Bipolar & Relationships: Breaking Up Is Hard To Do

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The end of a relationship often ushers in dark feelings like abandonment, guilt, and rejection. Even if the relationship was toxic and getting out was the right decision, there may be a sense of failure or self-blame.

In any case, there’s typically a period of destabilizing upheaval as the newly single adjust to life on their own, perhaps in different surroundings.

Dan of Minnesota recalls losing all the “couple friends” in his divorce — including several people he considered to be very close. The end of those connections was just part of a larger rupture in his sense of self.

“If we tend to lose ourselves in a relationship, to define ourselves by the person we’re with, it’s like taking away a major part of our self-worth,” he reflects.

During his recovery from the breakup, he jumped into another relationship “just to prove to myself I was worth something. It was just kind of a reaffirmation thing. It was a mistake.”

Getting into a relationship when you’re fleeing feelings of loneliness, hurt or abandonment is no solid foundation for attracting a good partner, says Anita H. Clayton, MD, interim chair of the department of psychiatry and neurobehavioral sciences at the University of Virginia School of Medicine.

“The idea of moderation may not be terribly appealing, but you really need to try to keep things steady,” she says. “Keep your sleep stable, stay away from high-risk activities, and do something that for you is positive and makes you feel better.”

Joan of Florida warns against turning to social media for affirmation after a split. That’s what she did, posting rants about an ex that brought comments from friends who were trying to be supportive: “You don’t need him.” “You’ve got to move on.” “Just get off this horse and hop on another one.”

Instead of soothing her hurt, however, those remarks “just fueled the anger,” she recalls, “and that fueled a manic stage. ” With her impulse control at zero, she ended up cycling through a series of sexual affairs. She regrets the way her mania torched any hope of reconciliation.

“Even if my marriage had been salvageable, I had moved on,” she says. “I didn’t even give it a chance.”

Redoubling your efforts at self-management during the post-breakup period will bring you toward a place of consistency and acceptance, which eventually will allow you to enter into a relationship “when you’re in the right space and for the right reasons,” says Ben Stover, a licensed clinical professional counselor in Chicago. “It’s very important to make sure you are taking care of yourself before you’re trying to take care of somebody else.”

Stover suggests acknowledging openly and fully that breakups are highly charged and rife with emotional triggers. During this time, don’t stop your medication. See your mental health professional if you have one; consider setting up an appointment with one if you don’t. Utilize your social supports and be careful to avoid isolation.

Above all, he advises, “Take your time. Allow yourself to heal.”

Read More: 

3 Tips to Keep Your Relationships on Track
The Sweethearts Deal: How To Keep Your Relationship Healthy

Printed as “Breaking Up is Hard to Do”, Summer 2016

dating, relationships, stability, summer 2016

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10 Reasons Why Bipolar Relationships Fail & Ways to Cope

In This Article

What are the common reasons why bipolar relationships fail? The answers are rarely straightforward since there are many variables to consider.

Navigating a relationship can be challenging, and bipolar disorder can add additional hurdles to overcome. Consequently, bipolar disorder breakups are not rare, although that doesn’t mean there aren’t many strong, fulfilling, and long-lasting bipolar relationships.

Before we describe the effects of bipolar disorder on relationships and why bipolar relationships sometimes fail, let’s define bipolar disorder first.  

What is bipolar disorder?

Bipolar disorder is a mental health condition characterized by extreme mood, energy, activity levels, and concentration shifts. The mood fluctuations go from extreme happiness, irritation, or energized behavior (also named manic episodes) to periods of extreme sadness, indifference, and helplessness (known as depressive episodes). 

Bipolar I disorder involves periods of mania that alternate with depressive episodes.

Bipolar II disorder consists of alternating depressive and hypomanic episodes (periods of elevated mood and energy milder in nature than manic episodes)

In the video below, Kati Morton, a licensed therapist, discusses in detail what Bipolar II disorder is.

Cyclothymic disorder is expressed by brief periods of hypomania taking turns with short depressive symptoms (less intense and shorter than the first two types). 

The shifts a person with bipolar disorder experiences are more dramatic than one would usually encounter. Although there can be symptom-free periods (known as euthymia), mood fluctuations can significantly impact a person’s day-to-day functioning. This could be one of the reasons why bipolar relationships fail. 

10 common reasons why bipolar relationships fail

Bipolar relationships can be complicated and may end up failing because of a variety of reasons. However, the disease is not the reason for this. The inability to healthily deal with the disease often causes the breakup. 

