Signs of Bipolar Disorder

What are the Symptoms of Bipolar Disorder? 

Bipolar disorder symptoms can vary in their pattern, severity, and frequency. No two people experience the condition the exact same way, which can sometimes complicate diagnosis. Episodes can be triggered by: 

• Viral infections or physical illness
• Substance use (including recreational drugs and caffeine)
• Hormonal changes, including those related to pregnancy or menopause
• Seasonal changes and disruptions to circadian rhythms
• High-stress life events

Some people experience distinct episodes with periods of normal mood in between, while others may have little or no break between episodes. 

Major Depressive Symptoms

The depressive phase of bipolar disorder shares many similarities with major depressive disorder. Symptoms include: 

• Persistent feelings of sadness, emptiness or hopelessness that last for most of the day
• Loss of interest or pleasure in previously enjoyed activities
• Changes in appetite and weight (increase or decrease)
• Sleep disturbances, either sleeping too much (hypersomnia) or inability to sleep (insomnia)
• Extreme fatigue and loss of energy
• Feelings of worthlessness, inappropriate guilt, or exaggerated self-criticism
• Difficulty concentrating, thinking clearly, or making decisions
• Recurrent thoughts of death or suicide

The risk of suicide during depressive episodes is most concerning, with research indicating that the likelihood of dying by suicide is 8.66 times higher in bipolar disorder compared to other mood disorders. This is why it’s important to get immediate treatment and have ongoing support. 

Physical symptoms can accompany bipolar depression as well, including headaches, digestive issues, and unexplained pain. These signs can sometimes lead to misdiagnosis or delayed treatment. 

Manic Symptoms

During manic episodes, a person experiences a dramatic shift in their mood that’s either elevated or irritable and is combined with increased energy or activity. Specific symptoms include: 

• Inflated self-esteem or grandiosity, feeling unusually important, talented, or powerful
• Decreased need for sleep without feeling tired
• Being much more talkative than usual, often with pressured speech that’s difficult to interrupt
• Racing thought or “flight of ideas” where thoughts jump rapidly between unrelated topics
• High distractibility and inability to focus
• Excessive involvement in pleasurable activities with high potential for painful consequences, such as spending sprees or risky investments

The emotional intensity and behavioral unpredictability during manic episodes can even strain relationships. In fact, partners and family members often experience significant emotional burden as manic episodes can create tension and conflict within the relationship dynamic. 

Hypomanic Symptoms

Hypomania involves the same symptoms as mania but as at less severe intensity. These episodes typically don’t cause the serious problems in work, school, social activities, or relationships that full mania does. Differences include: 

• Shorter episodes that usually last a few days rather than a week or more
• Symptoms don’t typically require hospitalization
• Psychotic features aren’t present

Many people may even find hypomanic states pleasant or productive, sometimes experiencing increased creativity or energy. This can make treatment compliance challenging as some individuals miss these elevated states when stabilized on medication. 

However, hypomania can evolve into full-blown mania if left untreated, especially with exposure to triggers like stress or substance use. 

Psychosis Symptoms

Not everyone with bipolar disorder experiences psychosis, but when present, these symptoms may be serious enough to warrant immediate medical attention. Research suggests that psychotic symptoms occur more frequently in Bipolar I versus Bipolar II, and more commonly during manic or mixed episodes than depressive phases. 

Psychosis in bipolar disorder may include: 

• Delusions, which are firmly held false beliefs that align with the current mood state (grandiose during mania, such as believing one has special powers; nihilistic during depression, such as believing everything is meaningless)
• Hallucinations, such as seeing, hearing, or feeling things that aren’t there
• Disorganized thinking and speech, making communication difficult
• Loss of touch with reality

These symptoms can be terrifying for the person experiencing them and for loved ones witnessing them. If you or someone you know is having a psychotic episode, please seek urgent medical care.