Mental and Behavioral Conditions
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Bipolar Disorder: Types, Symptoms, Causes, Treatment, and More

Medically reviewed by Anna Kravtsov, D.O., Psychiatrist

Written by Sindy Hoxha

February 7th, 2024

Bipolar Disorder is a condition that impacts around 2.8% of the United States population. The condition is known for being characterized by mood instability and continuous shifts between manic and depressive episodes (1).

What is Bipolar Disorder?

Bipolar Disorder is a mental health condition that is followed by manic-depressive episodes. This disorder is usually characterized by frequent mood fluctuations, where an individual goes through periods of intense mania or hypomania and depression (2).

Some of the key indicators of bipolar disorder are:

  • Episodes of mania and hypomania: These periods are followed by a significant increase in energy, good mood, and in some cases reckless behavior.
  • Episodes of depression: Usually followed by low mood, feelings of helplessness, sadness and a loss of interest in hobbies or participating in activities.

Bipolar disorder is usually diagnosed after a person goes through one or more visible manic episodes or when they go through a hypomanic and depressed episode. The difference between a manic and a hypomanic episode is all linked to severity of symptoms. A manic episode involves more intense feelings of euphoria, reckless behavior, heightened mood and being impulsive. A hypomanic episode, on the other hand, usually has the same symptoms but with less intensity.

Manic and hypomanic episodes may disrupt daily life, with hypomania being less severe. Depressive episodes, however, are known to cause a lot of distress as these episodes can also impact daily life through the loss of energy and motivation.

Types of Bipolar Disorder

Bipolar Disorder is divided into three separate types, depending on the intensity of symptoms and the frequency of episodic shifts. Here are the three types of bipolar disorder:

  • Bipolar I Disorder: This type requires at least one manic episode that lasts at least seven days. In extreme cases, sufferers sometimes require hospitalization because of the severity of the episode. In bipolar type I, individuals might experience depressive episodes, but they are not required to be diagnosed. In some cases, individuals may experience a mixture of manic and hypomanic episode symptoms. If an individual experiences more than 4 episodes annually, then their episodic shifts are defined as rapid cycling.
  • Bipolar II Disorder: The II type is less intense and is commonly associated with shifts between hypomania and depressive episodes.
  • Cyclothymic Disorder: Characterized by shifts between hypomania and depressive episodes. The only difference from Bipolar type II is that Cyclothymic Disorder doesn’t meet the full criteria of the symptoms and/or frequency associated with the episodes.

There is also a fourth type categorized as “Other Specified and Unspecified Bipolar and Related Disorders,” that often have some similarities to bipolar symptoms but do not meet the full criteria to fit into the three main types (3).

Note: It’s important to note that bipolar disorder lies on a spectrum, with its symptoms ranging from mild to severe depending on the individual.

Keep in mind that these descriptions of bipolar symptoms and episodes provide a general overview. The severity and symptoms are different from person to person. This means that the diagnosis and treatment process for bipolar disorder is not a one-size-fits-all approach and is a unique journey for every individual.

Symptoms of Bipolar Disorder

Bipolar disorder symptoms vary significantly and not one person is exactly alike. It’s important to recognise that the condition is diverse and may be associated with many symptoms such as:

  • Unstable mood: People that suffer from this condition often go through extreme mood swings. During manic or hypomanic episodes individuals may feel euphoric and energetic, while during depressive episodes they might feel sad and lack energy and motivation. Mood shifts can either happen gradually or suddenly (4, 5).
  • Mania: During manic episodes, people that have bipolar disorder may feel the need to engage in risky behavior such as gambling, overspending, substance abuse, unprotected and risky sex with mutual partners, etc (6, 7). Mania may also be associated with racing thoughts, and difficulty concentrating.
  • Depression: Depressive episodes are followed by feeling worthless, self-isolating, sleeping too much or trouble sleeping, changes in appetite or weight, difficulty making decisions or concentrating. Feelings of suicide and hopelessness can also occur during a severe depressive episode.
  • Mixed hypomania/mania: Episodes of mania and depression can happen during the same time. This is usually confusing and challenging to those affected by bipolar disorder, and in some cases, can increase the risk of self-harm or suicide (8).
  • Changes in energy levels: During depressive episodes, individuals with bipolar disorder may oversleep and experience low energy levels throughout the day. Manic episodes, on the other hand, are followed by high energy levels and less required sleep (9).
  • Changes in behavior and thinking: Manic episodes are associated with aggression, irritability, and impulsivity while depressive episodes lead to pessimism and feelings of guilt.
  • Psychosis: In some extreme cases, people with bipolar disorder can experience hallucinations or delusions. These symptoms may require additional treatment adjustments (10)
  • Cyclothymic Symptoms: Some people may experience shifts in milder versions of hypomanic and depressive episodes. Individuals experience some degree of mood dysregulation, but the symptoms are not enough for them to receive a full bipolar diagnosis (11).

