Bipolar disorder can be overwhelming. Like any mood disorder, this diagnosis can impact your relationships, your work, and your emotional well-being. But it’s possible to live a full and meaningful life, even with such a serious diagnosis. You can achieve this by finding mental health treatment that meets your unique needs.
About 2.8% of the population is diagnosed with bipolar disorder1 (once called manic-depressive disorder). And 83% of those cases are classified as severe. However, these numbers do not reflect cases that go undiagnosed. This condition is also frequently misdiagnosed as schizophrenia or borderline personality disorder (BPD). And without the proper diagnosis, finding treatment is a challenge.
If you have—or think you may have—bipolar disorder, you can start by learning more about its symptoms. And with that information, you’ll be better equipped to talk to a treatment professional about what to do next.
Bipolar disorder may be caused by a combination of factors.2 You might be genetically predisposed to developing it, even if previous generations of your family were never diagnosed. It may also be related to a neurochemical imbalance. Some experts believe it can be caused or made worse by traumatic experiences.
This diagnosis is characterized by “intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes,” according to the American Psychiatric Association. Bipolar disorder is differentiated from other mood disorders3 based on how long each episode lasts. The term “bipolar” leads some casual observers to believe that the associated mood swings are simply highs and lows. But that’s far from the reality of living with BPD. There are 3 complex mood states associated with this condition:
Although manic episodes4 include an elevated mood, they aren’t necessarily associated with happiness. Instead, this state often includes sleeplessness, anxiety, irritability, and disproportionate anger. It can also cause impulsivity, which may lead to excessive spending, promiscuity, or substance misuse.
Depressive episodes mimic the symptoms of major depression. Those symptoms may include fatigue, oversleeping, trouble concentrating, over- or undereating, and suicidal ideation. It is a common misconception that depression is simply extreme sadness. Although patients may feel sad during episodes of bipolar depression, they may also feel numb or disconnected from the world around them.
To qualify for a diagnosis of bipolar disorder,5 the “depressive symptoms that obstruct a person’s ability to function must be present nearly every day for a period of at least two weeks.” These symptoms may last longer than 2 weeks, but over time they must be interspersed with other emotional states, including mania, hypomania, and/or periods of a normal mood. If those swings are not present, the patient may instead be showing signs of major depression.
Patients with bipolar disorder are also prone to a 3rd emotional state: hypomania. This mood is often characterized as a less severe version of classic mania. Patients still show energy, impulsivity, and other signs of mania; however, their symptoms are less overwhelming. And unlike mania, “hypomania does not cause a major deficit in social or occupational functioning.”6 By definition, it lasts for at least 4 days, whereas mania lasts for at least a week.
Based on the frequency and severity of the patient’s mood states, bipolar disorder may be classified in 1 of 3 ways. This classification helps determine which type of treatment is most appropriate.
Patients with this condition also experience depressive episodes that may last for weeks at a time. In extreme cases, hospitalization can be necessary.
Bipolar I patients may also experience episodes of psychosis, in which they lose touch with present reality. With bipolar psychosis, “symptoms tend to match a person’s mood. During a manic phase, they may believe they have special powers. This type of psychosis can lead to reckless or dangerous behavior.” Partly because of this symptom, bipolar I is considered more severe than bipolar II.
Bipolar disorder II7 is more often associated with depressive episodes than mania. Patients with this condition experience similar swings, but their mania is both less severe and less frequent. Some experience depressive episodes interspersed with hypomanic episodes, without ever showing symptoms of mania.
Patients with cyclothymic disorder (or cyclothymia)8 also cycle between depression and hypomania. However, this condition includes less severe symptoms than other forms of bipolar. It can also take much longer to get an accurate diagnosis. Patients must experience mood swings for at least 2 years, without ever meeting the exact criteria for bipolar I or bipolar II.
It’s important to remember that bipolar disorder is a medical diagnosis, and not a reflection of a person’s character. Like any other diagnosis—from diabetes to depression—it can have a huge impact on your ability to function. And in addition, the events of your life may make symptoms more or less severe. Patients may have difficulty navigating regular activities as a result of this condition.
Trauma is linked to the development of many psychiatric conditions, including depression, anxiety, and a number of mood disorders. Bipolar is no exception. Experts agree that “childhood trauma in all its subcomponents appears to be highly associated” with BPD.9
After developing the diagnosis, various life events may bring on severe mood swings. Both traumatic events and extremely positive experiences may be risk factors for bipolar mood swings.10 Research has found that “bipolar patients are highly sensitive to reward, and excessive goal pursuit after goal-attainment events may be one pathway to mania. Negative life events predict depressive symptoms, as do levels of familial expressed emotion.”
When even positive events can trigger your symptoms, it may be difficult to maintain an upward trajectory. For that reason, bipolar disorder interferes with some patients’ ability to work.
One study on the effects of BPD on work performance11 found that “Occupational disability is one of the most problematic impairments for individuals with bipolar disorder due to high rates of unemployment and work impairments. Current evidence indicates that social stressors at work—such as social isolation, conflict with others, and stigmas—are common experiences for employed individuals with bipolar disorder.”
