What Are the Symptoms and Traits of Bipolar Disorder?

Bipolar disorder is a mental health condition that causes shifts in mood, energy, and activity levels. The shifts can be out of the ordinary or dramatic and range from high and low periods. These changes can make it hard for someone to carry out day-to-day tasks.

If left untreated, bipolar disorder often progresses and greatly affects a person's life. However, proper diagnosis and treatment can help people with bipolar disorder lead healthy, active lives, and better understand themselves.

Here's more about the signs and traits of bipolar disorder.

Types of Bipolar Disorder

There are a few categories of bipolar disorder, known as bipolar spectrum disorders. They differ based on how severe symptoms are and how long they last.

• Bipolar I disorder: Bipolar I disorder entails when a person has manic episodes lasting seven days or more or if they have severe manic symptoms requiring them to go to the hospital. Depressive symptoms may last at least two weeks.
• Bipolar II disorder: This type is similar to bipolar I disorder. The main difference is that manic episodes are less intense, or hypomanic.
• Cyclothymic disorder (cyclothymia): Cycloythmia is a less severe type of bipolar II disorder. The symptoms do not last as long and are not as intense as those in bipolar II disorder. Also, symptoms last at least one year in children and adolescents but at least two years in adults.

At times, a person might have episodes of mood-related symptoms of bipolar disorder that don't quite fit into one of the categories above. This is known as other specified bipolar and related disorder.

Affective Bipolar Disorder Symptoms

Mania

Bipolar disorder consists of episodes of mania and depression. During a manic phase, some people feel extremely "up," elated, irritable, or energized. During a depressive phase, they may feel "down," sad, indifferent, or hopeless.

Hypomania is a less severe form of mania. "Hypomania can be a pretty enjoyable state, really," Carrie Bearden, Ph.D., a professor in the department of Psychiatry and Biobehavioral Sciences at UCLA, told Health.

A person may feel very good and keep up with day-to-day life during a hypomanic episode. They might experience things like:

• An elevated mood
• Lots of energy and creativity
• Euphoria (feeling very happy or excited)

Family and friends may see changes in mood or activity levels as unusual. But the person may not even feel anything is wrong while in a hypomanic state.

Depression

If someone has depression as part of bipolar disorder, they may seem and feel just like someone with chronic depression. "They have the same problems with energy, appetite, sleep, and focus as others who have 'plain old depression,'" Don Malone, MD, President of Ohio Hospitals and Family Health Centers at Cleveland Clinic in Ohio, told Health.

Irritability

Sometimes people have both manic and depressive symptoms in the same episode. This is a state called "mixed mania." During this state, people may be highly irritable, as well as:

• Sad
• Empty
• Hopeless
• Energized

"We are all irritable or moody sometimes," said Bearden. "But in people with bipolar disorder, it often becomes so severe that it interferes with their relationships—especially if the person is saying, 'I don't know why I'm so irritable…I can't control it.'"

Behavioral Bipolar Disorder Symptoms

Erratic Behaviors

When they are in a manic phase, people with bipolar disorder can have inflated self-esteem. "They feel grandiose and don't consider consequences; everything sounds good to them," said Dr. Malone.

Common types of erratic behavior are spending sprees, unusual sexual behavior, and eating or drinking too much.

"I have had a number of patients who have had affairs who never would have done that if they weren't in a manic episode…during this episode, they exhibited behavior that is not consistent with what they would do normally," said Dr. Malone.

Inability To Complete Tasks

People experiencing a manic episode of bipolar disorder may think they can do many things at once. People who can harness their energy when in a hypomanic phase can be productive.

Others often go from task to task, planning grand, unrealistic projects that are never finished before moving on to something else.

By contrast, during a depressive episode, people with bipolar disorder may feel unable to do simple things.

"They can be quite distractible and may start a million things and never finish them," said Don Malone, MD, President of Ohio Hospitals and Family Health Centers at Cleveland Clinic in Ohio.

Trouble at Work

People with bipolar disorder often have difficulty in the workplace because so many symptoms can affect their ability to show up for work, do their job, and interact effectively with others.

According to one study, 81% of individuals with mood disorders experienced bullying at work. The study also noted that employed individuals with bipolar disorder reported:

• A hard time getting along with others
• Social isolation from others at work
• Exposure to stigma

Basically, a lot of workplace problems can be interpersonal ones, said Dr. Malone.

Alcohol and Drug Misuse

Some people with bipolar disorder also have problems with substance use. This is particularly the case with alcohol use, said Bearden. For example, one study published in 2021 said that the likelihood of someone having either bipolar I or bipolar II disorder and alcohol use disorder is 40-70%.

Many people will drink when they are in a manic phase to slow themselves down and use alcohol to improve their mood when they are depressed.

Issues With Sex Life

Bipolar disorder can have a negative impact on an individual's sex life, particularly with regard to risky sexual behavior.