Here are some possible reasons why bipolar relationships fail:

1. Dramatic changes in mood and behavior

Although the symptoms of bipolar disorder exist on a spectrum, hypo/manic and depressive episodes are present with this diagnosis. One of the reasons why bipolar relationships fail is related to dramatic changes in the mood and behavior that come with the episodes. 

For example, during manic episodes, a person seeks more pleasure through heavy drinking or partying. On the other hand, during a depressive phase, they might withdraw from their partner due to the heavy onset of hopelessness and despair. 

Living with someone with bipolar can be challenging as it requires the spouse to find ways to cope with the experience of these tense and sometimes extreme fluctuations.

2. Sole focus on the person with bipolar disorder

Dealing with any illness induces stress. In a bipolar disorder relationship, the focus is often on helping the person struggling with the illness, although the other partner is experiencing stress and needs care. 

Helping a loved one cope with the consequences of a mental disorder can take a toll. Although you choose to do it, you don’t always have the answers as to what is the most appropriate form of help. Often you might feel lost and in need of support. 

One of the reasons why bipolar relationships fail is forgetting to concentrate on the person without the diagnosis as well. Attention needs to be given to both partners since the relationship will flourish only when they are both doing well.

3. Emotional ups and downs

It is natural to be worried about your partner when experiencing hypomania or mania since they can be quite impulsive and unlike themselves during those times. 

When their mood changes towards the depressive spectrum, it can be upsetting differently, especially if the partner mentions suicidal thoughts. This can take you through an emotional rollercoaster, leaving you confused, worried, and helpless.

4. Irritability and anger

One of the misconceptions about bipolar disorder is that a person is happy when they are experiencing mania. Manic periods are better described as periods of elevated mood, including irritability and anger.

Living with someone with bipolar disorder can be challenging when they are irritable (or anyone irritable, for that matter) because it can lead to communication problems and conflicts. The negativity and criticism expressed can take a toll on the bipolar disorder relationship patterns when not dealt with.

5. Strict routine

People with bipolar disorder may rely heavily on routine to preserve periods of euthymia. They may have to stick to a strict sleep schedule, diet, and exercise to keep symptoms in check since, for example, lack of sleep can trigger a manic episode. 

This can affect the relationship as partners sometimes need extremely opposite things. It may lead the partner with the diagnosis to choose an early bed routine, preventing them from late-night gatherings or places where alcohol is served (as it can also trigger an episode or interfere with medicine). 

This may seem like an obstacle that can be dealt with, and often it is. However, the more severe the symptoms are, the more restrictive the routine can become, affecting the relationship.

6. The stress of managing the signs 

Treatment can help when continuous and focused effort exists. However, successful treatment can be challenging because many people miss their “up” periods and the euphoria of manic episodes, so they might seek to induce those periods of elevated mood.  

It might also be that they see those periods as times when they are being their best selves and decide to stop the treatment to have it again. 

Choosing to stop taking medication affects their partner too. Together they have worked towards establishing a symptoms-free period, and this act can be perceived as a betrayal after everything they did to help their loved one feel better. You can imagine how that can impact the relationship.

7. Destructive behaviors

Although depressive episodes are hard to cope with, mania brings other challenges that can be just as destructive. 

In a heightened mood, people with bipolar disorder are prone to risky behaviors such as overspending, excessive alcohol abuse, gambling, etc. These behaviors can have consequences that can take a serious toll on the relationship, with or without the bipolar in question.

8. Infidelity

Infidelity can break apart any couple. Many people struggle to regain trust once it has been broken; the same goes for bipolar disorder relationships.  

Bipolar and trust issues are often closely linked. Why?

One of the consequences of bipolar disorder is that it can induce the person to engage in infidelity to reduce their feelings of depression and boredom. Infidelity can be more common when people have not yet been diagnosed or stopped using their medication.

9. Issues while planning a family

If there is a partner with bipolar in a relationship, planning a family can become problematic due to multiple reasons. 

Certain medications prescribed for bipolar disorder can affect one’s chances of having children. This is one of the examples of bipolar disorder sabotaging relationships. One has to either stop their medication and live with the symptoms or consider other means of having children. 

10. Self-isolation

Self-isolation is usually because of the stigma surrounding bipolar disorder. The sufferer receives negative criticism from people, internalizes them and drifts into a state of self-stigma.

Just because of the derogatory remarks of the society, the person goes mental illness further and that causes them to communicate less and be involved in the relationship to the minimum.

