If you go on the internet, you will get a list of signs and symptoms of bipolar disorder. But to me, these are cold and rigid and far from reality. I will go into them here, but hopefully, add some insights that are not on the lists as I am someone diagnosed with bipolar disorder.
Types of Bipolar Disorder
There are 3 main types:
- Bipolar 1
- Bipolar 2
- Cyclothymia.
Commonly, people assume that bipolar 1 is more serious than bipolar 2, but in fact, this is misleading. Those diagnosed with bipolar 2 are just as likely as those with Bipolar 1 to attempt suicide 1. However, the diagnosis is based on the manic episodes, not the depression, and these are more serious in people diagnosed with bipolar 1. Technically, you only need to have one episode of mania for a diagnosis, but in reality, it is something that often occurs more than once.
Bipolar 1
People with bipolar 1 typically experience severe mania, with euphoria (not just very happy), speediness in thoughts, words and actions, and often so-called “delusions of grandeur”. These are episodes of beliefs that the person is very important, can do almost impossible (or actually impossible) things. What’s more, the person will act on these beliefs.
Less common, but relevant, are episodes of hallucinations. The thoughts are so fast that the person themselves can find it impossible to keep up and speech becomes like a rapid-firing machine gun. Often the thoughts are so fast, the person can’t finish sentences, only speaks in words and will jump from subject to subject rapidly. Anything and everything will distract the person.
Unfortunately, people in this state can get utterly frustrated with all around them who aren’t following their thoughts, aren’t believing their beliefs, and this can turn into rages against others. This anger can lead to terrible problems with those around them, long after the mania has stopped, as family and friends can be utterly devastated. Telling a person to calm down is probably the one things NOT to do. It is best to try to avoid reacting – but that is very, very hard.
Spending money like there is no tomorrow
Along with these problems, a person can also spend money like water, landing themselves and their families into debt and surrounded by a random array of objects, or investments that are rarely going to be of any use.
My husband would take away all my cards, despite my anger at this, and limit the amount of access to money I had.
Hypersexuality
Hypersexuality is arguably one of the worst aspects of bipolar. A person who, in an ordinary state, would never think of indulging in sex with strangers or anyone outside of their relationships, suddenly finds they have had sex in all kinds of places and ways that can be highly dangerous or unbelievably upsetting and embarrassing afterwards.
How to react when someone you know experiences mania
Sometimes, people in mania do things that sound very amusing to others – but often, they are not like that to the person with bipolar, once they come back down. Events can be embarrassing and cause people to withdraw in shame afterwards. It is wise, if possible, not to laugh in front of the person at these events or be very sensitive to their feelings once the mania has passed.
Typically in this state, people sleep very little for days on end, and the textbooks talk of having to have this state for two weeks non-stop to qualify as mania. However, in my experience, it can last for shorter periods, having just as devastating an effect on the person and the relatives/friends. This lack of sleep acts like a motor driving the mania on, causing more and more psychotic symptoms.
The Crash
Eventually, the Crash will happen. Exhaustion, lack of sleep, and sudden awareness of all that has happened will occur. The swing into depression can be sudden and dramatic. Most depression occurs as a gradual process, a person getting lower and lower. In bipolar, it can be like that. But often is a rapid descent. For many of the above reasons, this depression is very dangerous, as shame, anxiety, and despair hit hard. It is at this time that suicidal thoughts can occur strongly, and self-harm is fairly common. Self-harm can be substance abuse as well as direct harm to the body.
Bipolar 2
People with bipolar 2 have much of the above, but it’s a lower-level mania (“hypomania”). During this time, they can be more productive and have lots of good ideas, but often this period doesn’t last and the more destructive aspects can assert.
There is a state called a Mixed State, and this is very dangerous. The high mood, in this case, can lead to a lack of inhibition of mania, but with all the feelings of depression. This can lead to an impulsive suicide attempt. Therefore, you should take any suspicion that someone close to you experiences a mixed state very seriously.
As I said before, the depression in bipolar 2 is often frequent and severe. Some people with bipolar 1 never experience depression at all, but all people with bipolar 2 do. There is a misconception that people with bipolar 2 don’t get psychotic symptoms but this just isn’t true. Hallucinations and delusions can happen, almost always in the depressive aspect.
Cyclothymia
Cyclothymia is milder than the above symptoms but is still debilitating to the individual. It causes a sense of being out of control of their lives and the swings can still be dangerous, especially the depressions.
Treatments for Bipolar Disorder
Medications
Treatments usually start with medications: mood stabilisers, sometimes antidepressants and antipsychotics.
Antipsychotics aren’t only used for psychosis, but as they are major tranquilisers, they are used to calm the person. Antidepressants should never be used alone as they can easily precipitate a manic episode. Hospital admissions are common, at least once, but with help, these can be minimised.
Talking therapies and mindfulness
In addition to medication, many people diagnosed with bipolar can respond to talking therapies, and/or behavioural types such as CBT or DBT, psychodynamic and others. DBT (Dialectical Behavioural Therapy) was created originally for people with Borderline Personality Disorder. But the emphasis on behavioural changes and validation of emotions and sense of self can be highly effective.
Some people with bipolar have found that a structured life of Mindfulness and a careful diet means they can live on no medications or lower dosages. But this takes a lot of discipline and commitment. I have found medications debilitating at times, as do many people diagnosed with bipolar. So I am trying DBT to help me have the skills to manage my condition.
Problems with medications
Understanding is needed with people not taking medications, as medication can lead to a person not feeling alive and feeling worse. Relatives and friends tend to concentrate on the person taking meds non-stop and nag them, and this is understandable given the extremes of reactions of bipolar. But, some antidepressants and most antipsychotics cause a lot of weight gain and diabetes and can make the person feel like a zombie, so you need to take this into account.
How to help a person with bipolar
A lot of understanding and love is required in helping a person who is diagnosed with this form of mental distress.
Learn about and encourage mindfulness – sometimes this can help all people in a family to manage better. Mood diaries are also something often used and encouraging the person to monitor their moods can give clues when they are beginning to tip over.
Another very positive thing is to try to identify triggers and validate the early signs in the person. Something which might not bother you might be the trigger for a person to become stressed. For example, stressful events are often a trigger.
It’s not all doom and gloom
It’s not all doom and gloom. Some people manage med-free, some manage with meds and therapy and more are learning to manage more with mindfulness. It is not true that a person is necessarily bipolar for life. There may be very long times, even years, when a person has no signs. All the above list of signs sounds terrible, but most people don’t have all those reactions to distress.
Further Reading
- “Bipolar Disorder for Dummies” – Reasonable start but be critical in reading it.
- “Bipolar Disorder, the Ultimate Guide” by Sarah Owen and Amanda Saunders – really good insights and written by women who have both had family members living with bipolar.
- “Mindfulness for Dummies” – another good starter book.
- “Emotional Hijacking” by Marlene Schneider Potter
This article was written by Calypso, a member of the Mental Health Forum Staff Team.
Talk about Bipolar Disorder
Next review due: 19 June 2024
Sources of Information
- Novick, D. M., Swartz, H. A., & Frank, E. (2010). Suicide attempts in bipolar I and bipolar II disorder: a review and meta-analysis of the evidence. Bipolar disorders, 12(1), 1–9. https://doi.org/10.1111/j.1399-5618.2009.00786.x[↩]