Bipolar disorder, formerly known as manic depression, is a mental health condition that causes extreme shifts in mood, energy, and activity levels. People with bipolar disorder experience alternating episodes of mania and depression. Their behaviors and moods can change drastically during these episodes.
Manic Episodes
During manic episodes, people with bipolar disorder experience elevated or irritable moods and increased energy and activity levels. Common signs and symptoms of mania include:
- Feeling extremely happy, euphoric, or on top of the world
- Increased energy and restlessness
- Racing thoughts and rapid speech
- Decreased need for sleep
- Difficulty concentrating and heightened distractibility
- Impulsive or risky behaviors like reckless spending, impulsive sex, or substance abuse
- Irritability, aggression, or rage
- Excessive optimism, grandiosity, or delusions of grandeur
During a manic episode, a person’s behavior can be extremely energetic and active. They may talk very fast about many different things, sleep very little, and be constantly on the move. Their disorganized, racing thoughts can make them easily distracted. They may take on multiple tasks and projects and struggle to follow through with them.
Manic behaviors also often involve impulsivity and poor judgement. The person may spontaneously quit their job, go on a shopping spree, travel impulsively, engage in risky sex, or abuse drugs and alcohol. They may also become argumentative, hostile, or combative with others.
Hypomanic Episodes
Hypomanic episodes involve similar symptoms as manic episodes, but the changes in mood and behavior are not as extreme. During hypomania, the person may seem very energetic, productive, sociable, and irritable. Unlike mania, hypomania may not impair function greatly. The hypomanic person can often still go about their daily activities.
Some examples of hypomanic behaviors include:
- Taking on new projects
- Being more talkative and sociable
- Decreased need for sleep
- Racing thoughts and intensified focus
- Heightened optimism, creativity, and confidence
- Increased irritability
- Impulsive behaviors and poor judgement
Depressive Episodes
Depressive episodes involve extremely low, sad moods along with low energy and activity levels. Symptoms of bipolar depression can include:
- Depressed, sad mood
- Loss of pleasure and interest in activities
- Significant weight loss or gain
- Sleeping too much or too little
- Fatigue and loss of energy
- Physical or mental agitation
- Feelings of worthlessness and guilt
- Difficulty concentrating
- Suicidal thoughts
During periods of depression, a person with bipolar disorder often withdraws from others and has very low motivation or interest in activities. They may sleep excessively or have trouble getting out of bed. Appetite changes can lead to sudden weight loss or gain.
People in a depressive state often feel worthless or guilty over perceived faults or failures. They may fixate on negative thoughts and express suicidal ideations. In severe cases, they may neglect self-care, miss work or school, or become unable to function without assistance.
Mixed Episodes
In some cases, symptoms of mania and depression can occur at the same time. This is known as a mixed bipolar episode. Signs of mania and depression may alternate rapidly from one moment or one day to the next. The person may feel extremely energized and impulsively active while also experiencing suicidal thoughts or crying spells.
Mixed episodes involve greater mood instability that can lead to more dangerous behaviors like drug abuse, violence to self or others, hospitalization, and suicide attempts. A person in a mixed state may feel very agitated, have racing thoughts, and behave very erratically.
Rapid Cycling
In rapid cycling, a person has 4 or more manic/hypomanic/depressive episodes within a year. This more frequent switching between mood states makes bipolar symptoms more challenging to manage.
Some behaviors seen in rapid cycling bipolar disorder include:
- Frequently changing sleep patterns
- Extreme irritability
- Heightened impulsivity and risky behaviors
- Severe swings in energy and activity levels
- Ongoing difficulty concentrating
How Social Interaction is Affected
Bipolar disorder symptoms can significantly impact a person’s social interactions and relationships in the following ways:
- Mania: During manic episodes, a person may become very talkative, sociable, and outgoing. But their disorganized thoughts, “flight of ideas”, and impulsivity can damage relationships. Irritability and criticism towards others can cause arguments.
- Depression: Social withdrawal and loss of interest during depression can strain relationships. The depressed person may avoid activities with family and friends.
- Unpredictability: Frequent shifts between manic and depressive states make the person’s moods, behaviors, and functional abilities highly unpredictable. This can be confusing and stressful for loved ones.
- Impulsivity: Impulsive behaviors during manic/hypomanic episodes like overspending and substance abuse may have negative impacts on the family.
- Lack of self-awareness: Some people with bipolar have poor insight into their condition. They may deny there is a problem, minimizing its impact on relationships.
Despite the challenges, many people with bipolar disorder can maintain healthy relationships with professional help, medication adherence, healthy lifestyle choices, good communication and planning, and a strong support system.
Common Daily Life Impacts
In addition to impacting moods and behaviors, bipolar disorder can significantly disrupt major areas of daily life, including:
- Work/School: Both manic and depressive episodes may impair the person’s ability to perform their job duties or academic work. Frequent absences can lead to disciplinary action or loss of employment/failure in school.
- Finances: Manic spending sprees, loss of income from missing work, and healthcare costs can cause serious financial strain or even bankruptcy.
- Legal Issues: Shoplifting, violence, drug abuse, traffic violations and other illegal behaviors during manic episodes may lead to arrests and legal consequences.
- Physical Health: Poor self-care during depression, substance abuse, lack of sleep, and stress all impact physical health over time.
- Self-Esteem: The mood swings, inability to meet goals, relationship conflicts, and stigma around mental illness often erode the person’s self-confidence and sense of worth.
Seeking treatment, utilizing social support, avoiding drugs and alcohol, developing a routine, using calendars/reminders, and maintaining healthy habits can help minimize these impacts and improve daily stability.
Suicidal Thoughts and Behaviors
Suicide risk is extremely high among people with bipolar disorder. Warning signs that may indicate heightened risk include:
- Talking about death, dying, or suicide
- Expressing feelings of hopelessness or worthlessness
- Acting recklessly or engaging in risky activities
- Withdrawing from family and friends
- Giving away possessions
- Saying goodbye to loved ones
- Looking for ways to kill oneself
Suicidal ideation is most common during severe depressive episodes. However, research shows that the highest risk for suicide attempts is during mixed states and periods of improvement or transition between episodes. Impulsivity and agitation mixed with poor judgement create a “perfect storm” for suicide risk.
If a suicidal crisis occurs, immediate medical help should be sought, including calling emergency services or driving the person to the ER. Inpatient psychiatric hospitalization may be required to ensure safety and stabilize moods.
Conclusion
Bipolar disorder involves dramatic, unpredictable swings in mood, energy, behavior, and functioning. Manic and depressive episodes each create their own set of characteristic thoughts, emotions, and actions. Mixed states and rapid cycling involve even greater instability.
While bipolar certainly impacts a person’s quality of life, many are able to manage their symptoms and live happily with proper treatment. Key elements include medication, psychotherapy, healthy lifestyle choices, routine/structure, social support, and open communication. With proper care and self-management, it is possible to gain control over bipolar disorder and reduce adverse effects.