Bipolar Disorder Symptoms and Traits
Mania, depression, and in-between episodes
Medically reviewed by Dakari Quimby, PhD
Bipolar disorder causes periods of dramatically altered mood, behavior, and energy characterized by manic or hypomanic episodes, which are periods of elevated or irritated mood, and depressive episodes, dips in mood and energy, among other symptoms. How bipolar disorder presents can vary from person to person and can differ significantly between women and men.
This article examines the different types of bipolar disorder, how certain factors—including sex—can influence symptoms, and ways to manage the condition.
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Sex & Gender
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as its sources use them.
Types of Bipolar Disorder Symptoms
When diagnosing bipolar disorder, healthcare providers categorize bipolar disorder cases into three major types:
Bipolar 1
Bipolar 2
Cyclothymic
Each type causes mood episodes; however, each has unique characteristics.
Bipolar 1
When screening for bipolar 1, a healthcare provider will ask if you’ve experienced at least one manic episode a week or more, during which your energy and mood were elevated most of the time for most days, or if the symptoms led to hospitalization. To be diagnosed, symptoms must not be substance induced. During periods of mania, you may:
Become irritable or agitated
Engage in more activities or riskier behaviors than usual
Experience hallucinations, false beliefs, or delusions (in rare and severe cases)
Experience inflated self-esteem or grandiosity
Feel elated, like the “center of the world,” or abnormally giddy
Have rapid and uncontrolled thoughts or talk without staying on topic
Not require as much sleep or sleep less without feeling tired
Bipolar may also cause hypomanic episodes, which are less severe manic episodes that typically don’t last as long. They’re defined as at least four days of more moderate but disruptive symptoms.
Sometimes—but not always—bipolar 1 also causes depressive episodes in which everything feels “low.” Depressive episodes are characterized by symptoms lasting the majority of the day, most days for 14 days; signs include:
Difficulty falling asleep, getting up earlier than usual, or sleeping more than usual
Feelings of sadness; depressed mood
Feelings of worthlessness or hopelessness
Forgetfulness, talking slowly, or forgetting what you want to say
Inability to concentrate
Lack of energy
Lack of motivation; loss of interest in activities
Thoughts of death or suicide
In addition, bipolar 1 causes periods of no symptoms (euthymic episodes) as well as “mixed” episodes. As the name suggests, the latter are periods in which you have both depressive and manic symptoms. Some also experience “rapid cycling,” which is defined as having four or more mood episodes within a year.
Bipolar 2
Healthcare providers diagnose bipolar 2 disorder when you have at least one hypomanic episode and one depressive episode. Between these, people return to their baseline mood, behavior, and functions.
Manic episodes aren’t a feature, but the condition causes significant impacts on your social, personal, and professional life. Substance abuse problems are more prevalent with bipolar 2 disorder. As with bipolar 1, some experience rapid cycling.
Cyclothymic
When you have cyclothymic disorder, you experience frequent and rapid shifts between periods of hypomanic and depressive-like symptoms. Though these mood swings are dramatic, the symptoms are milder and don’t fulfill the criteria for full-blown mood episodes. To be diagnosed, your mood episodes must occur more than half the time over the course of two or more years without ever stopping for more than two months at a time.
Comorbid Conditions and Bipolar Symptoms
Certain mental health conditions are more likely to arise if you have bipolar disorder. These comorbidities (co-occurring conditions) include:
Generalized anxiety disorder or panic disorder
Eating, drug, or alcohol use disorders
These conditions worsen mood episode symptoms, which can also trigger them.
Bipolar Disorder Symptom Differences
Certain health conditions and lifestyle factors can influence the severity of bipolar disorder symptoms. They can trigger mood episodes, make them more severe, and get in the way of treatment. The most common of these include:
Personal trauma: Traumatic life events, such as a divorce, child abuse, loss of a loved one, or financial problems can trigger or worsen bipolar episodes.
Stress: Negative stress worsens symptoms and leads to shorter symptom-free periods.
Sleep disruptions: Though sleep disruptions are features of bipolar disorder, insufficient sleep or interruptions to your sleeping patterns can also trigger or worsen symptoms.
Substance use disorder: Substance use disorder (SUD) often accompanies bipolar disorder (especially bipolar 2). It can also aggravate symptoms and contribute to manic, hypomanic, and depressive episodes.
Hormonal shifts: Changes in estrogen can influence this disorder in women, triggering or worsening mood during your menstrual cycle, postnatal period (after childbirth), and menopause.
Thyroid disorders: Underactive thyroid (hypothyroidism) can cause more severe depressive symptoms and trigger manic episodes.
Weather changes: Season or weather changes can impact bipolar disorder, and many cases are comorbid with seasonal affective disorder (SAD).
Mental health conditions: Anxiety and substance use disorder—which often occur together—can also make symptoms more severe, hinder treatment, and increase the chances of thinking about suicide.