5 ways to cope when a bipolar relationship fails

Bipolar disorder affects relationships complexly; hence there isn’t a blanket approach or solution. However, some guidelines can be helpful nonetheless.

1. Don’t blame the disease

In the search for why bipolar relationships fail, we need to remember that what breaks apart most couples (bipolar or not) is making assumptions. When couples start attributing everything to the diagnosis instead of searching for ways to overcome problems, they enter a hopeless mindset.

The disease is never the only reason for a relationship to fall apart. Many couples dealing with mental illnesses can make it work if they have the right information, approach, and support from experts. 

How?

The key is to remember NOT to generalize!

One person with bipolar will have trouble controlling their anger; another won’t. Someone else may experience extreme irritability during hypomania or mania; another won’t. A mental condition, although called the same, will have many faces. 

If you saw the relationship through the lens of their diagnosis, you might ignore the true problem. This approach might have made your partner feel judged and categorized. 

2. Educate yourself further

A person who is bipolar falling in and out of love can leave you feeling confused and frustrated, even after you break up. The best way to combat this after breaking up with a bipolar person is to educate yourself. 

Take the time to read up on the different aspects of being bipolar and loving a bipolar person. You can also join certain support groups to talk to people who may have had similar experiences. 

3. Consider counseling

A bipolar relationship cycle can make a partner question themself and their relationship ability. It can create doubts, insecurities and frustration if one does not understand the disorder.  

Bipolar relationship breakups are hard and a relationship therapist can help you understand different aspects of it. It can make you see what went wrong, what you could’ve done differently, and what aspects weren’t your fault. 

4. Accept that they didn’t need fixing

We all see potential in the person we love, but falling in love or staying with someone because of their potential is the common reason bipolar relationships fail (or any other). 

The key to making the relationship work is NOT trying to fix them. Otherwise, you may have sent them a message they are not good enough the way they are, and that may have caused the breakup. 

You don’t have to feel guilty or frustrated that they did not change, as it was not your responsibility to do that. 

If you were focused on who they can be, you are not dating the person they are. That means you may have been pushing them to become someone they might not be and missing out on being present and dealing with the problems at hand.  

5. Practice self-care

“You can’t pour from an empty cup.”

To be there for your partner, you must take care of yourself too. One of the reasons for bipolar relationship breakups, or any other that involves any illness, is forgetting to take care of the caregiver (not that you are always in that role). 

Surround yourself with the support of people who understand what you’re going through and regularly practice self-care. For each person, self-care will mean something different, of course. 

The key is to remember to check in with your needs regularly, not only when you are exhausted.

Watch this video to learn more about how to retrain your brain through self-care:

Some commonly asked questions

Here are the answers to some questions related to bipolar disorder that can help you understand the different aspects of being in a bipolar relationship.

About 90 percent of married couples end up divorced if one partner is bipolar. It showcases not just how difficult it is to be in a bipolar relationship but also how people often lack the tools to make these relationships work. 

With the right and informed approach, bipolar relationships have a higher chance of success.

There are many misconceptions about bipolar disorder or any mental illness, for that matter. One of them is that bipolar and relationships are not a good match, and eventually, the disorder ruins the bond. 

However, it is important to recognize that it is NOT a fact that bipolar destroys relationships. Dating or living with someone with bipolar may produce additional challenges from battling the mental disorder. However, this does not mean that ALL bipolar relationships fail. 

However, relationships end for various reasons, and thinking that diagnosis is the key or main reason is fortifying the stigma regarding mental illnesses. The truth is that the diagnosis is only part of the equation for bipolar breakup.

Bipolar relationships are hard because people usually lack the knowledge and understanding of this particular mental illness and how to cope. Without the tools, bipolar relationships can become burdensome and problematic. 

To successfully manage bipolar symptoms, you must ensure that your partner is committed to continued treatment and ongoing communication with a mental health specialist. As their partner, you can provide the support and encouragement required for regular checkups. 

Additionally, as someone who knows them well, you can notice any troubling symptoms when they first appear so they can schedule an appointment immediately. When addressed promptly, an episode onset can be prevented, and a symptom-free period can continue. 

Sometimes it is a matter of changing the medicine or the dosage.

Final thoughts

When we ask why bipolar relationships fail, we must also ask why some succeed. 

What breaks apart one couple can make another stronger. It all depends on how they approach the situation and resolve the problem. 

