Bipolar disorder is a treatable mental health condition marked by extreme changes in mood, thought, energy, and behavior. It is not a character flaw or a sign of personal weakness. Bipolar disorder was previously known as manic depression because a person’s mood can alternate between the “poles” of mania (highs) and depression (lows). These changes in mood, or “mood swings,” can last for hours, days, weeks or months.
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On this page:
- Bipolar Disorder Diagnosis
- Symptoms of Bipolar Disorder
- Mania Screeners
- Risk Factors
- Types of Bipolar Disorder
- Bipolar Disorder in Children
- Bipolar Disorder in Young Adults
- Bipolar Disorder in Older Adults
- Bipolar Disorder Treatment Options
Bipolar Disorder Diagnosis
When people experience symptoms of both mania and depression at the same time, they’re said to be experiencing a mixed state (or mixed mania). They have all of the negative feelings that come with depression, but they also feel agitated, restless and activated, or “wired.” Those individuals who have had a mixed state often describe it as the very worst part of bipolar disorder.
The screeners provided below are confidential assessment tools to explore your mental health and determine whether you should contact a mental health professional.
Symptoms of Bipolar Disorder
Mania: The “Highs” of Bipolar Disorder
Symptoms of mania include
- heightened mood, exaggerated optimism and self-confidence;
- excessive irritability, aggressive behavior;
- decreased need for sleep without experiencing fatigue;
- grandiose thoughts, inflated sense of self-importance;
- racing speech, racing thoughts, flight of ideas;
- impulsiveness, poor judgment, easily distracted;
- reckless behavior; and
- in the most severe cases, delusions and hallucinations.
Depression: The “Lows” of Bipolar Disorder
Symptoms of depression include
- prolonged sadness or unexplained crying spells;
- significant changes in appetite and sleep patterns;
- irritability, anger, worry, agitation, anxiety;
- pessimism, indifference;
- loss of energy, persistent lethargy;
- feelings of guilt, worthlessness;
- inability to concentrate, indecisiveness;
- inability to take pleasure in former interests, social withdrawal;
- unexplained aches and pains; and
- recurring thoughts of death or suicide.
People with bipolar disorder experience bipolar depression (the lows) more often than mania or hypomania (the highs). Bipolar depression is also more likely to be accompanied by suicidal thinking and behavior.
It’s during periods of bipolar depression that most people seek professional help and receive a diagnosis. In fact, most people with bipolar disorder in the outpatient setting are initially seen for—and diagnosed with—unipolar depression. Unfortunately, incorrect treatment for bipolar disorder can actually lead to episodes of mania and other problems, so it’s important monitor your symptoms and follow up with your health care providers.
- Screening for Adult Mania
- Screening for Child/Youth Mania
- Screening for Child/Youth Mania (Parent Version)
While there is no single cause of mood disorders, researchers have identified a number of risk factors that may contribute to an individual experiencing a mood disorder.
These risk factors include:
- Having a family member who lives with a mood disorder or other mental health condition
- Having specific genetics or brain structure
- Experiencing trauma or stressful life events
- Adverse Childhood Experiences (ACEs) such as poverty or abuse
- Excessive use of drugs or alcohol
Types of Bipolar Disorder
There are several types of bipolar disorder. Each kind is defined by the length, frequency, and pattern of episodes of mania and depression. Mood swings that come with bipolar disorder are usually more severe than ordinary mood swings and symptoms can last weeks or months, severely disrupting a person’s life. For example, depression can make a person unable to get out of bed or go to work or mania can cause a person to go for days without sleep.
Bipolar I Disorder
Bipolar I is characterized by one or more episodes of mania or mixed episodes (which is when you experience symptoms of both mania and depression).
Bipolar II Disorder
Bipolar II disorder is diagnosed after one or more major depressive episodes and at least one episode of hypomania, with possible periods of level mood between episodes.
The highs in bipolar II, called hypomanias, are not as high as those in bipolar I (manias). Bipolar II disorder is sometimes misdiagnosed as major depression if episodes of hypomania go unrecognized or unreported. If you have recurring depressions that go away periodically and then return, ask yourself if you also have:
- Had periods (lasting four or more days) when your mood was especially energetic or irritable?