Health conditions: Obesity, type 2 diabetes, migraine, and cardiovascular diseases also often arise alongside bipolar disorder and can worsen some cases.
Men vs. Women
How bipolar disorder presents can also vary based on the sex assigned at birth. In a study of adults with bipolar 1, women were more likely to experience depressive episodes, whereas men were more likely to have manic episodes.
Other studies found that men had higher rates of rapid cycling and suicidal thoughts. As a result, bipolar disorder in women is more likely to be misdiagnosed as clinical depression.
Teens vs. Adults
There also are differences in how bipolar disorder presents based on age. In most cases, symptom onset occurs between 15 and 25. Though teenagers and adults can have manic, hypomanic, or depressive episodes, there are some differences in how these present.
In a wide-ranging review of the literature, researchers found adolescents are more likely to experience irritability and aggression—rather than giddiness—during manic or hypomanic episodes. In addition, children and teenagers are more likely to experience rapid cycling. Some studies found teenagers were more likely to have depressive episodes as the first sign of bipolar disorder.
Bipolar Disorder Traits and Signs in Other People
If your loved one has bipolar disorder—or if you suspect they do—it’s important to understand the signs someone else is having a mood episode.
Signs of Manic Episodes in Others
There are several signs that someone is having a manic or hypomanic episode. Traits that may be signs in others include:
The person is unusually energetic, giddy, irritable, or cranky.
The person talks faster than usual and changes topics more often.
The person has an abnormally high appetite for food, sex, gambling, substances, alcohol, or other pleasurable activities.
The person exhibits erratic or unusual behavior.
Signs of Depressive Episodes in Others
If someone is having a depressive episode, signs you may recognize include:
The person has reduced their level of activity or displays a loss of interest in their favorite activities.
The person withdraws from family or social events.
The person speaks or moves more slowly or lacks focus on their tasks.
The person eats less and experiences noticeable weight changes.
The person has angry outbursts.
The person forgets things more frequently or cannot perform daily tasks.
The person regularly engages in negative self-talk, mentioning feelings of worthlessness or wanting to self-harm or commit suicide.
When to Call 911
If you or a loved one experiences suicidal thoughts, thoughts about hurting themself or others, hallucinations, delusions, or lithium toxicity symptoms, call 911. Lithium toxicity symptoms include nausea, vomiting, dizziness, vision changes, slurred speech, and tremors, among others.
Managing Bipolar Disorder Symptoms
Managing bipolar disorder symptoms can involve medications, psychotherapy and counseling, and lifestyle changes. Because bipolar disorder is a lifelong condition—and because of the risk of medication side effects—the condition requires consistent monitoring.
Medications
Several medications help with both manic and depressive episodes of bipolar disorder and are the frontline treatment option. Healthcare providers prescribe mood stabilizers such as lithium or Depakote (valproic acid) or some atypical antipsychotics such as Seroquel (quetiapine) and Risperdal (risperidone) for manic episodes.
Healthcare providers treat depressive episodes associated with bipolar disorder with combination therapies—often Depakote, lithium, and Seroquel. Your provider may also prescribe selective serotonin reuptake inhibitors (SSRIs) or another antidepressant, Wellbutrin (bupropion), alongside mood stabilizers. These should be taken with caution because SSRIs can worsen manic symptoms or lead to rapid cycling in folks with bipolar disorder.
Depending on any co-occurring conditions, you may be prescribed medications for comorbid sleep problems and anxiety.
Psychotherapy
Your primary healthcare provider may recommend that you (or your loved one) meet with a psychiatrist, psychologist, or mental health counselor for therapy alongside any medication. In psychoeducation therapy, you work with a therapist to learn how to identify, prevent, and treat triggers or factors that make mood episodes worse. Cognitive behavioral therapy involves developing strategies to change your relationship to your condition and cope.
Electroconvulsive Therapy
In rare and severe cases, healthcare providers consider electroconvulsive therapy. In this therapy, electrical shocks delivered to the brain create a kind of controlled seizure. This eases the symptoms of both depressive and manic episodes.
Lifestyle Changes
Specific lifestyle changes are an additional means of managing triggers and symptom severity. These include:
Adopting a healthy diet rich in nutrients from fresh vegetables and healthy proteins and low in added sugars and salts
Regular exercise, which improves sleep and eases stress
Relaxation activities, like meditation or yoga
Quitting alcohol or avoiding recreational drug use
Understanding and logging your or your loved one’s symptoms, medications, and potential side effects
Summary
Bipolar disorder causes prolonged periods of altered mood, energy, and behavior, known as mood episodes. These are either manic, in which mood and energy are elevated; depressive, marked by sadness and loss of motivation; or mixed, showing attributes of both. The severity and character of bipolar disorder symptoms depend on the type you have and health and personal factors. Treatments for this condition range from medications and therapy to lifestyle changes.
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