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Clinical resource

How A Person With Bipolar Thinks

Your depression is more than just a case of "feeling sad." Bipolar depression manifests itself in a variety of ways for various people. It's possible that you're having problems sleeping.

Medically reviewed byDr. Sarah Boss, MD
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Quick Summary

  • Bipolar disorder can involve depressive, manic, hypomanic, or mixed symptoms that affect sleep, energy, concentration, judgment, and daily functioning.
  • Depression, irritability, fear of rejection, and difficulty following conversations may contribute to withdrawal or conflict in close relationships.
  • Loved ones can offer calm, compassionate support, encourage professional assessment and treatment, watch for relapse signs, and protect their own well-being.

Your depression is more than just a case of “feeling sad.” Bipolar depression manifests itself in a variety of ways for various people. It’s possible that you’re having problems sleeping. Alternatively, you may sleep excessively and find it difficult to wake up. Even the tiniest decisions might seem monumental. Suicidal thoughts need prompt professional or crisis support. Call local emergency services if there is immediate danger or inability to stay safe.

Other indications to keep an eye out for include:

  • You don’t seem to be able to enjoy anything.
  • It’s difficult for you to concentrate.
  • You consume either too little or too much food.
  • You’re tired, and your emotions appear to be slow.
  • You have a bad memory.

Diagnosis of bipolar disorder requires clinical assessment of the full episode history. Bipolar I requires a manic episode; depression is not required. Bipolar II requires hypomania and major depression, with no history of mania.

Related: How to fix Bipolar Disorder without Meds

Mania involves a marked change in mood, energy and activity, not ordinary happiness or a brief burst of enthusiasm. Experiences and episode frequency vary.

Hypomania is a milder version of mania. Hypomania does not include psychosis (loss of contact with reality); psychosis during an elevated mood episode indicates mania and requires prompt assessment. This does not mean hypomania can never progress to mania. You may feel terrific and accomplish a lot, but those around you may notice variations in your attitude and level of activity.

A clinician distinguishes mania, hypomania and depression and excludes other causes. Hypomania alone does not establish bipolar I or II.

These signs may occur during mania, but this list is not a diagnostic test:

  • You’re not in a good mood. It may feel fantastic at first, especially if you’ve been depressed. However, it swiftly becomes unpredictable and uncontrollable.
  • Your judgment is completely erroneous. You take a lot of chances. You make poor decisions without considering the consequences. You might, for example, spend money irresponsibly or engage in unsafe sexual behavior.
  • You get irritable and enraged.
  • You’re tense or irritable.
  • You need substantially less sleep without feeling tired, which differs from difficulty sleeping despite wanting rest.
  • You have the impression that your mind is a motorway. You may speak quickly and switch topics, or you may believe you can do too many things at once.

Mania and despair can coexist in some periods. You might, for example, be both hyper-energetic and depressed at the same moment.

Not everyone with bipolar disorder is aware of their condition. There are a multitude of reasons how someone with bipolar disorder may be unaware of it—or may deny having it even if they do. There are some things you may do to aid if you suspect someone you know has untreated bipolar disorder.

It’s comparable to other mental health issues. People with bipolar disorder are frequently diagnosed with something else initially, such as depression or ADHD. Depression commonly occurs in bipolar disorder but is not required for bipolar I; it is required for bipolar II. ADHD can resemble bipolar illness in appearance, especially in children.

When a person is diagnosed with bipolar disorder, it may override any previous diagnoses—or they may have numerous mental health issues at the same time. If you know someone who is being treated for a mental illness but still has bipolar disorder symptoms, it’s worth thinking about what else might be going on.

It is indeed difficult to accept that you have a mental disease. It might be difficult to accept the reality and nature of bipolar disorder even after a person has been diagnosed. Living with a mental illness can be extremely challenging… and bipolar disorder comes with its own set of difficulties. Some people believe that if they deny the diagnosis of “bipolar disorder,” they will be able to escape some of the difficulties. However, ignoring bipolar disorder will not make it go away.

Labels, it turns out, can certainly set you free. Being identified with bipolar disorder gives you a better understanding of what you’re going through. It makes therapy alternatives available to you that can make you feel better. It also places you in great company with lots of other people all throughout the world, who have achieved amazing things.

People who do not understand any better, on the other side, sometimes use the term “bipolar” to define someone who is simply moody. When you’re not an expert, be cautious about imposing labels on others. Encourage your acquaintance to contact a mental health expert who can examine and diagnose them if you suspect they have bipolar illness.

If you have bipolar disorder, you’re probably already aware of the negative effects it can have on a genuine romantic connection. People with bipolar disorder don’t always understand why, and it isn’t always a conscious decision. However, for them, it can be perplexing, hurtful, and unnerving. It’s also perplexing for others around them because if they don’t understand why they’re pushing them away, they won’t either. Bipolar people have a tendency to drive others away for a variety of reasons, and it can also be the result of a series of acts. The following are some of the reasons why:

They believe people do not want them: Depression can make them feel worthless and useless. They don’t see why someone would want to spend some time with them because they think they don’t have anything to contribute or will bring them down. When people introduce them to do activities, they get the impression that it is out of pity or obligation, rather than a genuine want to see us.