A 2019 study noted that people with bipolar disorder are highly vulnerable to risky sexual behaviors (RSBs). RSBs are defined as:

• Having two or more sexual partners
• Having unprotected (condomless) sex
• Having sex after alcohol consumption
• Exchanging money for sex in the previous 12 months

The 2019 study authors found almost half of the participants with bipolar disorder reported risky sexual behavior.

Another study found that participants with bipolar disorder had more partners in the last year. These individuals were also more likely to have had sex without condoms compared to participants without bipolar disorder. Also, compared to women with bipolar disorder, men with bipolar disorder had more sex partners and had more sex with strangers.

According to Paul Hokemeyer, Ph.D., psychotherapist and author of "Fragile Power," individuals with bipolar disorder may also do the opposite and altogether avoid sex.

Rapid Speech

Rapid speech, known as pressured speech, is one of the most common symptoms of bipolar disorder. This kind of speech is fast, continuous, and hard to interrupt. Speech in depression is often slower and softer.

Rapid speech occurs when someone is really not in a two-way conversation, said Bearden. The person will talk quickly and will likely talk over you if you try to speak. At times, they will also change topics frequently. 

"What's kind of a red flag is when it is atypical for the person to talk like this," doing it only when they are in a manic cycle but not at other times, said Bearden.

Sleep Problems

People with bipolar disorder often have sleep problems. They may sleep too much and feel tired all the time. They could also not sleep enough but still never feel tired. Even with just a few hours of sleep each night, they may feel great and have lots of energy.

Cognitive Bipolar Disorder Symptoms

Loss of Time

Many people with bipolar disorder find that it seriously impairs their concept of time, said Hokemeyer. Researchers of a 2018 study said that time is either too fast or too slow for individuals with bipolar disorder.

"Deadlines in appointments become ethereal, as does the ability to stick to a schedule," explained Hokemeyer. Ultimately, this can hurt their relationships with others, their careers, and even their parenting ability. "Time and its passage is an elusive construct," said Hokemeyer.

Grandiosity

While everyone can dream big, people with bipolar disorder may take dreaming big to another level, known as experiencing grandiosity. People having manic episodes may feel like they are unusually important, talented, or powerful.

This can distract them from pursuing tangible accomplishments, according to Hokemeyer. "So a person who enjoys acting will only take the stage if they get the best part in the most esteemed theater company," said Hokemeyer.

Flight of Ideas

This symptom may be hard to recognize, but it frequently occurs when someone is in a manic phase. People feel like their mind is racing and that they can't control or slow down their thoughts. This flight of ideas sometimes occurs with rapid speech. People with bipolar may not realize or admit that their mind is racing out of control, said Bearden.

Bipolar Disorder Symptoms in Children and Teens

Children and teens can have bipolar disorder, too.

Some symptoms of bipolar disorder in children or teens are similar or the same as those in adults for manic and depressive episodes. Those symptoms include things such as:

• Irritability
• Talking fast
• Sleep and attention issues
• Sadness or hopelessness
• Low energy 

Additionally, these younger individuals might be very happy or silly for long periods of time, complain about pain (e.g., headaches), or eat too much or not enough. These signs will also be different from how the child or teen usually acts but also different from peer healthy behaviors.

Treatments for Symptoms of Bipolar Disorder

Medications

Some individuals may be prescribed antipsychotic medications (that can help with delusions) or mood stabilizers if they have been diagnosed with bipolar disorder. Mood stabilizers, in general, are medicines that may reduce severe mood episodes or prevent the episodes from happening.

However, the use of antidepressants is controversial in people with bipolar disorder.

According to a 2018 analysis, many clinicians worry about the capacity of antidepressants to cause affective switching or mood destabilization. The authors concluded that further long-term studies are needed as the evidence that antidepressants are effective in treating bipolar depression is weak.

"Antidepressants can be downright dangerous in people with bipolar because they can send them into mania," said Dr. Malone. One study published in 2022 found that individuals with bipolar I disorder taking antidepressants had a manic episode one week after a depressive episode. 

But the 2018 analysis authors concluded that further long-term studies are needed since there is limited evidence that antidepressants help treat bipolar disorder.

Different Types of Therapy

Talk therapy, or psychotherapy, could be part of treatment for bipolar disorder along with medications. For example, cognitive behavioral therapy (CBT) can help with any depressive symptoms a person may experience.

Additionally, Bearden said staying on a regular sleep schedule is one of the first things recommended for bipolar patients. Establishing this schedule might be part of cognitive behavioral therapy for insomnia, or CBT-I. CBT-I focuses on good sleep habits, like waking up at the same time every day and going to bed when you feel sleepy.

Other talk therapies for bipolar disorder could include interpersonal and social rhythm therapy (IPSRT) or family-focused therapy. There are also other forms of treatment for symptoms of bipolar disorder, such as:

• Electroconvulsive therapy (ECT)
• Transcranial magnetic stimulation (TMS)
• Light therapy
  

A Quick Review

Bipolar disorder can severely impair an individual's academic and work performance, social and family relationships, and quality of life. However, knowing these signs and symptoms of bipolar disorder can help with early diagnosis and appropriate treatment. Long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.