What Does Bipolar Disorder Look Like?

When it comes to diagnosing mood disorders or personality disorders, it’s important to recognize that there is often a great amount of variability in how a particular disorder might manifest. While there are certain symptoms and behaviors that may be common to a diagnosis, such as an inflated sense of self for those with narcissistic personality disorder, some disorders show a great deal of variability in the manifestation of symptoms.

The most defining feature of bipolar disorder is the tendency to experience significant swings in mood, energy, and behavior over the course of time. You may meet someone with this disorder at a point where they are feeling super pumped and on top of the world, but when you see them weeks or months later, they are mired deep in a depressed funk.

It is the “super highs” and manic behavior that define the disorder. If someone exhibits episodes of manic behaviors, which are predominantly accompanied by periods of depression, this is classified as Bipolar I. However, an episode of depression is not necessary in order to diagnose a person with this disorder If the swing between moods include depressive episodes, but the "highs" reflect hypomanic behaviors, not full blown manic episodes, this qualifies as Bipolar II. Cyclothymia is a type of this disorder that is defined by the presence of symptoms of both depression and mania that last for two or more years in adults.

What is it like to have bipolar disorder?

On their “high days,” one client described their mood as feeling “vibrant.” They were a musician and might go on days-long practice binges where their “vibrancy” would keep them alert and their fingers dancing across the keyboard for periods far longer than their peers could handle.

On other days, they would be unable to leave their bedroom, and if questioned, they would describe these days as their “morbid” days. They wouldn’t leave their bed, would forego meals, and would be uncommunicative. Their swings from “vibrant” to “morbid” were exhausting, and until accurately diagnosed, no one could figure out what was going on with them; they felt like this was their “normal.”

Other signs that a person may be struggling with bipolar disorder can include efforts to self-medicate, including substance abuse; difficulty thinking through decisions and issues in a logical, lucid manner; and problems with anxiety. These individuals might also show unexpected reactions to antidepressants, which can trigger manic episodes for them. It can take years before an accurate diagnosis is made, which can lead to significant problems in daily living. Controlling the disorder is the goal; until that happens, the disorder controls the individual.

10 specific types of bipolar disorder

Bipolar disorder can manifest in different ways, such as the following.

Anxious distress: At least two symptoms of anxiety (worry, tenseness, restlessness, etc.) are present during a mood episode.

Mixed features: A mood episode reflects a mixture of both depressive and manic symptoms during the same period.

Rapid cycling: This isn’t a “day/night” type of rapidity but describes episodes that have occurred at least four times in the past year, and individuals experiencing at least one instance where their mood completely switched from stable to depressive or manic or went from one extreme directly to another.

Melancholic features: This is characteristic of severe depression and would include symptoms such as weight loss, lack of interest in activities once found pleasurable, insomnia or early rising, and feelings of overwhelming guilt.

Atypical features: Unexpected symptoms are present, such as oversleeping, overeating, being super sensitive to rejection or criticism, and actually feeling worse during pleasurable activities.

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Mood-congruent psychotic features: This describes the appearance of psychotic features, including delusions and hallucinations, that are clearly reflective of the current mood state.

Mood-incongruent psychotic features: Alternatively, some individuals may exhibit psychotic behaviors or experiences that are incongruent with their mood.

Catatonia: Hallmark symptoms of catatonia include unresponsiveness, muscle rigidity, restless and purposeless movements, and uncommunicativeness.

Peripartum onset: The disorder occurs shortly before or after childbirth; the hormonal changes some women experience can significantly affect mental health.

Seasonal pattern: Symptoms of the disorder may only show up during certain times of the year, typically when there is less daylight, much as seasonal affective disorder (SAD) shows up for some.

What type of therapy works best?

Treating bipolar disorder is a challenging task, and psychotropic medications are generally an important component of care. Lithium has been used in the treatment of bipolar disorder for over 50 years, and recent studies indicate that ketamine might be an effective treatment for this form of depression as well as major depressive disorder. Ketamine infusions have shown great effectiveness in reducing depressive symptoms and reducing suicidal ideation and behavior. It also positively affects work productivity and decreases days missed due to symptoms—important goals for clients trying to manage this disorder and get their lives back on track.

Regarding psychotherapy as a treatment for this disorder, a meta-analysis of the literature (Miklowitz et al., 2021) revealed that cognitive behavioral therapy, family therapy, and psychoeducation contributed positively to treatment outcomes when combined with medication. These forms of therapy are effective when the focus is on learning skills that help the client manage their illness or help families work together towards this goal.

Supporting someone you care about with bipolar disorder

1. Be consistent in your interactions with them, and don’t give up just because they refuse support in one instance. Be patient and continue to show your willingness to be there for them.
2. Help keep them focused on their goals and pay attention to their actions and behaviors. Don’t highlight the disorder as the problem—that’s too big a challenge to address in the moment. If they aren’t eating, encourage them to eat and remind them that it helps them stay healthy. If they are not sleeping, encourage them to get rest to help them feel more in control of their lives. Work on small steps that can have significant positive effects.
3. Let the person you care about know how caring for them is important to you and that it is hard for you when they turn down your offers of support. Let them know it’s hard for you to see them feeling less well than they might.
4. Don’t blame them for the disorder, and don’t vilify the disorder. Focus on ways that the symptoms can be reduced and on the ways in which they can manage their symptoms for a better quality of life and healthier interactions with others.
5. Seek the support you need so that you don’t burn out or grow so resentful of the individual that you can no longer offer them the care that you normally would.