Remember, bipolar disorder hangs on a spectrum, and symptoms may vary significantly from person to person. Additional factors such as substance abuse, chronic stress, and other medical conditions can impact the severity of one’s symptoms.

Manic, Hypomanic and Depressive Episodes

Understanding bipolar disorder better involves diving deeper into the symptoms of the three episodes including mania, hypomania and depression. These phases usually impact a person’s daily functioning to a high degree:

Manic Episodes

Manic episodes are known as the “highs” of Bipolar Disorder. During this episode, individuals experience intense moods and shifts in behavior. Here are some important points to keep in mind about manic episodes:

  • Manic episodes are followed by high energy levels, euphoria, impulsivity and excitement
  • Some additional symptoms are racing thoughts, and in less frequent cases, delusions or hallucinations.
  • Impacts relationships with friends and family.
  • Taking part in risky behaviors such as overspending, gambling, quitting a job, risky or unprotected sex, reckless driving, risky investments, moving/traveling somewhere without notifying others.

Hypomanic Episodes

Hypomania, which is present in the diagnosis of bipolar II disorder, is a less severe form of mania. Here are some key points:

  • Hypomanic episodes are followed by an increase in productivity and energy.
  • During this type of episode, psychosis is generally absent.
  • Hypomania doesn’t significantly impact daily life or relationships with friends and family.

Understanding the differences between mania and hypomania is important for healthcare experts to provide proper treatment to patients diagnosed with bipolar disorder.

Depressive Episodes

Having bipolar disorder doesn’t necessarily mean that the individual also goes through a depressive episode. However, there are many cases where depressive episodes are present. In some cases, treating a manic episode may lead to a shift into a depressive state or slightly lower mood. Some depressive symptoms include:

  • Feeling fatigued and lethargic.
  • Constant low mood followed by feelings of sadness or emptiness
  • Persistent sadness
  • Loss of interest in once enjoyed hobbies
  • Changes in sleep patterns
  • Changes in eating habits
  • Feeling guilty or worthless
  • Having a hard time concentrating or focusing
  • Moving or talking in a slower motion or feeling restless
  • Thoughts of suicide or dying

Bipolar disorder may be challenging to handle without the proper support, knowledge and treatment plan. Remember that you’re not alone in this journey. It’s important to seek support from a trusted family member, your doctor, or a support group. If you are experiencing more severe symptoms of bipolar disorder, it’s important to seek proper medical attention as soon as possible.

Bipolar Disorder Symptoms in Females vs. Males

According to statistics, both men and women are equally likely to suffer from bipolar disorder. However, there are noticeable differences depending on the biological sex assigned from birth. Understanding these differences may help experts accurately diagnose patients and provide them with a more tailored treatment plan.

Note: It’s important to understand the difference between sex and gender, as they play distinct roles in the experience of bipolar disorder.

Sex: Refers to biological characteristics, such as chromosomes and reproductive organs (woman assigned at birth or male assigned at birth).

Gender: Expresses the identity of an individual (transgender, genderfluid, nonbinary etc).

The difference between sex and gender is important to better understand how bipolar disorder impacts bigger groups of people differently.

Bipolar Disorder in Biological Females

Females are usually diagnosed for Bipolar Disorder later in life when compared to males (12). Females also have a higher rate of Bipolar II compared to men (13). In some women, the first symptoms of bipolar disorder appear while they are pregnant or after giving birth (14).

The noticeable difference that separates them from males is that it’s more common for females to experience hypomanic episodes. Females also experience more depressive episodes than men (15). Rapid cycling (experiencing 4 or more episodic shifts a year) is more common among females (16)..

Bipolar disorder relapsing (experiencing a mood episode after a period of remission) is also more common among females. This relapse is a lot more likely to happen during pregnancy and the postpartum period (14, 12).

Bipolar Disorder in Biological Males

Males with bipolar disorder have slightly different symptoms. They are more likely to be diagnosed earlier in life (12).

Males are also more likely to be diagnosed with type I bipolar disorder (17, 15, 18). There’s also a higher chance for males to have worsened symptoms due to the high rates of substance use disorder among males with bipolar disorder (17, 15, 18). During a manic episode, it’s more common for males to become aggressive in comparison to females (19, 20).

Experts continue to research more on how sex impacts the manifestation of bipolar disorder in individuals. This is done in the hopes of better treatment plans and an advanced understanding of the condition.

Bipolar Disorder Symptoms in Children and Teenagers

Diagnosing bipolar disorder among children and teens is more challenging as symptoms are different when compared to adults. It’s important to note that children might not show clear symptoms of bipolar disorder. Mood changes and episodic shifts may also not align with that of an adult with bipolar disorder. There are also instances where symptoms of bipolar can be mixed up with symptoms of other mental health conditions such as ADHD, for example (21).

Symptoms of Bipolar Disorder in Children

Children with bipolar disorder can, in some cases, experience some symptoms that are also present in adults. Although mood changes are often considered a normal part of child behavior, those that are caused by bipolar disorder are more visible and usually impact the child’s day to day functioning.