Bipolar disorder can put additional hurdles to the relationship; that is true. But a diagnosis of mental illness in a partner is not a death sentence for the relationship. 

Many couples make it work and live a happy, fulfilling life together. Please focus on the person in front of you, not their diagnosis; make a point of NOT approaching a problem due to the illness; instead, look for other causes and focus on continuous treatment and self-care. 

Navigating a romantic relationship can be challenging, but we do it daily!

Bipolar affective disorder (BAD), its signs, types and methods of treatment

May 12

2020

May 17

2023

10 minutes

Manifestations of various emotions, a change in a person’s mood, manifestations of both sadness and joy are normal and depend on many factors – from temperament and character to ongoing events that influence from the outside. However, when these changes are excessive, often unexpected and for no apparent reason, emotions get out of control, or a person remains in a radically positive or negative mood for a long time, it is very likely that bipolar disorder can be diagnosed. This disease was first described at the end of 19century, the famous German psychiatrist Emil Kripelin, calling it manic-depressive psychosis. Many world famous personalities such as Vincent van Gogh, Isaac Newton, Ludwig van Beethoven, Abraham Lincoln suffered from this disease. The pronounced form of this disease, which in the international classification of diseases is called bipolar affective disorder (BAD), is detected in 3% of the world’s population.

CONTENT OF THE ARTICLE

• 1. Bipolar Personality Disorder – Overview
• 2. Symptoms and signs
• 3. Types of bipolar disorder
• 4. Phases of Bipolar Disorder
• 5. Bipolar disorder in women
• 6. Treatment of Bipolar Personality Disorder

Often, the treatment uses a complex method that combines drug therapy and cognitive-behavioral or interpersonal therapy with a psychotherapist.

Bipolar personality disorder – general information

According to statistics, people from 14 to 44 years old suffer from bipolar disorder. Unlike adults, children and adolescents experience more frequent mood swings from mania to depression, sometimes several times a day. 90% of young people make their debut precisely from the phase of depression or melancholy. Another feature of bipolar disorder is that, due to the low level of diagnosis, the patient can live with this disease for 5-10 years without knowing the cause of the painful symptoms.

Most often, bipolar disorder is diagnosed in people whose immediate family members have had a similar problem. The causes of this disease are unknown, but stress, overstrain, and various diseases can provoke the manifestation of its symptoms. However, having fenced off a person from the influence of these factors, it is impossible to get rid of the problem, you need to seek help from a psychotherapist.

Bipolar disorder is a disease that cannot be completely cured. But with properly selected medication and psychotherapy, the quality of life is significantly improved and the periods between phases are lengthened. The person remains socialized and able to work.

Symptoms and signs

From the name it is clear that we are talking about two different poles of affective manifestations, that is, mood manifestations. One of these conditions is depression. Depression in bipolar disorder is pronounced, with vivid symptoms. It can last up to a year and is manifested not only by low mood, lack of ability to enjoy and interest in ongoing events, but also by psychosis, when ideas of self-accusation arise, the patient feels inferior, unnecessary, poisoning the life of others. There are also nihilistic thoughts about suffering from some kind of severe illness, despite medical evidence to the contrary. There may be delusional thoughts, as well as suicidal thoughts and even attempts.

The other pole of bipolar disorder is a hypomanic state or hypomania, the characteristic features of which are an increased euphoric emotional background, the patient is constantly on the move, hyperactive, and is distinguished by very fast, associative speech. The patient is constantly cheerful, often hypersexual, almost always awake or sleeping 2-3 hours a day.

Hypomania is often followed by a manic bipolar state with psychotic manifestations. The patient develops convictions in his own greatness, he believes that he is capable of anything, feels that he has a special calling in this world or that he is a descendant of great people. In extended manic episodes of mania with psychotic manifestations, anger, irritability, and direct aggression often occur. This condition leads the patient into extremely unpleasant and sometimes dangerous situations.

In addition to the typical symptoms of the disease, there are a large number of comorbid mental disorders. Comorbid mental disorders are those that accompany the underlying disease. The most common disorder of this kind is anxiety, which is manifested, among other things, by nonspecific autonomic symptoms, including sweating, palpitations, tremors of the limbs, various disorders of the gastrointestinal tract, dizziness, headaches, suffocation, and many others. In the case when these symptoms occur suddenly, mainly in public places, they are called panic attacks.

Types of bipolar disorder

Bipolar disorder can be of Ι and ΙΙ types.