They perceive themselves as a drain on others around us, and they push people away because they don’t want to be a burden. They don’t want to share our sorrows with them because they’re afraid it would make their mood worse. When they are in any type of relationship, our lack of energy and self-confidence makes us feel like others are taking on a lot.

Related: Get help from a luxury rehab program

They’re supposed to converse, smile, and laugh despite our lack of energy. They’re expected to participate and join in. When they’re depressed, they have to put on a show for the rest of the world. The artificial facade consumes so much of our energy that it’s sometimes simpler to isolate yourself due to people’s unpredictability. It’s a never-ending loop of deciding what’s worth our time and effort.

They have trouble concentrating: keeping track of talks without getting lost takes a lot of concentration. They don’t want to disappoint anyone, which can make us feel anxious. When they lose track of the discussion, don’t talk enough, or talk too much, they are concerned about appearing dumb or unpleasant.

They are quickly irritated: Due to the overwhelming mood fluctuations they encounter, they have a poor tolerance threshold for things and are easily angry and annoyed. They may lash out at those around us, especially if they do something unexpected or change things abruptly. When they become upset and lash out, it can feel as if they’re driving people away, which adds to the guilt they already feel.

They’re afraid of being hurt: It’s simple to believe that others will tire of us and depart. They can’t leave us if they push them away, and they can’t damage us if they push them away. They have the upper hand, so it’s a lot easier. It can be more tempting to be alone than to be continually concerned about others departing.

They don’t want to disturb others: It might be upsetting for our loved ones to hear how bad they’re feeling, especially if they care about us. Sharing our feelings can be difficult since they don’t want to upset our loved ones. They don’t want to be perceived as pessimists. Suicidal thoughts should be shared promptly with a trusted person and a crisis or mental health professional; immediate danger or inability to stay safe requires emergency help, not isolation. They notice them pondering why they aren’t doing more to assist. Our loved ones may be perplexed as to why they feel the way they do. They don’t want them to be wounded, so they don’t want it to happen.

It’s just easier: To put it another way, it’s sometimes just easier than pretending everything is fine. They decided that isolating and withdrawing was preferable to the alternative.

Bipolar mood episodes vary and do not establish a predictable relationship breakup cycle. Elevated mood does not necessarily mean sound judgment or improved functioning. When they are in a “bad mood,” though, they may miss deadlines, feel anxious, and have self-deprecating thoughts.

Consistency is tough to achieve when thinking in cycles. Mood episodes can strain relationships, but behavior varies; a diagnosis does not excuse hurtful conduct or establish someone’s character. These states of mind don’t remain a defined period of time – some last a long time, while others are fleeting. Her manner of thinking is also influenced by her emotions.

Throughout most of his adolescent years, his moods change dramatically as well. They are full of energy, exceedingly eager, and carry themselves with confidence on some days. On other days, I was fatigued, utterly overwhelmed, and extremely depressed about my situation.

On-again, off-again relationships are not unique to bipolar disorder, and relationship cycling is not a diagnostic feature. New research suggests that couples who split up and then makeup often, a practice known as “relationship cycling,” may be setting themselves up for a lifetime of mental pain.

According to studies, these on-again, off-again relationships might lead to increased melancholy and anxiety. They’re not only limited to sitcom characters, either: An estimated 60% of individuals in the United States have been involved in one or more of these situations. Bipolar disorder does not rule out a stable relationship. Experiences vary, and effective care, communication and support can help. Medications and psychotherapy are two of the most common treatments for bipolar illness. Treatment should address the person’s symptoms, well-being and prevention of future episodes.

It’s difficult to deal with the highs and lows of bipolar disorder, and it’s not only for the individual who has it. Everybody around a person with bipolar disorder is affected by their emotions and behaviors, particularly family members and close friends. It might put a huge strain on your relationships and cause chaos in your home.

You may have to deal with risky behavior, excessive demands, exploding outbursts, and unwise judgments during a manic episode. And once the storm of mania has subsided, it’s usually up to you to deal with the fallout. You might have to pick up the slack for a close one who doesn’t have the stamina to meet tasks at home or at work during depressive periods.

The good news is that with adequate treatment, medication, and support, most people with bipolar disorder can regulate their moods. Your patience, compassion, and understanding can go a long way toward helping your loved one get better. Having somebody to talk to can often make a huge difference in a person’s outlook and motivation.

However, if you disregard your own needs when caring for someone with bipolar disorder, it’s crucial to strike a balance between helping your loved one and taking good care of yourself.

Convincing someone who suffers from bipolar disorder to seek medical attention

Aside from providing emotional support, encouraging and supporting therapy is the greatest method to assist your loved one with bipolar disorder. Often, this is more difficult than it appears. It’s not often simple to encourage persons with bipolar disorder to see a doctor because they have little understanding of their illness. When a loved one is manic, they are in a good mood and are unaware that there is an issue. When someone you care about is depressed, they may notice something is wrong yet feel exhausted to seek treatment.

