Bipolar Disorder Symptoms and Triggers

All the things you need to know and everything you haven’t heard

You probably know that bipolar disorder is made up of two main mood swings, mania and depression, and that this is why it used to be called “manic depression.” But did you know there are many other symptoms associated with the illness? This page includes a description of the main symptoms of bipolar disorder, followed by a short discussion of bipolar disorder triggers.

The Main Symptoms of Bipolar Disorder

Mania and Hypomania

There are two kinds of mania: full blown mania and hypomania. A bipolar disorder diagnosis is based on the kind of mania a person has. If they have full blown mania, it’s Bipolar I (one). If they have hypomania, as I do, it’s Bipolar II (two). People with Bipolar I go way, way up and often have to be hospitalized if the mania is not caught early and treated. If you were just diagnosed with Bipolar 1, there is a good chance your diagnosis occurred in the hospital. People with Bipolar 2 also have mania, but in a milder form called “hypomania.”

To make matters more complex, both mania and hypomania can be either euphoric or dysphoric. Euphoric mania can be very fun and exciting. A person will have lots of energy and may become very creative, but it almost always ends up destructive due to poor decision-making, often involving money and sex. Euphoric hypomania is less intense than full-blown euphoric mania, but can also be destructive, and often goes undiagnosed. The number one sign of euphoric mania is sleeping a lot less yet not being tired the next day.

Dysphoric mania, on the other hand, is no fun at all. It’s a combination of an uncomfortably high energy level mixed with anxiety and an agitated mood. It’s also called “mixed mania” as there are depressive qualities associated with it. It is more dangerous than euphoric mania because it is associated with suicidal thoughts, aggressive behaviors and an inability to calm oneself down. The number one sign of dysphoric mania is the same as with euphoric mania: sleeping a lot less yet still having a lot of energy the next day. However, a person with dysphoric mania simply can’t sleep, while a person with euphoric mania doesn’t want to sleep, as there are so many wonderful things to do!

Depression

Most people know the signs of depression: sadness, hopelessness, despair, crying, trouble concentrating, excessive sleeping, negativity, loss of pleasure, significant weight changes, fatigue, feelings of worthlessness, guilt, anxiety, etc. Every person with bipolar disorder experiences depression. In fact, bipolar disorder is primarily a depressive illness. People with Bipolar 2 have much more depression than hypomania, and those with Bipolar 1 often experience depression with their mania. What most people don’t know is that the treatment of bipolar depression is very different from typical depression treatment. Bipolar depression treatment must always think of mania first. The two come together. This means that all medications for bipolar depression must first pass the mania test- if a medication causes mania, it has to be used very carefully if at all. Unfortunately, this means that people with bipolar depression often aren’t able to take the antidepressants that work so well for non-bipolar depression.

Bipolar Psychosis

Psychosis is the most misunderstood and under-diagnosed symptom of bipolar disorder. It’s present in over 50% of full blown manias, and while not as common, it can be present in depression as well. I work with many people who describe psychotic symptoms to me yet who don’t realize this is what they are experiencing. They may believe people are constantly talking about them, or may see animals running across the floor. When I tell them these are symptoms of psychosis, it is often the first time they’ve heard that psychosis is a common symptom of bipolar disorder.

It is important to recognize the difference between psychosis and the symptoms of mania and depression so that each can be treated appropriately. Psychosis is a break with reality that involves hallucinations and/or delusions. A hallucination is where you see, hear, taste, feel or smell something that isn’t there, such as hearing your name called when no one is around. Delusions, on the other hand, are false beliefs where you truly believe something is happening that isn’t. For example, feeling that your partner goes out every night to meet their ex-husband, who just happens to live in another state, is a delusion. Delusions are often negative, involving fear and paranoia, but they can also be grandiose such as believing you’re the most powerful person in the world.

Bipolar psychosis can become very problematic if it not recognized and treated when symptoms first arise, and it is often difficult for a person having a psychotic episode to know that it’s happening. This is why it’s so important to recognize your particular early warning signs and take appropriate steps as soon as you notice them. It’s often family members who must recognize the first signs, so a true and accurate understanding of psychotic symptoms is essential. My Health Cards System has helped me manage my own psychosis, and I cannot recommend it enough.

Anxiety

It is estimated that 90% of people with depression also experience anxiety. Anxiety is a feeling that something is wrong or that something is going to go wrong. It is felt in both the mind and the body. Bipolar anxiety is always complicated by other mood swings. For example, a person with depression can be worried, nervous and irritable all because of the anxiety that comes with their depression. People with dysphoric mania always experience anxiety.

There are seven main types of anxiety disorders: generalized anxiety disorder, obsessive compulsive disorder (OCD), social phobia, panic disorder, agoraphobia (fear of the marketplace), specific phobia and post traumatic stress disorder (PTSD). People with bipolar disorder can have symptoms that resemble symptoms from all these types of anxiety disorders, but this does not necessarily mean they have a separate disorder. If a person has anxiety that is clearly separate from a manic or depressive mood swing, they may have a separate anxiety disorder on top of bipolar disorder.

Irritation, Anger and Aggression

Irritation, anger and aggression are common bipolar disorder symptoms that aren’t talked about as much as they need to be. People with bipolar disorder can become extremely irritated and even exceptionally angry at times, particularly when experiencing dysphoric mania. The combination of high energy and agitation associated with dysphoric mania may be one reason why our jails are filled with so many men with bipolar disorder (and sometimes women). Combine this with the negative and often self destructive feelings of depression and it’s easy to see how violence can result. Those of us with bipolar disorder and the people close to us need to recognize the warning signs and irritation and anger, and take the appropriate steps to reduce these potentially dangerous symptoms.

Suicidal thoughts and behaviors

There is a lot of fear and silence around the issue of suicidal thoughts and behaviors, yet we need to be open and honest about this topic. Suicidal thoughts are normal for people with bipolar disorder. They are a symptom just like paranoia, anxiety and irritation are symptoms, and it’s ok to talk about them. In fact, they need to be talked about. They also need to be addressed separately from depression. While the two are clearly linked, suicidal thoughts have a different language, more compulsion and are a lot scarier than depressive thoughts.

There are two kinds of suicidal thoughts in bipolar disorder: passive and active. Passive thoughts are about wanting to die. (“I wish I were dead.” “The world would be better if I were dead.” “What is the point of life?” “Nobody is going to miss me if I am gone.” Etc.) These thoughts can be scary and shocking to the person who has them because they often seem to come out of nowhere, and they can be devastating for family members and partners when they are spoken out loud. Active suicidal thoughts and behaviors are far more dangerous. When someone is actively suicidal, it’s time for immediate professional intervention. Once the suicidal episode has passed, the person must create a plan to keep it from happening again. I have managed my own suicidal thoughts for over 25 years and I know they are a normal part of the illness. Using my Health Cards System I created a plan involving my friends and family, and they now know exactly what to do if I get suicidal.

Bipolar Disorder Triggers

Know your triggers. Know yourself.

Bipolar disorder triggers are defined as anything a person does or experiences that leads to bipolar disorder mood swings. These can include personal choices as well as uncontrollable outside events. It’s up to the individual to learn their particular triggers in order to modify them, manage them and ultimately prevent the ones that make them ill. Family and friends play a very important role in helping someone identify and manage triggers, because they can sometimes identify troublesome behaviors that a person with bipolar disorder can’t, and also because they are sometimes the triggers themselves! Here is a list of some typical triggers that anyone can look for and avoid.

Common Bipolar Triggers