You’ll too often hear that bipolar disorder makes a person switch moods or personality, like Jekyll and Hyde, or that it means a person is moody or manic all the time. But these descriptions of bipolar disorder are incorrect, dismissive, and stigmatizing—the types of stereotypes that so many people living with it hope to do away with.
Because so many aspects of bipolar disorder are misunderstood, we interviewed several people living with a diagnosis about their experiences in order to paint a more accurate and sensitive picture of what bipolar disorder really is, as well as the bipolar disorder facts they wish more people grasped about the mental illness.
We also spoke with Wendy Marsh, M.D., director of the Bipolar Disorders Specialty Clinic and an associate professor in the department of psychiatry at the University of Massachusetts Medical School, and Igor Galynker, M.D., associate chairman for research in the department of psychiatry at Mount Sinai Beth Israel, for their expert perspectives. Here are some of the things they want to clear up.
1. People with bipolar disorder are not always experiencing symptoms.
Individuals with bipolar disorder do experience periods of extreme changes in mood and energy levels, but not around the clock.
First, these shifts are called “episodes”—and there are a few different types, as SELF reported previously:
- Mania: A manic episode is typically characterized by having high energy and activity levels, a reduced need for sleep, and/or feeling confident or euphoric. But someone in a manic episode may also feel irritable and agitated while also being energized.
- Hypomania: This is a less severe version of mania but still presents generally as high energy and activity while feeling as if you don’t require sleep.
- Depression: A depressive episode may cause a person to feel sad or down, fatigued, or they may have difficulty concentrating or think about death or suicide.
- Mixed: A mixed episode means that a person is experiencing a manic or depressive episode with some symptoms of the opposite mood state at the same time.
The types of episodes that you go through depend on whether you have bipolar I or II (the two main types, although there are other conditions related to bipolar disorder). And how a person feels or acts during their bipolar episodes (and the length of them) can vary greatly and be quite subjective. (Mood episodes generally last at least a week.)
But bipolar episodes, regardless of what types affect you, are interspersed with periods without any symptoms—which is important to remember. “One time, when I shared that I had bipolar disorder, someone said, ‘That explains why you're so happy all the time!’ Wrong,” Emma, a 20-year-old college student, tells SELF. “There's a difference between my personality and my symptoms showing themselves. I'm a bubbly person—that's my personality. But [I can also be] frantic, I overthink, and I definitely put on a mask that I have it all together. That right there is my bipolar disorder. Don't confuse the two.”
2. Bipolar disorder is often mistaken for other illnesses.
The symptoms associated with bipolar disorder may be similar to those of other illnesses (including schizophrenia and depression), which makes bipolar disorder difficult to diagnose clinically, the National Institute of Mental Health (NIMH) explains.
People with bipolar disorder may also have other conditions concurrently, such as an anxiety disorder, and that can make it even more difficult to distinguish the symptoms of bipolar disorder from those of other diagnoses.
3. And it can take clinicians a long time to diagnose bipolar disorder properly.
“It can take 10 years in some cases to diagnose bipolar disorder correctly,” Dr. Galynker says. “Especially if you have someone who has subclinical symptoms, oftentimes in cases of bipolar II, when hypomania isn’t affecting a person’s ability to function.”
Mike, 66, was diagnosed with bipolar disorder in 1988, but he remembers recognizing his mood swings as early on as 1980, he tells SELF. “I recall keeping a calendar at work where I logged how I felt,” he says. “I was trying to track my own rhythm—my up and down time, so I knew when to plan events, like vacations.”
Emma says she was originally diagnosed with generalized anxiety disorder and mild depression. Then, last year, she was diagnosed with bipolar II. “We get help when we're at our worst, so you get diagnosed based on the symptoms you're evincing,” she explains. “But the thing about bipolar disorder is that it's all dependent on patterns. If no one asks you to work backwards in your own timeline, you can't figure out those patterns.”