Bipolar I disorder is a condition in which the patient has persistent manias, i.e. overexcitation, enthusiastic inappropriate behavior, manic psychosis, as well as severe depressions. Symptoms of this type are more severe, so hospitalization is indicated in most cases.

Bipolar I disorder is characterized by short periods of hypomania followed by periods of deep depression. Hypomania is a pre-manic state with less active manifestations. Hypomania lasts a very short period of time – from several days to several hours, so sometimes patients do not even notice them and do not inform the doctor about it. Only careful, painstaking work with the patient makes it possible to identify hypomania, make the correct diagnosis and prescribe treatment.

Phases of bipolar disorder

There are several phases of bipolar personality disorder:

1. Depressive (unipolar depression). People experience a depressed mood, despair and despondency, complain of a lack of energy and mental concentration, they can either eat too much or too little and sleep.

Depersonalization and derealization may occur at the peak of bipolar depressive disorder. The boundaries of their own “I” and the world around them become blurred, patients experience difficulties in perceiving what is happening. Familiar places seem new, the colors of the surrounding world change, the patient constantly experiences a feeling of “déjà vu”. Sounds become muffled, even if someone is talking very close, it seems to the patient that the voice is coming from afar.

2. Manic (hypomanic). In this state, patients are full of energy, overly happy or optimistic, euphoric, and have extremely high self-esteem. At first glance, these are positive signs, but when a person experiences large-scale manic episodes, these symptoms and such an emotional state can reach dangerous extremes. A patient in this phase may indiscriminately spend huge amounts of money or behave carelessly, not realizing the full danger. In conversation, people may choke on words, speak at a high speed, or jump from one thought to another. These episodes may also be accompanied by delusions of grandeur or the adoption of serious decisions without thinking about the further consequences.

In the development of the manic phase, the following stages of development can be distinguished:

• Hypomania – increased arousal, emotional upsurge.
• Mania – all signs are more pronounced, aggression, irritability, irascibility and rage are possible.
• Phase peak. The patient constantly experiences nervous excitement, he cannot relax. All his emotions are “heated” to the limit, coordination of movements is disturbed, thoughts are illogical and abrupt, in speech he constantly jumps from one sentence to another.
• Relief of symptoms. The patient gradually calms down. Movement disorders are on the decline. The speed of thinking and increased emotional mood remain unchanged.
• Return to normal.

3. Mixed. Sometimes people have complaints that are characteristic of both depression and mania at the same time. They may also experience frequent phasing—4 or more episodes in one year.

In the intervals between depressive and manic phases in bipolar disorder, there is a light period during which the general background of mood becomes relatively stable, the person continues to adequately respond to certain events, the emotional sphere is under his control. This is the main criterion for remission of bipolar disease.

Bipolar disorder in women

Statistically, type Ι bipolar disorder occurs with the same frequency in men and women, and type ΙΙ disease is more often diagnosed in women. It is also known that the female course of the disease is characterized by rapid cycles and mixed episodes. Comorbidities often include eating disorders, borderline personality disorder, alcohol or drug addiction, and psychotropic drug abuse. Women are more susceptible to such somatic diseases as migraine (intense headaches), thyroid pathologies, diabetes, and obesity.

For women, a special technique is being developed to alleviate this disorder, since from adolescence to menopause there are specific changes in hormonal levels that must be taken into account. In addition, psychotropic substances, which are supposed to stabilize the condition, can adversely affect the intrauterine development of the fetus if the woman is in position. It is noted that in the first trimester of pregnancy this disorder is milder, but after childbirth they often have to deal with postpartum depression. Thus, at each stage of the development of the female body, a competent doctor must review and adjust the treatment regimen. Often in the treatment of women, a complex method is used that combines drug therapy and cognitive-behavioral or interpersonal therapy with a psychotherapist. This approach gives the fastest results.

Treatment for bipolar disorder

Attempts to get rid of bipolar disorder on your own do not bring the desired result and, ultimately, lead to an aggravation of the situation, including the development of drug or alcohol addiction. In the diagnosis of the disease, keeping a mood diary can help, where the patient records all his thoughts, emotions, feelings, changes in mood. Such records will help the doctor to assess the mental state in detail and make the correct diagnosis. If you suspect bipolar disorder, you should consult a doctor, and the sooner a person realizes that he has a disease and comes to the clinic for help, the sooner professional help will be provided to him and painful symptoms will be replaced by a stable condition. It is impossible to get rid of the disease on your own, since a person cannot fully adequately assess not only his actions, but also the alternation of the phases of the disease.

