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% 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 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 behaviours 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% 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 can 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

  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.