By Dina Cagliostro, PhD and Jennifer Nelson
Like the name suggests, bipolar disorder is marked by polar opposite mood swings—at one point, you feel like you can conquer anything; at another, you can barely get your butt out of bed.
Once called manic depression, bipolar disorder affects up to 5.7 million adults. It impacts both men and women equally and the typical onset of symptoms usually occurs between ages 15-25. Of course, those years are notoriously emotional ones—first loves, college, new careers!
Like many mental disorders, bipolar illness is genetic and tends to run in families, meaning oftentimes, one or more family members also have a form of bipolar disorder. (It’s important to note that the illness can start in early childhood or as late as the 40s-50s.)
Types of Bipolar Disorder
Three of the most common types and each defined by their own symptoms and episodes include Bipolar I disorder, Bipolar II disorder, and Cyclothymic disorder. Here’s what you need to know.
1. Bipolar 1 Disorder. Bipolar I is characterized by the occurrence of at least one manic episode, preceded or followed by a hypomanic or major depressive bout lasting at least a week. Manic episodes may be so severe they significantly disrupt your daily functioning or may even trigger a break from reality (psychosis).
People who have a manic episode often describe it as feeling invincible and euphoric. You’ll usually experience three or more symptoms such as inflated self-esteem, decreased sleep, being more talkative, distracted, goal-directed, or idea-driven, or get involved in activities that can have painful or even financial consequences, like spending thousands (you don’t have) on a designer handbag—or five. You may even need hospitalization with bipolar I. The disorder is characterized by the distinct periods of mania and depression.
2. Bipolar 2 Disorder. If you are living with bipolar 2, you’ll likely experience at least one major depressive episode lasting two weeks or more and at least one hypomanic episode lasting at least four days. But you won’t have manic episodes, says Anandhi Narasimhan, MD, a double board-certified staff psychiatrist at Masada Homes in Gardena, California. With bipolar II, episodes of mania are replaced with hypomania, a less severe form of mania, but one that can still impact your daily life. Bipolar II symptoms don’t typically require hospitalization. However, the symptoms may be harder to identify with this type because they’re less severe, prolonging diagnosis and treatment.
3. Cyclothymic Disorder. Cyclothymic disorder is a rarer form of bipolar affecting about 3.29 million people in the U.S. that’s characterized by at least two years of multiple occurrences of hypomania and depressive symptoms. While symptoms are less severe than typical hypomanic episodes and major depressive episodes, they are more chronic.
Symptoms can stay constant for at least two months. People who have cyclothymia are affected by impulsivity and poor decision making, affecting relationships, family, and social life, and they may also experience problems with the law and financial difficulties. Less than half of those with cyclothymia will go on to develop a more severe form of bipolar disorder.
Signs and Symptoms
Before you self-diagnose, remember, we’re not talking about being down in the dumps over a breakup or having a bad day, or being super-happy over a promotion or a new relationship. These are natural highs and lows that everyone experiences. The classic symptoms of bipolar disorder are kind of like being on the steepest roller coaster, where moods dip from the lowest depression to the highest high (mania or hypomania).
When you live with bipolar disorder you can feel energetically happy with boundless energy during manic states. You may make reckless decisions or act impulsively. You can get irritated and agitated easily and act out, you can even feel euphoric, have a decreased need to sleep or insomnia, and have racing thoughts or a grandiose self-image.
You may feel elated, like you just won the lottery, while really, it’s just any old day and you’re slogging through a pile of dirty dishes. Hypomania, which people with bipolar may also experience, is a less severe form of mania, where you generally feel pretty good–with a better sense of well-being and higher productivity.
There’s a laundry list of different symptoms for this manic phase, and they generally center around an elevated or irritable mood. They may include goal-directed activities like staying up all night cleaning obsessively or going on a shopping spree—things you wouldn’t do typically. Manic behaviors may interfere with school, work, and relationships. Specific signs and symptoms include:
- Abnormally talkative. You want to express all these thoughts, so you’re extra chatty and may jump from topic to topic.