Bipolar disorder is one of the few mental disorders in which medication is indicated in 100% of cases, and psychotherapy is an auxiliary tool. This disease is incurable, but its diagnosis and treatment is extremely important. Treatment can reduce the number of episodes, their severity and intensity, as well as prevent negative life events, help prevent relationship breakups, job loss, and even suicidal attempts. Thus, the quality of life of a patient with bipolar disorder who is undergoing treatment will be several times higher than that of a person who neglects treatment. If the patient loses touch with reality and harms himself and others, he is subject to hospitalization, outpatient treatment in this case is not permissible.

If you have a disease, it is recommended to exclude coffee, strong tea, alcoholic and energy drinks from your diet in order not to provoke an overexcited state. If possible, you should stop smoking and in no case should you take even soft drugs. It is also very important to establish a sleep pattern, sleep at least 8 hours a day and try to go to bed at about the same time. You should learn to recognize mood swings and notice the early manifestations of new episodes.

If you suspect that you have bipolar personality disorder, there is no need to panic, only a doctor can diagnose the disease, so you need to make an appointment with a psychotherapist with extensive experience in managing such patients at our MedAstrum clinic. If the diagnosis is confirmed, the doctor will make the necessary medication, if necessary, prescribe psychotherapeutic sessions and give recommendations for further lifestyle adjustments. You can make an appointment yourself on the website or by contacting our administrators.

Article checked by a doctor

Gevorgyan Gevork Eduardovich

Psychotherapist, psychiatrist.
Member of the Russian Society of Psychiatrists.
Experience 30 years.

More about the doctor

“Most people face various stressful situations almost every day and intuitively try to deal with them in accessible ways.”

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Bipolar Disorder | Symptoms, complications, diagnosis and treatment

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Episodes of mood swings may occur infrequently or several times a year.

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When the mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, alertness, judgment, behavior, and the ability to think clearly.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medication and psychological counseling (psychotherapy).

Symptoms

There are several types of bipolar and related disorders. These may include mania, hypomania, and depression. The symptoms can lead to unpredictable changes in mood and behavior, leading to significant stress and difficulty in life.

• Bipolar I. You have had at least one manic episode, which may be preceded or accompanied by hypomanic or major depressive episodes. In some cases, mania can cause a break with reality (psychosis).
• Bipolar disorder II. You have had at least one major depressive episode and at least one hypomanic episode, but never had a manic episode.
• Cyclothymic disorder. You have had at least two years – or one year in children and adolescents – many periods of hypomanic symptoms and periods of depressive symptoms (though less severe than major depression).
• Other types. These include, for example, bipolar and related disorders caused by certain drugs or alcohol or due to medical conditions such as Cushing’s disease, multiple sclerosis, or stroke.

Bipolar II is not a milder form of Bipolar I but is a separate diagnosis. Although bipolar I manic episodes can be severe and dangerous, people with bipolar II can be depressed for longer periods of time, which can cause significant impairment.

Although bipolar disorder can occur at any age, it is usually diagnosed in adolescence or early twenties. Symptoms can vary from person to person, and symptoms can change over time.

Mania and hypomania

Mania and hypomania are two different types of episodes, but they share the same symptoms. Mania is more pronounced than hypomania and causes more noticeable problems at work, school, and social activities, as well as relationship difficulties. Mania can also cause a break with reality (psychosis) and require hospitalization.

Both a manic episode and a hypomanic episode include three or more of these symptoms:

• Abnormally optimistic or nervous
• Increased activity, energy or excitement
• Exaggerated sense of well-being and self-confidence (euphoria)
• Reduced need for sleep
• Unusual talkativeness
• Distractibility
• Poor decision-making – for example, in speculation, in sexual encounters or in irrational investments

Major depressive episode

Major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in daily activities such as work, school, social activities, or relationships. An episode includes five or more of these symptoms:

• Depressed mood, such as feeling sad, empty, hopeless, or tearful (in children and adolescents, depressed mood may present as irritability)
• Marked loss of interest or feeling of displeasure in all (or nearly all) activities
• Significant weight loss with no diet, weight gain, or decreased or increased appetite (in children, failure to gain weight as expected may be a sign of depression)
• Either insomnia or sleeping too much
• Either restlessness or slow behavior
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Decreased ability to think or concentrate, or indecisiveness
• Thinking, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorder may include other signs such as anxiety disorder, melancholia, psychosis, or others.