- Were you:
- Feeling abnormally self-confident or social?
- Needing less sleep or more energetic?
- Unusually talkative or hyper?
- Irritable or quick to anger?
- Thinking faster than usual?
- More easily distracted/having trouble concentrating?
- More goal-directed or productive at work, school or home?
- More involved in pleasurable activities, such as spending or sex?
- Did you feel or did others say that you were doing or saying things that were unusual, abnormal or not like your usual self?
If so, talk to your health care provider about these energetic episodes, and find out if they might be hypomania. Getting a correct diagnosis of bipolar II disorder can help you find treatment that may also help lift your depression.
Other Specified Bipolar and Related Disorder (OSBARD)
Previously referred to as Bipolar Disorder-Not Otherwise Specified (BP-NOS), this diagnosis is used when individuals have clear manic and depressive symptoms that wax and wane but do not fit bipolar I, bipolar II, or cyclothymia.
Cyclothymia is a milder form of bipolar disorder characterized by several episodes of hypomania and less severe episodes of depression that alternate for at least two years. The severity of this illness may change over time.
Bipolar disorder with rapid cycling is diagnosed when a person experiences four or more episodes of mania, hypomania, or depressive episodes in any 12-month period. Rapid cycling can occur with any type of bipolar disorder and may be a temporary condition for some people.
Bipolar Disorder in Children and Adolescents
Mania in children often appears as extreme irritability or rage. Children and teens are more likely to have destructive outbursts than to be excited or euphoric. Depression in early life may have symptoms such as headaches, muscle aches, stomachaches or tiredness, frequent absences from school or poor performance in school, talk of or efforts to run away from home, irritability, complaining, unexplained crying, isolation, poor communication and extreme sensitivity to rejection or failure. Other signs of a possible mood disorder are alcohol or substance use and difficulty making or keeping friends.
Young people may also have a continuous, rapid-cycling, irritable and mixed symptom state that may co-occur with disruptive behavior disorders, particularly attention deficit hyperactivity disorder (ADHD) or conduct disorder (CD). Young people may have symptoms of ADHD and CD before having bipolar symptoms.
A child or adolescent who has symptoms of depression along with ADHD-like symptoms that are very severe, with excessive temper outbursts and mood changes, should be evaluated by a psychiatrist or psychologist with experience in bipolar disorder, particularly if there is a family history of the condition. This evaluation is especially important since medications prescribed for ADHD may worsen symptoms of mania.
The Parent and Caregiver Network (PCN), a program of the Depression and Bipolar Support Alliance (DBSA), guides families raising children with mood disorders to the answers, support, and stability they seek.
Bipolar Disorder in Young Adults
The transition to adulthood is challenging. Young adults (18-29 years of age) typically experience many changes such as moving out on their own, finding their first job, and building relationships with significant others. For those living with a mood disorder, this time of life can be particularly difficult. DBSA has specialized resources to help support young adults through these challenges as well as help them connect to other young adults.
Bipolar Disorder in Older Adults
It is uncommon for bipolar disorder to appear for the first time in late life, but some people may have symptoms throughout adulthood and not be diagnosed until later in life. For older adults, it is important to have a complete medical examination, and to discuss all mental health history, family history, and current medications with health care providers. Other illnesses and the medications that treat them may trigger or mimic bipolar disorder symptoms. Older adults may tolerate or metabolize medications at different speeds than younger adults, so they may need different dosages. Talk therapy, group therapy and peer support, including DBSA support groups, can be valuable additions to older adults’ treatment.
Older adults are also encouraged to start support groups for older adults that meet earlier in the day, are accessible to people with disabilities, are closer to people’s homes or meet other special needs.
Bipolar Disorder Treatment Options
As with any treatment or medical procedure, different people will have different responses. DBSA does not endorse or recommend the use of any specific treatment or medication. For advice about specific treatments or medications, consult your healthcare provider.