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  4. Signs of Bipolar Disorder

Signs of Bipolar Disorder

  1. Mania
  2. Hypomania
  3. Depression
  4. Psychosis
  5. Mixed states
  6. Rapid cycling
  7. Early signs
  8. Signs of new episodes
  9. Signs in women
  10. Signs in children and teenagers
  11. Types
  12. When to seek medical advice
  13. FAQs

Mania

Mania, or experiencing an elevated or high mood, is the primary characteristic of bipolar disorder.[1] 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][3][4][5][6]

  • 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 bipolar mania that last at least one week, are considered an episode of mania. Without treatment, manic episode symptoms 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 the condition can still be disruptive. There is a risk of hypomania developing into mania.[4][7]

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
  • An increased willingness 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:[3][4][5][8]

  • 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 bipolar depression even harder to cope with.

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

Read more about depressive episodes »

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.[9][10]

Around 50 percent of people with bipolar disorder will experience a psychotic episode in their lifetime.[11]

Common symptoms of psychosis are:[9][12][13]

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:[9][13][14]

  • 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 bipolar depression. Signs of psychosis, which a person with depressive psychosis may present, include:[6][15][16]

  • 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.[3]

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) categorizes mixed features as someone experiencing either:[17]

  • 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.[6][17]

Rapid cycling

According to John Hopkins Medicine, the average person with bipolar disorder will experience nine episodes over a lifetime.

When four or more episodes of mania, hypomania or depression are experienced within a year, this is termed rapid cycling.[18][19]

Around 10 to 20 percent of people with bipolar disorder experience rapid cycling. It is more common in people with bipolar II disorder and also more commonly experienced by women.[20]

Early signs of bipolar disorder

There is an understandable desire for people to know the early signs of bipolar disorder, particularly early bipolar disorder signs 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.[21]

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 that are comparable to beginning to experience mild 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.[22]

If a person experiences one of the following, it could be an early sign that they will become affected by bipolar disorder:

Good to know: Many people may experience one of these symptoms without going on to develop bipolar disorder. Other reasons for experiencing one or more of the above symptoms may include temporary stress, another medical condition or other mental health conditions. Those who experience a longer depressive episode won’t necessarily develop bipolar disorder. Rather, they are much more likely to experience only a so-called unipolar depressive episode. However, a person experiencing any of the symptoms above should seek a diagnosis by a medical professional, as early as possible, to make sure they get the most appropriate treatment.

If you are worrying that you or someone you know may be experiencing bipolar disorder, try the Ada app free symptom assessment for guidance.

Signs of 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.[23]

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.[24]

Signs of bipolar disorder in women

The presentation and course of bipolar disorder often differs in men and women.

The following aspects of bipolar disorder tend to be more common in women than in men:[25][26]

  • Later age of onset
  • Bipolar II disorder, which includes at least one episode of severe depression and episodes of hypomania, rather than mania
  • Seasonal pattern of mood disturbance
  • Depressive symptoms
  • Rapid cycling
  • Mixed states / features
  • Additional medical and psychiatric conditions, particularly thyroid disease, eating disorders, migraine and anxiety disorders
  • Delayed diagnosis and treatment Women with bipolar disorder tend to have more depressive symptoms and different accompanying conditions than men. There is a high risk of symptoms recurring after giving birth and during menopause. Bipolar disorder in women also correlates with increased risk of sexually transmitted diseases, weight gain, unplanned pregnancies and cardiovascular disease.

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

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

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

Read more about bipolar disorder in women »

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. Adolescents aged 15 to 19, the typical age that bipolar first develops, are likely to experience typical symptoms of bipolar disorder, which may include mania, hypomania or depression.

Symptoms in younger children may not be typical and therefore may be harder to identify.[27] 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, when mood episodes switch weekly, monthly or, rarely, even more frequently.[28] Worried you or a young person you know may be experiencing bipolar disorder? Try the Ada app to assess their symptoms.

Children and teenagers may also have other conditions, such as ADHD, generalized anxiety disorder or issues with substance abuse, which may delay a diagnosis of bipolar disorder.[29]

Some behaviors by younger children during a manic episode can include:[30][29]

  • 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 behaviors in older teenagers during a manic episode can include:[30][29]

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

Behaviors which children and adolescents with bipolar disorder may exhibit during a depressive episode can include:[30][29][31]

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

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.[29]

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 without delay.[32]

Good to know: The American Academy of Child and Adolescent Psychiatry urges caution in looking for signs of bipolar disorder or attempting to diagnose it in children under six years old. This is because of the difficulty of applying adult diagnostic criteria to very young children. Furthermore, they advised the Food and drug administration (FDA) to only allow the inclusion of children aged 10 or older in medication trials, given the diagnostic challenges in younger children. [28][30]

Types of bipolar disorder

There are multiple ways of classifying bipolar disorder and depending on the symptoms people show they may be diagnosed with a specific variant or subtype of bipolar disorder. Most commonly used is a diagnostic differentiation between Bipolar disorder Type 1 and Type 2.