Should you argue with a bipolar person? No. Don’t argue with your loved one if he or she refuses to consider the likelihood of bipolar disorder. Be aware that the concept may be unsettling to them. Instead, suggest a standard medical checkup or a doctor’s visit for a specific complaint like insomnia, irritability, or fatigue—then call ahead to confidentially inform the doctor of your concerns regarding bipolar disorder.

Some things you could say to help:

  • “Bipolar disorder, like hypertension, is a serious illness. It necessitates medical attention.”
  • “Bipolar disorder is not your fault. You have nothing to do with it. “It’s not your fault.”
  • “It’s possible for you to feel better. There are a variety of treatments available.”
  • “Bipolar disorder frequently becomes worse if it isn’t treated.”

Helping a loved one who is being treated for bipolar disorder

You can assist your family member or friend by becoming a treatment partner if they agree to consult a doctor. Volunteer to be fully involved in your loved one’s wants or needs since your support can make a great impact on their treatment success.

You may help a loved one with bipolar disorder by doing the following:

  • Find doctors and therapists who are competent.
  • Make appointments and stick to them.
  • Give the doctor your thoughts.
  • Keep an eye on your loved one’s emotions.
  • Find out what medications they use.
  • Keep track of your treatment’s progress.
  • Keep an eye out for indicators of relapse.
  • Problems should be reported to the doctor.
  • Motivate your dear one to take medication for bipolar disorder.

Medication is the foundation of bipolar illness treatment, and most patients require it to keep their moods in check and avoid relapse. Despite the fact that medication is required, many persons with bipolar disorder refuse to take it. Some people quit because they feel better, others because of the side effects, and yet others because they love the mania symptoms. People who do not believe they have a problem are more likely to discontinue their medicine.

You may assist your loved ones in staying on track by highlighting the necessity of medicine and ensuring that they follow all prescription instructions to the letter. Urge your loved one to discuss any problematic side effects with their doctor.

Discuss side effects with the prescriber, who can assess whether a medication or dose change is appropriate; do not adjust treatment yourself. Inform your loved one that discontinuing medication suddenly can be risky.

Family tips for dealing with bipolar disorder

Accept the limitations of your loved one. Mood episodes are not simply a matter of willpower, but a diagnosis does not justify abuse or remove your right to safety and boundaries. During a manic episode, they can’t immediately snap out of it or snap out of their depression. Self-control, willpower, or reasoning will not help you overcome sadness or mania. So asking your loved one to “Stop behaving wild” or “Keep a positive attitude” isn’t going to help.

Accept your limitations. You can’t save your loved one who has a long-term bipolar disorder, and you can’t make them accept responsibility for their own recovery. You can offer assistance, but the person with the sickness is ultimately responsible for their own recovery.

Reduce your stress levels. Bipolar disorder is exacerbated by stress, therefore try to find strategies to lessen stress in your loved one’s life. Inquire about how you can assist, and offer to take over some of the person’s responsibilities if necessary. Family stress can be reduced by establishing and sticking to a daily schedule, which includes regular hours for waking up, eating, and going to bed.

Maintain an open line of communication. When it comes to dealing with bipolar disease in the family, open and honest communication is crucial. Share your worries in a compassionate manner, inquire about how your loved one is feeling, and make an effort to fully listen—even if you disagree or don’t understand what’s being said.

Bipolar Disorder

Questions

Frequently Asked Questions

Is Paranoia A Symptom Of Bipolar?
Paranoia, a conviction that the world is full of individuals who are “out to get you,” is one of the psychotic symptoms in bipolar disorder. Paranoia is a significant problem for persons with bipolar disorder, despite the fact that many of us use the term casually in everyday discourse.
Psychosis, including delusions, can occur during severe manic or depressive episodes, but it is not inevitable. New or worsening loss of contact with reality needs prompt assessment; immediate danger requires emergency help.

Editorial evidence

Evidence & sources

Selected clinical guidelines, peer-reviewed research, and public-health sources used in this article.

01StatPearls. (2024). Bipolar disorder. StatPearls Publishing.View source
02Cochrane. (2021). Lithium for acute mania (review).View source
03World Health Organization. (2023). Mental disorders.View source
View all 10 sourcesShow fewer sources
04Substance Abuse and Mental Health Services Administration. (n.d.). FindTreatment.gov.View source
05National Institute of Mental Health. (n.d.). Suicide prevention. U.S. Department of Health and Human Services.View source
06National Institute of Mental Health. (n.d.). Bipolar disorder. U.S. Department of Health and Human Services.View source
07American Psychiatric Association. (n.d.). What is bipolar disorder?View source
08National Health Service. (n.d.). Bipolar disorder.View source
09MedlinePlus. (n.d.). Bipolar disorder. National Library of Medicine.View source
10National Institute for Health and Care Excellence. (2023). Bipolar disorder: Assessment and management.View source
What this includes
01

Clinical context

Clear information is framed around complex and co-occurring presentations.

02

Individual factors

Assessment remains essential because needs and risks differ from person to person.

03

Next steps

A confidential conversation can help clarify the most appropriate route forward.

Not sure where the situation fits?

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Jil Moore
Jil MooreClient Relations Director
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Cynthia NakhleAdmissions Manager

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