One of my best friends from childhood, Jenny, describes her bipolar disorder like being on a swing.
She tells me that during her manic episodes she feels like she’s on the swing going as high as she can go and then the metal latches just release her to the sky flying upward with no end in sight. She describes that the resulting depression feels like a quick downward force pulling her down, back onto the latches, and then deep into the ground beneath the earth. She gets stuck there.
As many as 5.7 million U.S. adults – the same amount as Colorado’s entire population – are living with bipolar disorder.
Chances are, if you are reading this, like me there someone in your life that has been diagnosed with bipolar disorder. As a mental health practitioner committed to deepening and visibilizing an understanding of this diagnosis,, I am sharing facts and real reflections from people with bipolar disorder. Names are changed for privacy, including above.
What is bipolar disorder?
Bipolar disorder is a mood or affective disorder meaning that a person’s emotional state or mood is distorted or inconsistent with life circumstances.
Bipolar disorder causes dramatic shifts in a person’s mood, energy and ability to think clearly. People with bipolar experience high and low moods—known as mania and depression—which differ from the typical ups-and-downs most people experience. The average age of onset is about 25, but it can occur in the teens, or more uncommonly, in childhood.
Types of Bipolar Disorder
Bipolar I Disorder, Bipolar II Disorder, Cyclothmic Disorder, or Bipolar unspecified.
To be diagnosed, a person must have experienced at least one episode of mania or hypomania. Mental health care professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the “type” of bipolar disorder a person may be experiencing. We assess the pattern of symptoms and how impaired the person is during their most severe episodes.
How Does Bipolar Feel?
There is not one answer. Everyone’s experience with bipolar disorder is different, and the signs and symptoms vary. Many people undergo distinct periods of stability, mania, and depression. Others can feel both depressed and manic at the same time—simultaneously feeling very sad and energized.
What are the Signs and Symptoms?
Mania and Depression
Mania is defined by an elevated state of mood which is a change from the usual self and can typically be noticed by others. Symptoms include feelings of invincibility, lack of sleep, racing thoughts and ideas, rapid talking and having false beliefs or perceptions.
Sara, a 32-year-old with bipolar disorder described, “Being manic is like having five minds functioning at once. I feel like I have no control and also simultaneously love relinquishing control.” For Sara becoming hyper fixated on a tasks like cooking, cleaning, working on her TikTok page caused her to lose sleep for days.
A manic episode may include these symptoms:
- Intense feelings of euphoria, excitement, or happiness
- Appearing abnormally jumpy or wired
- Having excessive energy
- Insomnia or restlessness (a decreased need for sleep)
- Speaking fast or being unusually talkative
- Having racing or jumbled thoughts
- Inflated self-esteem
- Doing impulsive, uncharacteristic, or risky things like having unsafe sex or spending a lot of money
- Increased agitation and irritability
For many, the manic cycle of bipolar disorder is what defines the illness. Indeed, what distinguishes it from depression is those defining moments of mania.
Still, it is the depression that will often dominate and disrupt life – it lasts longer and occurs more frequently. A study at the University of California published in the Archives of General Psychiatry found that people with bipolar I experience depression three times as often as mania. For bipolar II disorder, the astounding ratio of time spent in depression versus mania is 40:1.
Dan, a 27-year-old, share about the depressive episodes she experiences that, “I was so debilitated that I would feel physically stuck in bed for days, catatonic, unable to move… I would commit to a week of plans before my depression and then cancel all of them.”
A depressive episode may include these symptoms:
- Feeling down, sad, worried, worthless, anxious, guilty, empty, or hopeless
- Lack of interest, or no interest, in activities
- Feeling tired, low energy
- Difficulty concentrating
- Changes in sleep, either sleeping too much or too little
- Changes in appetite, either eating too much or too little
- Thoughts of death and/or suicide
People with bipolar disorder also experience high suicide rates — up to 19% of those with bipolar disorder die by suicide and up to 50% make a non-fatal suicide attempt. Suicide risk is strongly associated with depressive phases (NAMI, 2023). If you or a loved one is need of someone to talk to, please call or text the national suicide hotline at 988. If you or a loved one are in immediate danger call 911 or go to your nearest hospital.
Because bipolar and major depressive disorder or depression can seem similar, psychiatrists have to take into account family histories and ask patients if they have ever experienced symptoms of mania or hypomania. Treating only depression for someone with bipolar disorder can cause serious harm, including the potential to induce mania.
Cycles of Bipolar
According to Very Well Mind, there is no definitive answer to the duration or frequency of bipolar cycles since they are as varied as the people who experience them. A change or "mood swing" can last for hours, days, weeks, or even months.
Bipolar Disorder and Relationships
One of the most difficult aspects of bipolar disorder is that it precipitates feelings of being unlovable, hinders the ability to give love, and sometimes causes destruction. Experiencing bipolar symptoms simultaneously is the moment when the most comfort and love is needed. It’s impossible to do everything right with a loved one experiencing bipolar disorder, but there are some stand out repetitive themes around “the don’ts of supporting those with bipolar disorder”.
Here are the top three:
- Do not manage care. The biggest and most consistent request from people with bipolar is to maintain boundaries between loved ones and their own medical management. Sara shared, “I do not want you to ask if I'm taking my meds or when the last time I had therapy… Maintaining the boundary between loved one and medical professional is really important.”
- Do not make someone feel badly for not showing up. Chances are the person you love with bipolar disorder wants to be there. Pressuring them creates more feelings of shame, guilt, and self-loathing. Jenny told me that when people express disappointment when she doesn’t show up “it’s the most gut wrenching don’t of all. I already know I’m a disappointment to myself. To be that for others is a whole other level of self-hatred.”
- Do not define people by their diagnosis. When someone shares that they have been diagnosed with bipolar disorder they are making themselves vulnerable. Be aware of the impact on bringing it up in normal interactions. Dan shared, “Before I was diagnosed, I was always a loud, vibrant, and outgoing person. I was out with some friends and one friend asked if I was having a manic episode. I was completely crushed.”
Living with Bipolar Disorder
Stigma and its twin internalized shame compound the challenges that prevent healing. They are so powerful that more than half of adults with mental illness go untreated. It is entirely possible to live well with bipolar disorder with a team of medical experts, the right medication, living a healthy lifestyle, maintaining a consistent routine, avoiding substance use, minimizing stress, and a reliable support network.
Jenny and I were discussing this article together. I wanted to be able to capture the complexity of bipolar disorder while also providing clarity. Jenny reassured me. She wanted anyone reading to know “if you’re confused by the end of reading this – then it’s the first successful step in understanding what it feels like to be inside of the mind of someone with bipolar disorder”.
Big thank you to her and others who were willing to share their experiences.
Self, What Exactly is Bipolar Disorder?
Gabe Howard + Dr. Nicole Washington, Inside Bipolar:
Psych Central, Fact Sheet:
Very Well Mind, How Often Do People Cycle?
Mind, Supporting Someone with Bipolar Disorder:
[Courses for Family and Friends]
National Alliance on Mental Illness (NAMI), Family to Family Support: https://namicolorado.org/family-support-groups/f2f-family-to-family/