Bipolar Disorder - The Symptoms

Bipolar disorder, also known as manic-depression, is a treatable psychiatric disorder marked by extreme changes in mood, thoughts, behaviors, activity, and sleep. A person with bipolar disorder will experience intense emotional states or “mood episodes,” shifting from mania to depression. The ups and downs experienced by someone with bipolar disorder are very different from the normal ups and downs that most people experience from time to time. These changes in mood can last for hours, days, weeks, or months. In between these extremes, the person’s mood may be normal.

Living with Bipolar Disorder

While each person diagnosed with bipolar disorder experiences the disease in a very personal way, families and society are affected by it as well. People with the illness often have poor social functioning and struggle at their job or school. They can have difficulty holding a job or caring for themselves, so they rely on others for help. In some cases, their symptoms are so severe that they may need to be hospitalized.

Recovery Is Possible

While all of this can sound overwhelming, keep in mind that recovery is possible! A combination of helpful therapies, education in managing one’s illness, and supports to provide assistance and encouragement can lead to fewer symptoms, better relationships with other people, and achievement of meaningful and fulfilling life goals.


Bipolar disorder must be diagnosed by a trained mental health professional. While lab tests can’t diagnose the illness, they can help rule out other conditions that sometimes have similar symptoms, like thyroid dysfunction, brain tumor, and drug use.

To make the diagnosis, a trained mental health professional will conduct a comprehensive interview and pay careful attention to the symptoms, their severity, and how long they have lasted.

Sometimes, individuals with bipolar disorder are misdiagnosed with major depression because they’re more likely to seek help when they’re feeling depressed rather than when they’re feeling manic. That’s why a thorough interview is needed to prevent this misdiagnosis.

Managing Bipolar Disorder Throughout Life

While bipolar disorder is treatable, it’s a chronic illness and the severity of symptoms tend to vary over time. Because of this, it must be carefully managed throughout life. Here are a few statistics about bipolar disorder to keep in mind:

  • Bipolar disorder usually begins in the late teens or early adulthood.
  • More than half of all cases start before the age of 25, although some people experience their first symptoms in childhood or even later in life.
  • More than 90% of individuals who have a single manic episode go on to have recurrent mood episodes.
  • Approximately 60% of manic episodes occur immediately before a major depressive episode.

The Three Types of Bipolar Disorder

Type Defined By… Keep in Mind…
Bipolar I Disorder One or more manic episodes. Although most people with the disorder also have a major depressive episode during the course of their lives, it is not a requirement for the diagnosis.
Bipolar II Disorder At least one hypomanic episode and at least one major depressive episode.  
Cyclothymic Disorder Numerous periods of hypomanic and depressive symptoms over a two-year span without ever meeting criteria for a manic, hypomanic, or depressive episode. These periods of mood disturbance must be present for at least half the time during the two-year period, and the individual cannot be symptom-free for more than two months at a time.


Bipolar Disorder Symptoms:

What is a Manic Episode?

A manic episode is a distinct period time when a person feels extremely happy or extremely irritable with increased energy – to an abnormal extent. This period of abnormal mood must occur most of the day, nearly every day, for at least one week (less if hospitalized).

During this period of time, the person must also experience at least three of the symptoms below (four of the symptoms below if the mood is only irritable).

  • Inflated self-esteem or grandiosity (has a high opinion of self and may be unrealistic about his or her abilities)
  • Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or racing thoughts (has too many thoughts at the same time or rapid speech that jumps from topic to topic)
  • Distractibility (attention is easily drawn to unimportant or irrelevant things)
  • Increased goal-directed activities (e.g., social, sexual, or at work or school) or psychomotor agitation (purposeless non-goal-directed activity)
  • Excessive involvement in activities with a high potential for painful consequences (e.g., shopping sprees, driving recklessly, and unsafe sex)

The mood disturbance and symptoms must be severe enough to interfere with social or work functioning, require hospitalization, or include psychotic features like hallucinations (false perceptions, such as hearing voices) and delusions (false beliefs, such as paranoid delusions).

What is a Hypomanic Episode?

A hypomanic episode is like a manic episode, but this period of abnormal mood must occur most of the day, nearly every day, for at least 4 consecutive days. During this period of time, the person must also experience at least three of the symptoms listed above (four if the mood is only irritable).

Unlike a manic episode, symptoms of a hypomanic episode must not be severe enough to cause impairment in social or work functioning or require hospitalization. Additionally, the individual must not have any psychotic symptoms.

What is a Depressive Episode?

A depressive episode is defined as a distinct period during which an individual abnormally and persistently feels depressed or loses interest or pleasure in most activities. This period of abnormal mood must occur most of the day, nearly every day, for at least two weeks. During this period of time, the person must also experience at least 4 of the symptoms below. The mood disturbance and accompanying symptoms must be severe enough to impair social, work, or other areas of functioning.

  • Significant weight loss when not dieting, weight gain, or a decrease or increase in appetite
  • Insomnia or hypersomnia (difficulty falling asleep or staying asleep, waking early in the morning and not being able to get back to sleep, or sleeping excessively)
  • Psychomotor agitation (e.g., inability to sit still or pacing) or psychomotor retardation (e.g., slowed speech, thinking, and body movements)
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate or indecisiveness
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a specific plan for committing suicide, or a suicide attempt

Other Common Symptoms

There are other psychiatric symptoms that people with bipolar disorder may experience.

  • Anxiety
  • Bodily aches and pains (instead of feelings of sadness)
  • Psychotic symptoms (which usually disappear when the symptoms of bipolar disorder have been controlled):
    • Hallucinations (false perceptions, such as hearing voices)
    • Delusions (false beliefs, such as paranoid delusions)
  • Suicide, particularly during a depressive episode

Similar Psychiatric Disorders

Depression – People with bipolar disorder often seek treatment for their depressive symptoms rather than their manic symptoms. This can result in a misdiagnosis of major depression. Major depression can be distinguished from bipolar disorder by the absence of manic episodes.

ADHD – Bipolar disorder shares symptoms with other psychiatric disorders as well. Attention-deficit/hyperactivity disorder (ADHD) can mimic the manic symptoms of bipolar disorder because it is characterized by excessive energy, impulsive behavior, and poor judgment.

Psychotic Disorders – Some individuals have psychotic symptoms when manic, such as the belief that the person is Jesus Christ. These symptoms are similar to those seen in psychotic disorders, such as schizophrenia and schizoaffective disorder. But the symptoms of these disorders differ over time. Individuals with bipolar disorder usually do not experience psychotic symptoms when their mood is stable, while individuals with schizophrenia or schizoaffective disorder experience psychotic symptoms even during periods of stable mood.

Medication and Substance Abuse – Bipolar disorder must also be distinguished from a mood disorder associated with general medical conditions or substance-use, in which mood symptoms are judged to be the direct consequence of alcohol/drug abuse, medication or toxin exposure.

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