux, Gerd; Möller, Hans-Jürgen (2015). Duale Reihe Psychiatrie, Psychosomatik und Psychotherapie. Stuttgart: Thieme Georg Verlag. p. 81. ISBN 313128546X, 978-3131285461.

  31. US National Library of Medicine. “Suicidal ideation and suicide attempts in children and adolescents with bipolar disorder: a systematic review of prevalence and incidence rates, risk factors, and targeted interventions.” July 2013. Accessed April 5, 2018.

  32. National Institute of Mental Health. “Bipolar Disorder.” November 2015. Accessed April 5, 2018.

  33. US National Library of Medicine. “Progression along the bipolar spectrum: a longitudinal study of predictors of conversion from bipolar spectrum conditions to bipolar I and II disorders.” February 2012. Accessed April 5, 2018.

  34. Mind. “How can I help myself cope?” October 2015. Accessed April 5, 2018.

  35. Bipolar UK. “Bipolar UK Mood Diary.” 2017. Accessed April 5, 2018.