What are the symptoms of bipolar disorder?
The symptoms of bipolar disorder can be considerably varied. The following lists outline the symptoms of depression, mania, and the psychotic episodes that can occur as part of extreme changes in mood.
Depressive episodes cause extremely low moods. Some people with bipolar disorder can find these episodes to be particularly difficult, and may find that the contrast between the highs of mania and the lows of depression make depressive episodes feel worse.
The emotional and behavioural symptoms of depression include:
• A lack of interest or enjoyment in normal activities
• Low self-esteem and low confidence
• Lack of appetite
• Difficulty concentrating
• Feeling upset or tearful
• Feeling tired and lethargic
• Feeling hopeless or worthless
• Feeling pessimistic or doubtful
• Feeling tense and irritable
• Feeling suicidal
• Not doing usually enjoyable activities
• Avoiding other people and social events
• Doing less physical activity
• Difficulty sleeping or sleeping too much
• Eating too much or too little
• Misusing alcohol or drugs
• Attempting suicide
Manic episodes cause extreme emotional highs. These episodes can last for weeks or months at a time, and can disrupt your ability to carry out basic daily activities. In severe cases, treatment in hospital may be required to get symptoms of mania under control.
The emotional and behavioural symptoms of mania include:
• Feeling very happy, euphoric, or overjoyed
• Feeling confident or extremely assertive
• Feeling uncontrollably excited
• Feeling irritable or agitated
• Feeling easily distracted and unable to concentrate
• Feeling full of new ideas and plans
• Feeling invincible and unable to be harmed
• Feeling like you can hear, see, and do things better than before
• Feeling like you can hear, see, and do things better than other people
• Talking a lot and talking very quickly
• Being more physically active than usual
• Being particularly friendly
• Being rude or aggressive
• Sleeping very little or not at all
• Losing social inhibitions
• Misusing alcohol or drugs
• Seriously risking your own safety
• Saying or doing things that are inappropriate or out of character
• Spending vast amounts of money, or spending more money than usual
Some people with bipolar disorder will experience symptoms of psychosis as part of their extreme changes in mood. This is when someone perceives reality differently from others around them, sometimes through hallucinations or delusions.
Psychotic episodes most commonly occur during manic episodes, but there are people who also experience psychosis as part of a depressive episode. Psychosis is particularly distressing and can result in hospitalisation at its most severe.
There are three types of psychosis that people with bipolar disorder may experience:
A delusion is when someone holds a firm belief in something that is untrue. Even though other people may not share their belief and there is no hard evidence to prove the belief to be true, the delusion can feel very real for the person experiencing it. This can be particularly frightening and distressing.
A ‘delusion of grandeur’ may make someone believe they hold great power and authority, perhaps with the ability to control the weather or tomorrow’s winning lottery numbers. This can sometimes make someone vulnerable to financial issues.
‘Persecutory’ delusions can make someone believe that another person or organisation is conspiring to harm, control, or kill them. This can leave someone feeling very threatened or unsafe.
Hallucinations occur when someone sees, hears, feels, smells, or tastes something that doesn’t exist outside of their mind. Examples of these include:
• Sight - seeing people’s faces, colours, animals, shapes, or religious imagery.
• Sound - hearing voices and other sounds, both pleasant or threatening.
• Touch - feeling touched when no one is there, feeling insects crawling on your skin.
• Smell - smelling odours that no one else can, both pleasant or unpleasant.
• Taste - tasting things that aren’t in your mouth, both pleasant or unpleasant.
Disorganised Thinking and Speech
Disorganised thinking and speech is a type of psychosis that causes racing thoughts and ‘flights of ideas,’ where we feel out of control of our thoughts and make links between ideas that can seem nonsensical to other people.
All of this can occur at the same time, affecting our ability to speak and articulate what we’re thinking. A person with disorganised thinking may find it difficult to hold their attention on one thing at a time, or change the topic of a conversation rapidly. Disorganised speech can make someone stumble over their words and speak very quickly, and may also cause them to group words together by the way they sound rather than by what they mean.
Mixed Episodes and Rapid Cycling
It’s possible to feel the symptoms of depression and mania at once or in quick succession. These are known as mixed episodes or rapid cycling, where the extreme highs and lows of bipolar disorder become entangled or there is little time between mood swings.
The symptoms of both depression and mania individually remain the same during these episodes. Someone experiencing a mixed episode might feel depressed yet overactive, while someone experiencing rapid cycling might swing between depression and overactivity very quickly with no relief.
Mixed episodes and rapid cycling can be significantly more challenging as it can be hard to pinpoint exactly how you’re feeling and what support you might need. This may make suicidal thoughts and self-harm worse, especially if others around you are struggling to identify the best way to help.
Are there different types of bipolar disorder?
There are different types of bipolar disorder that are determined by the way you experience the symptoms of the condition and how severely they affect you. A doctor may diagnose you with a specific type of bipolar disorder depending on these criteria.
This diagnosis may be given if you have experienced at least one manic episode that has lasted longer than one week. This mania may be accompanied by depressive episodes, but this is not the case for everyone.
This diagnosis may be given if you have experienced at least one severe depressive episode and at least one severe manic episode.
This diagnosis may be given if you have experienced both manic and depressive episodes over the last two years or more, and your symptoms aren’t severe enough to meet the criteria for a diagnosis of Bipolar I or Bipolar II.
A diagnosis of cyclothymia can be difficult to receive as it can feel like your experience is not being taken seriously by healthcare professionals. However, cyclothymia can still cause distress to those it affects and should therefore be treated with the same understanding as other types of bipolar disorder.