These social stressors can make or break a patient’s success in the workplace. And for people with bipolar, social support is especially impactful throughout the healing process.
Strong relationships are uniquely important for people with this condition. Data suggests that for people with bipolar disorder, social support may be directly linked to the severity and frequency of symptoms.12
According to experts, “empathy and understanding from another person can make it easier to cope with bipolar disorder.13 Social interaction can also provide opportunities to challenge negative ruminative thoughts and prevent the onset of a major mood episode.” A loss of social support, on the other hand, can trigger either mania or depression.
When your diagnosis has such a great impact on so many aspects of life, it can be hard to disentangle your symptoms from normal emotional reactions. And remember, not all healthy reactions are positive. For example, it’s perfectly healthy to experience anxiety if you have to switch jobs. Patients with bipolar disorder may struggle to stay present with that anxiety, instead of tipping into a manic episode. Without support, these challenges can lead to unhealthy coping mechanisms, including addiction.
There is a high prevalence of substance abuse among people with bipolar disorder.14 This may be an attempt to self-medicate by regulating unstable moods, and/or a response to symptomatic impulsivity.15
Also, experts believe there may be “a shared neurobiology between bipolar disorder and addictions.”16 If this is true, it would mean that people with a diagnosis of bipolar are neurologically predisposed to substance use disorders. Much more research is needed on this subject, however.
Because bipolar disorder may be related to neurochemical imbalances,17 substance use of any kind can have a direct impact on your symptoms. That’s true of both addictive behavior and appropriate use of prescription medications. Because of this concern, it’s absolutely vital for patients to find clinicians who have experience with this diagnosis.
If you have both bipolar disorder and a history of addiction, you may benefit from a rehab for co-occurring disorders. These programs address the whole picture of each patient’s diagnoses, rather than treating their symptoms individually.
Bipolar disorder is considered a chronic condition. Once you receive this diagnosis, it will probably continue to apply for the rest of your life. That being said, bipolar can absolutely go into remission, and some patients go for long periods of time between manic, hypomanic, or depressive episodes. With appropriate care and management, you can significantly improve your quality of life.
While there are a number of ways to treat bipolar disorder,18 most patients benefit from a combination of therapy and medication. During treatment, you’ll work closely with your providers to decide which options are best for you. Certain modalities are proven to be extremely effective.
Talk therapy is a powerful way to begin healing from almost any mental health diagnosis. With this approach, you’ll develop a 1-on-1 relationship with a provider. Therapy sessions will take place more often during inpatient treatment—sometimes even daily. Outside of rehab, it’s more common for patients to meet with their therapists once a week. However, your specific therapist may suggest you see each other either more or less often.
This modality allows patients to work through difficult feelings in a safe context. Therapy can work as a release valve, in which you can express extreme feelings without jeopardizing other relationships. It’s your therapist’s job to hold space for you, no matter what you think or how you feel. You can safely and ethically set aside any concern that they’ll judge you negatively for having mood swings.
Research has demonstrated that therapy is extremely important for people with this condition. Experts write that “psychotherapy, when added to medication for the treatment of bipolar disorder,19 consistently shows advantages over medication alone as a treatment for bipolar disorder. There are many different types of psychotherapy. If you attend an inpatient program, the team at your facility will help you choose which modality best suits your needs.
Cognitive behavioral therapy (CBT) teaches you how to change your thought patterns20 using practical, repeatable strategies. For example, you might learn to recognize when you’re having a disproportionate emotional reaction. In those moments, CBT skills can help you ground yourself in the present moment, and respond from a calmer place.
Data suggests that this type of therapy is especially helpful for patients with certain conditions. Specifically, CBT “has a positive impact on patients with bipolar disorder21 in terms of reducing depression levels, improving mania severity, decreasing relapse rates and increasing psychosocial functioning.”
Medication can be hugely beneficial for people with bipolar. Specifically, psychiatrists often prescribe lithium, lamotrigine, or antidepressants like Prozac. Because this condition is thought to be a neurochemical imbalance, these treatments may be necessary even if talk therapy proves helpful.
However, it’s also important to consider the relationship between bipolar and substance use disorders. Even with a prescription in hand, some patients may be tempted to fall back into unhealthy patterns. In order to avoid this, it’s extremely important to stay in close communication with your mental health team about your medication use. For some, having access to a prescription of any kind may be a trigger. If that’s the case for you, be sure to ask your therapist about substance-free treatment options.
With extreme emotions, introspection can be difficult. Some patients with bipolar disorder struggle to find clarity, or even to ask for help. If these symptoms resonate with your experience, know that you have the right to reach out. It’s important to get the care you need.
Because bipolar disorder touches on so many aspects of life, it can be difficult to imagine what healing would look like. Remember that, no matter how severe your symptoms may be, no emotion lasts forever. Over time, you can and will feel differently. And, with the right support, you can even feel consistently better. It’s absolutely possible for clients with bipolar to live rich and meaningful lives.
To learn more about your options and take the first step towards healing, see our directory of mental health treatment centers for information including conditions treated, therapies offered, pricing, and more.
Reviewed by Rajnandini Rathod