4. No two people experience bipolar disorder in the exact same way.
How bipolar episodes cycle and present for an individual depends “on all kinds of things,” Dr. Galynker says. “It depends on the person, age, illness severity, which medications they are being treated with now, which medications they were treated with previously, whether they are taking their medications—all sorts of factors.”
So, as you can imagine, bipolar disorder can be very complex to treat and manage. “Part of what makes for successful treatment is keeping open and regular communication between a patient and their doctor,” he notes.
5. Not everyone’s symptoms and patterns fit neatly into the clinical guidelines for diagnosing bipolar disorder.
According to the clinical guidelines within the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person with bipolar disorder needs to present a certain number of specific symptoms to be considered manic/hypomanic or depressive. “If you have, let’s say, two or three of the four symptoms you need to clinically be having a mood elevation, we would call that partial remission, or having subdiagnostic symptoms,” Dr. Marsh says.
But Dr. Marsh emphasizes that just because a person doesn’t meet all of the clinical criteria for having a mood episode, that doesn’t mean their mood changes should go ignored or without intervention. “Our main concern as clinicians is when symptoms become dysfunctional,” she says. “When there is a clear change in thinking and behavior, we want to address that quickly and early.”
6. You can’t simply snap out of a mood episode.
If someone is already in a full mania/hypomania or depression, medication is needed to treat symptoms. “One cannot pull themself out of a mood episode,” Dr. Galynker says. “Sometimes people will have this awareness that they are in or near an episode, but not all the time depending on the person’s own level of awareness and familiarity with their symptoms as well as the severity,” he says—and this may affect whether or not they have the awareness to then take their medication.
Some medications for bipolar disorder can treat mania, hypomania, and depression, while other drugs only treat certain episode types or combinations. Some medications can prevent symptoms from becoming a full episode if taken in time.
In many cases, a person will exhibit similar early signs when a mood episode is coming on, Dr. Galynker says (e.g. changes in their voice, they start sleeping less, they are dressing differently). So ideally a person is somewhat familiar with those initial symptoms and can recognize them and implement the appropriate treatment before they tip into a full episode.
“Like all of us, for a person with bipolar, their mood can change before they’re necessarily even aware of it. We call this insight—do you have insight that you’re not behaving and thinking in your normal, healthy fashions?” Dr. Marsh explains. Level of insight is very variable, “but it tends to be that people who have insight during their early episodes keep that insight, and those who don’t have that insight are less likely to have it moving forward,” she says.
This is where psychotherapy plays an important role, Dr. Marsh says, as it helps teach a person with bipolar disorder how to spot and manage those early symptoms.
7. Bipolar disorder is something you have to learn to manage for the rest of your life.
“Bipolar is a lifelong diagnosis that starts usually in the late teens or early 20s,” Dr. Marsh says. “And, ideally, very soon after those first mood-elevated episodes, that person is getting word from the appropriate experts and clinicians that they are at risk for the rest of their lives of having another [episode].”
So, a person with bipolar will very likely be on medication and working with a therapist all throughout their life. “The symptoms don't magically disappear because I go to therapy and I have medication and I've taken the time and effort to develop coping mechanisms,” Emma says. “Having a mental health disorder is like having a cold, but the cold is in your head. Sometimes I need to sleep a little more. Sometimes my appetite isn't there. And I need my medication to help the process along.”
8. People with bipolar are not “crazy” or dangerous.
“I think people sometimes have the misconception that people with bipolar disorder are ‘crazy,’” Emma says, which is a stigmatizing term for any person living with mental illness. “And that's simply because they don't understand what it means or what living with it looks like,” she adds.
“People think you're incapable of making logical, rational decisions,” Andrea, 41, who was diagnosed with bipolar II in 2010, tells SELF.