Bipolar I disorder

Someone with bipolar I disorder, pronounced as bipolar 1 disorder, may experience:[2][33][34][35]

  • Manic episodes that last at least a week
  • It is also common to experience periods of depression, though not in every case
  • Manic episodes may be severe enough to require hospitalization or lead to other significant difficulties at work and/or socially
  • People may experience episodes of stable mood between episodes

Bipolar II disorder

Someone with bipolar II disorder, pronounced as bipolar 2 disorder, may experience:[6][35][36]

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

When to seek medical advice

Anyone at risk of harming or severely endangering themselves or others because of severe depression, mania or psychotic symptoms, should be brought to the attention of a medical professional immediately, e.g. by taking them to an emergency room. If there is an acute risk of suicide or harm to others, an ambulance should be called. For more information on what to do in a mental health emergency, see the resource from the National Alliance on Mental Illness.

Hospitalization may become necessary if a person:[37][38][39]

  • Stops being able to take care of themselves or dependents, such as young children
  • Has bipolar 1 with psychotic features, such as hallucinations, delusions, confused and disturbed thoughts, and a lack of insight and/or self-awareness
  • Is threatening to or appears to be at significant risk of harming themselves or others
  • Stops responding to other previously successful treatments and needs to adjust to a new medication regimen
  • Has other medical conditions that require their medication being monitored, such as substance withdrawal or intoxication

Good to know In the case where a person has symptoms that are weaker than the ones above, but still needs more medical support than can be provided to them at home, there may be options of partial hospitalisation or day treatment in a hospital, where the person may still be able to spend their evenings and nights at home. This will depend on factors such as the severity of their symptoms, the provisions of the health system they live in, and their health insurance.

No matter the setting of the first medical contact, a medical doctor will attempt to help the person, by diagnosing them once any emergency measures like caring for wounds have been taken. A doctor will take a history of symptoms, sometimes asking about their presentation over several years prior to the most recent presentation. For this and in general, it may help a person to keep track of mood and behavior changes in a diary to provide evidence and help with remembering and reporting symptoms as accurately as possible.[21][24]. Even with a mood diary, some people may still find it takes a long time to receive an accurate diagnosis of bipolar disorder.

Read more about treatment and management 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 and longer lasting than those emotional swings also experienced occasionally by most people not affected by 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. The symptoms in this age group are similar to those in adults, and may include 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, disrupted sleep patterns and lots of other symptoms, that may at this young age actually be part of a normal behavioral development, or may also be part of entirely different medical or mental health conditions.[28]

Read more about the signs of bipolar disorder in children and teenagers »

Q: What are the signs of bipolar disorder in women?
A: Bipolar signs 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 depression than women without bipolar disorder.

Read more about signs of bipolar disorder in women »

Q: Is there a bipolar test?
A: There is no direct medical test for bipolar disorder. Lab tests can rule out physical conditions that may show similar or overlapping symptoms, such as a thyroid problem. During assessment, a GP or psychiatrist will usually focus mainly on taking a thorough history that looks at the affected person’s mood swings and other emotional and physical symptoms.

This may include the doctor asking questions about, for example, the person’s:[40]

  • Family history and background, as well as personal medical history
  • Sleeping patterns
  • Recent stressful life events -Diet
  • Prescribed medication and use of illicit drugs, alcohol and other substances
  • Behavior in various situations
  • Thoughts, concentration ability, distractibility and feelings about self-worth
  • Specific problems and impairments they experience at work or home

Q: Bipolar 1 vs 2 – what is the difference?
A: Bipolar 1 disorder or bipolar I disorder involves episodes of severe mania and often depression. Bipolar 2 disorder or bipolar II disorder involves a less severe form of mania called hypomania. In bipolar I disorder, one or more major depressive episodes usually occur, but are not required for a diagnosis, whereas in bipolar II disorder, one or more major depressive episodes must be seen for a diagnosis. Both types may include periods without symptoms.

Q: Am I bipolar?
A: If you think you may be experiencing symptoms of bipolar disorder, a visit to your GP and/or psychiatrist can help you get a definitive diagnosis. To get a first idea regarding your symptoms, you can also, try the Ada app for a free assessment.

Q: What is schizoaffective disorder bipolar type?
A: People with schizoaffective disorder experience episodes similar to those of bipolar disorder, mania or hypomania, often also with episodes of depression.

As well as this, they experience psychotic symptoms. These include:

  • Hallucinations
  • Delusions
  • Confused and disturbed thoughts
  • A lack of insight and/or self-awareness

People who are diagnosed with bipolar disorder experience their symptoms either within a depressive episode or a manic episode, which may include psychotic symptoms. They also experience stable periods without symptoms. If psychotic symptoms are experienced outside of a manic, depressed or mixed state period, then the person may be considered for a diagnosis of schizoaffective disorder.[41]

Q: What is the relationship between bipolar disorder and post traumatic stress disorder (PTSD)?
A: Bipolar disorder is a risk factor for the development of PTSD, and high rates of PTSD are found among people with bipolar disorder, as many people with bipolar disorder are more likely to be exposed to trauma.[42]

Read more about Post Traumatic Stress Disorder (PTSD) »

Q: Is bipolar disorder hereditary?
A: There appears to be a strong genetic link, especially in the case of bipolar I disorder, as the chance of developing bipolar disorder is about seven times greater if a first-degree family member is also affected.[43] Children of people with bipolar disorder are also more likely to develop another mental health condition. However, not all children of people with bipolar disorder will develop this or another mental health condition, and not all people who develop bipolar disorder have other family with the condition. In the case of identical twins, one twin may develop bipolar disorder while the other does not, indicating that environmental factors may also act as a trigger for bipolar disorder.


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