- Abnormally upbeat. This isn’t just a normal good mood. We’re talking feeling zippy and energized, even in situations that don’t warrant it, like feeling giddy taking out the trash. It’s like you’re not in charge of your mood or responding to your environment. Instead, you’re just stuck on cheerful mode.
- Cranky and/or impatient. You feel like no one can keep up with you, and it’s frustrating.
- Easily distracted. With all this internal racing going on, it’s nearly impossible to focus.
- Euphoric. This is beyond happy; your excitement and energy are almost uncontained.
- Excess energy. You have all these ideas and energy and start taking on a lot of new projects.
- High sex drive. You’re constantly thinking about and wanting sex.
- Invincibility. Along with this surge of energy and risk-taking, you get a huge boost in self-confidence. Even people who are shy or humble may suddenly seem arrogant and think they can literally do anything.
- Jumpy. You can imagine when you have this kind of energy surge, you feel reactive. Picture electricity zooming through your body.
- Poor decision-making. As you might imagine, a manic episode is not a great time for decision-making. Your emotions are skewed, and your sense of consequence and danger are dulled. It’s a pretty scary combo. You may take risks like making financial investments, engaging in sexual indiscretions, or going on shopping sprees.
- Pressured speech. This is a giveaway sign of a manic episode. It goes along with being talkative and is marked by a stream of talking, without pausing in the normal way you would during conversation. It’s like just bulldozing right through and not allowing the other person to talk, talking over them.
- Psychosis. A detachment from reality that may include delusions or hallucinations.
- Racing thoughts. It’s hard to keep track of everything swirling around in your brain—you have all kinds of ideas, plans, and opinions.
- Unattainable plans. You’re determined to book a trip to Paris— even though you don’t have the funds.
- Wired. People having a manic episode feel like they can stay up all night or don’t need as much sleep.
And here comes the crash. You may feel overwhelming sadness or an urge to cry, experience feelings of hopelessness and worthlessness, and have a negative outlook on life. You may have an increased need to sleep, feel unable to complete daily tasks, and feel deeply demoralized. This isn’t just mild sadness. But for some, it can be debilitating depression that can even lead to suicidal thoughts.
“In the most severe instances of bipolar, psychotic features including hallucinations or delusions can be present during extreme mood events,” says Michael Pipich, MS, LMFT, a psychotherapist and author of Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder.
Specific signs and symptoms include:
- Feeling sad. On a daily basis, you feel empty, hopeless, or tearful.
- Feelings of fatigue. You feel so tired and just want to sleep. (Though insomnia is also a symptom.)
- You can’t picture anything good in the future.
- Inability to concentrate. You lose your focus.
- Maybe it’s because you feel hopeless or ambivalent about everything, but you really can’t make your mind up, even about small things.
- Loss of interest and finding no pleasure or interest in day- to-day activities. This is a classic depression syndrome—things that used to be interesting and fun hold no appeal anymore.
- Low energy. This is the kind of energy drain that makes you just want to lay on the couch or under the covers all day.
- Low motivation. You just don’t feel like doing anything.
- Weight fluctuations. Depending on whether depression zaps or increases your appetite, a person suffering may gain or lose a significant amount of weight.
And just when you think your mood has hit rock bottom, the ride takes you back up to the summit with feelings of euphoria and endless energy. It’s these extreme mood swings that define bipolar disorder. They can occur as frequently as weekly, or, show up more sporadically—maybe just twice a year.
Unlike a predictable monthly cycle or known allergy that triggers a reaction, there’s no defined pattern or predictability to the mood swings—i.e. you can’t plan a job interview or vacation a week from Monday when you’ll be symptom-free. The condition just doesn’t work like that. And, there’s no rhyme or rhythm to which will come first, the depression or the mania or vice versa. What’s more, the length of time you’re in one state or the other can vary, too.