Gracie, 30, who was diagnosed with bipolar disorder this past July, points out that when a person with bipolar feels out of control, that is a result of very real health symptoms. “Wouldn’t it be nice to choose how you wanted to feel, to be able to feel in the moment and not some random time, to be able to laugh because you’re actually happy, to be able to cry because you just watched a drama that pulled at your heartstrings, to be able to be sad but not stay in that moment for what seems like forever—and to do it all without medications?” she tells SELF. “We want to be in control; we don’t like feeling this way.”
9. Mania is not necessarily a pleasant experience.
“Many people assume that mania is always this great, fantastic place to be—this ‘I can do anything’ type of experience,” Dr. Marsh says. “But mania can be really miserable or unpleasant for somebody.”
You could still be experiencing depressive symptoms simultaneously, or you could feel agitated and angry while also feeling “revved up,” she explains. (You can read more detailed accounts of what mania really feels like for a person with bipolar disorder here.)
10. It can be hard for someone with bipolar disorder to talk about it openly.
“I’d say the most frustrating thing is that I feel like I cannot admit to having [bipolar disorder] to my employers. Instead, I just say I have a chronic illness,” Joey, 41, who is diagnosed with both bipolar II and Asperger syndrome, tells SELF. “If I had cancer, my ups and downs would be accepted and people would bring casseroles to my house instead of firing me.”
Emma says that people without the diagnosis can also come off as uncomfortable discussing bipolar disorder. “People are so afraid to just talk about it,” she says. “People also think that, if you're open to sharing your story, that means you're brave. But I didn't ask for this. This is just my life, my reality. I have no choice but to manage it and fight it. Because if I didn't, I wouldn't be here.”
11. Bipolar disorder deserves to be taken as seriously as any other chronic health condition.
“Bipolar disorder is a disease that is serious and deadly just like cancer and heart disease. People don’t understand that and dismiss the disorder as something that is easy to fix or get over—it’s not,” Mike says.
“A recent example of this is a man saying to me, ‘Watch a good movie and you’ll feel better,’” Mike recalls. “My dad would say to me when I was in my teens and 20s and showing symptoms of bipolar disorder to ‘find yourself a new girlfriend and you’ll feel better.’ This is a complex disorder and difficult to manage, but that does not register with people.”
12. You can support someone you love with bipolar disorder by educating yourself and understanding these facts.
“Learn as much as you can about bipolar disorder, Nina*, 25, who has bipolar II, tells SELF. “There are so many books for families and friends.”
Bradley, who is 54 years old and has bipolar I, first picked up on symptoms of his condition when he was 48. He tells SELF that a reliable, informed support system is key in helping a person with bipolar stay on top of their treatment. “If the person is in denial about their condition, then friends and family need to conduct a loving intervention to explain their care and the need for the person to be evaluated,” he suggests. “They need to do it together and all go with the person to see a great psychiatrist, then provide assistance in order to make sure that their [medication] is regularly taken. No exceptions.”
Mike uses his wife as a example of how family can be hugely important for someone with bipolar disorder: “[She] makes sure I take my meds. She has learned to recognize signs that I am experiencing unnatural highs and lows. She will force me to have contact with others even though I don’t want the contact. She asks how I am, and she engages me in conversation even when I don’t want to talk,” he says. “I appreciate that, and it always helps.”
Dr. Galynker agrees that family and friends can be game-changing in helping someone with bipolar disorder manage their illness. He recommends going to therapy with your loved one if they are open to that and being in the know about the specific medications they are taking and for what.
13. People with bipolar disorder can live normal, happy lives.
Bradley points out that “people are not aware that there are lots of people who have the condition, including leaders of major corporations and musicians. [We’re often] viewed us as defective, yet the evidence is to the contrary.”
Emma says, “Just because I'm managing, just because I have a life where I can be a full-time college student with two jobs, doesn't mean I don't have bipolar disorder anymore.”
And Andrea wants to remind others that people with bipolar disorder aren’t necessarily suffering. “Don't judge and don't make assumptions. Many famous, talented, productive people have dealt—I hate the word suffer—with bipolar disorder,” she says. “There's something to be said for the blasts of creativity that occur.”
*Name has been changed.
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