If untreated, bipolar disorder often worsens and can have an ultimately devastating impact on an individual's life. However, proper diagnosis and treatment can help people with bipolar disorder lead healthy and active lives.
Here are 13 signs and symptoms of bipolar disorder.
Mania
Bipolar disorder is characterized by up-and-down episodes of mania and depression, according to the NIMH. During a manic phase, some people can have a total break from reality—feeling extremely "up," elated, irritable, or energized. During the depressive phase, they may feel very "down," sad, indifferent, or hopeless.
Hypomania is a less severe form of mania. As described by the NIMH, a person may feel very good and keep up with day-to-day life during a hypomanic episode. The person may not even feel that anything is wrong, but family and friends may recognize the changes in mood or activity levels as possible bipolar disorder.
"Hypomania can be a pretty enjoyable state, really," Carrie Bearden, PhD, a professor in the department of Psychiatry and Biobehavioral Sciences at UCLA told Health. A person's mood can be elevated, they may have a lot of energy and creativity, and they may experience euphoria. This is the "up" side of bipolar disorder that some people with the condition actually enjoy—while it lasts.
Inability To Complete Tasks
According to NAMI, people experiencing a manic episode of bipolar disorder think they can do a lot of things at once. People who can harness their energy when they are in a hypomanic phase can be really productive.
Otheres often go from task to task, planning grand, unrealistic projects that are never finished before moving on to something else.
By contrast, during a depressive episode, people with bipolar disorder may feel unable to do simple things.
"They can be quite distractible and may start a million things and never finish them," said Don Malone, MD, President of Ohio Hospitals and Family Health Centers at Cleveland Clinic in Ohio.
Complicated Sex Lives
Bipolar disorder can have a negative impact on an individual's sex life, particularly with regard to risky sexual behavior.
A 2019 study published in BMC Psychiatry noted that people with bipolar disorder are highly vulnerable to risky sexual behaviors (RSBs)—defined as having sex with two or more sexual partners, having unprotected sexual intercourse, having sex after alcohol consumption, or exchanging money for sex in a previous 12 months. The study authors found almost half of the participants with bipolar disorder reported a risky sexual behavior.
A 2016 study published in Psychiatry Journal found that participants with bipolar disorder had more partners in the last year and were more likely to have had sex without condoms compared to participants without bipolar disorder. Compared to women with bipolar disorder, men with bipolar disorder had more sex partners and had more sex with strangers.
According to Paul Hokemeyer, PhD, psychotherapist and author of Fragile Power, individuals with bipolar disorder may also go to the other extreme and completely avoid sex.
Depression
A person who is in a bipolar depressive state is going to look just like someone who has regular depression. "They have the same problems with energy, appetite, sleep, and focus as others who have 'plain old depression,'" said Dr. Malone.
Unfortunately, the use of antidepressants is controversial in people with bipolar disorder. According to a 2018 analysis published in the International Journal of Bipolar Disorders, many clinicians worry about the capacity of antidepressants to cause affective switching or mood destabilization. The study authors conclude that further long-term studies are needed as the evidence that antidepressants are effective in treating bipolar depression is weak.
"Antidepressants can be downright dangerous in people with bipolar because they can send them into mania," said Dr. Malone.
Irritability
Sometimes people experience both manic and depressive symptoms in the same episode—a state called "mixed mania," says the NIMH. During this state, they are often extremely irritable. They can also feel sad, empty, hopeless, and extremely energized at the same time.
"We are all irritable or moody sometimes," said Dr. Bearden. "But in people with bipolar disorder it often becomes so severe that it interferes with their relationships—especially if the person is saying, 'I don't know why I'm so irritable…I can't control it.'"
Rapid Speech
"Pressured speech" is one of the most common symptoms of bipolar disorder. According to the National Library of Medicine, pressured speech is a rapid and continuous production of speech that is difficult to interrupt. Reciprocally, speech is slow and soft, in depression.
This kind of speech occurs when someone is really not in a two-way conversation, said Dr. Bearden. The person will talk rapidly and if you try to speak, they will likely just talk over you.
They will also sometimes jump around to different topics. "What's kind of a red flag is when it is atypical for the person to talk like this," doing it only when they are in a manic cycle but not at other times, said Dr. Bearden.
Loss of Time
Many people with bipolar disorder find that it seriously impairs their concept of time, said Dr. Hokemeyer. "Deadlines in appointments become ethereal, as does the ability to stick to a schedule," Dr. Hokemeyer explained.
Ultimately, this can have a negative impact on their relationships with others, their careers, and even their ability to parent. "Time and its passage is an elusive construct," said Dr. Hokemeyer.
Trouble at Work
People with bipolar disorder often have difficulty in the workplace because so many of their symptoms can interfere with their ability to show up for work, do their job, and interact productively with others.
According to a 2018 study in the Journal of the Society for Social Work and Research 81% of individuals with mood disorders experienced bullying at work. The study also noted that employed individuals with bipolar disorder reported difficulties getting along with others, social isolation from work relationships, and exposure to stigma.
In addition to having problems completing tasks, you may have difficulty sleeping, irritability, and an inflated ego during a manic phase, and depression at other times, which causes excessive sleeping and additional mood problems.
A lot of the workplace problems can be interpersonal ones, said Dr. Malone.
Alcohol or Drug Misuse
About 50% of people with bipolar disorder also have a substance misuse problem (per the Substance Abuse and Mental Health Services Administration), particularly alcohol use, said Dr. Bearden.
Many people will drink when they are in a manic phase to slow themselves down and use alcohol to improve their mood when they are depressed.
Erratic Behavior
When they are in a manic phase, people with bipolar disorder can have inflated self-esteem.
"They feel grandiose and don't consider consequences; everything sounds good to them," said Dr. Malone.
Two of the most common types of behavior that can result from this are spending sprees and unusual sexual behavior.
"I have had a number of patients who have had affairs who never would have done that if they weren't in a manic episode…during this episode they exhibited behavior that is not consistent with what they would do normally," said Dr. Malone.
Grandiosity
While everyone needs to dream big and shoot for the stars, people with bipolar disorder often experience a from a delusional grandiosity. According to NIMH, people having a manic episode may feel like they are unusually important, talented, or powerful.
This can distract them from pursuing tangible accomplishments, according to Dr. Hokemeyer. "So a person who enjoys acting will only take the stage if they get the best part in the most esteemed theater company," said Dr. Hokemeyer.
Sleep Problems
People with bipolar disorder often have sleep problems. During a depression phase, they may sleep too much, and feel tired all the time, according to NIMH.
During a manic phase, they may not sleep enough—but still never feel tired.
Even with just a few hours of sleep each night, they may feel great and have lots of energy.
Dr. Bearden said staying on a regular sleep schedule is one of the first things recommended for bipolar patients.
Flight of Ideas
This symptom may be something hard to recognize, but it occurs frequently when someone is in a manic phase. People feel like their mind is racing and that they can't control or slow down their thoughts.
This flight of ideas sometimes occurs with pressured speech.
People with bipolar may not recognize or admit that their mind is racing out of control, said Dr. Bearden.
Bipolar Mood 'Swings': What to Know About Manic and Depressive Episodes, and How Long They Can Last
Seeking Treatment
Bipolar disorder can severely impair an individual's academic and work performance, social and family relationships, and quality of life—and even carries a risk of suicide, according to Medline Plus.
Knowing these signs and symptoms of bipolar disorder can help with early diagnosis and appropriate treatment. Long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.
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