Manic Symptoms:

  • Having a difficult time concentrating
  • Engaging in dangerous behavior
  • Frequently changing topic
  • Talking too fast
  • Trouble with sleeping habits without getting tired
  • Displaying irritability
  • Anger outbursts

Depressive Symptoms:

  • Frequent crying
  • Unexplained and continuous sadness
  • Changes in appetite and sleeping patterns
  • Feeling guilty or worthless
  • Loss of interest in hobbies and activities
  • Physical pain such as headaches or stomach pain
  • Thoughts of death or suicide.

Keep in mind that these symptoms are not definite for bipolar disorder in children. If these symptoms are present, there’s also a possibility that the child might suffer from another mental health disorder or a mix between bipolar disorder and another condition. Reach out to a medical expert to properly track the child’s symptoms and come to an accurate diagnosis.

Symptoms of Bipolar Disorder in Teenagers

Changes in behavior in teenagers is common due to hormonal changes and life adjustments during puberty (22). However, extreme mood fluctuations or taking part in life-threatening behaviors might increase the chances of a teenager having bipolar disorder. Symptoms become more easily identifiable in later adolescence.

Manic Symptoms:

  • Risk-taking behaviors
  • Substance use
  • Elevated mood
  • Sleep disturbances
  • Irritability
  • Unprotected and frequent partaking in sexual activity
  • Difficulty concentrating

Depressive Symptoms:

  • Continuous sadness
  • Social withdrawal
  • Changes in sleep and appetite
  • Thoughts of death or suicide

Some behaviors such as curiosity to try different substances, and being more interested in sex, are normal among teens. However, if there are recognizable patterns, then it might need further attention.

Pointing out bipolar symptoms in children and teens can be complicated. But if you see any visible patterns and conclude that it’s disrupting the child’s daily functioning, then it’s best to talk to a healthcare professional specializing in pediatric mental health.

Bipolar Disorder Causes

The exact origins of Bipolar disorder continues to remain unknown to researchers. However, there are several causes that may increase the chances of an individual developing the condition:

  • Genetic factors: There are many ties linking bipolar disorder and genetic factors. Studies show that people with a parent or sibling that are diagnosed with the condition are 5% to 10% more likely to have bipolar disorder (23). This doesn’t necessarily mean that someone with a close family member with the condition will end up having bipolar disorder.
  • Environmental factors: Traumatic life events, extreme and continuous stress or physical illness can lead to developing bipolar disorder in some cases. These factors could end up triggering or worsening the symptoms of those that are at higher risk of developing the condition (24, 25).
  • Brain chemistry and structure: The way the brain functions and is wired could increase the risk of bipolar disorder. Neurotransmitter pathways and irregularities can also lead to an increased risk of developing the disease (26).

Keep in mind that these factors are not definite causes of bipolar disorder, they may only increase the risk of developing the condition. Every experience with bipolar disorder is different and many factors play hand in hand in the development of the condition.

Bipolar Disorder Risk Factors

Bipolar disorder usually becomes more visible during late teens and early adulthood. There are some less common cases where it may emerge in childhood. The exact reason for this remains unknown, but researchers believe that there are some risk factors that play a role for developing this condition later in life.

Potential risk factors for developing bipolar disorder are:

  • Family History: A close family member diagnosed with the condition can increase the chances of an individual developing the conditions (27).
  • Substance misuse: Abusing drugs and alcohol can worsen the symptoms of bipolar disorder, with many using these substances during a manic or depressive episode (28).
  • Stressful life events: Experiencing extreme stress in life or trauma can lead to the development of the disorder (29).
  • Other health conditions: People with a diagnosed bipolar disorder may also be suffering from other health conditions such as seasonal depression, anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). The presence of these conditions vary, and not everyone with bipolar disorder experiences them (30).

Although these factors are linked to bipolar disorder, they are not definite factors for causing the disease. Bipolar disorder is a complex condition that is unique to each person’s experience. If you think you or your loved ones are at risk of having the condition, seeking professional guidance is the best option to manage symptoms and to get on the right treatment plan.

Bipolar Disorder Diagnosis

The first step of getting diagnosed with bipolar disorder is to go through a psychiatric assessment and meet all the criteria for having experienced a manic or hypomanic episode in the past. If the individual experiences hypomanic episodes, they might also be evaluated deeper for depressive episodes and experiencing low moods (31).

Diagnosis of Bipolar I Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) (32), a diagnosis of bipolar I disorder needs:

  • At least one manic episode that lasts for a minimum of 7 days.
  • Symptoms that significantly affect daily life.
  • Symptoms that are unrelated to other medical disorders or substance misuse.
  • While not mandatory, a diagnosis becomes more clear if a person has experienced:
  • Hospitalization during a manic episode.
  • Psychosis
  • At least one manic-depressive episode, referred to as mixed features.
  • Experiencing other episodes such as hypomania and depressive episodes apart from the manic episodes.

Diagnosis of Bipolar II Disorder

A diagnosis of bipolar II disorder requires:

  • At least one hypomanic episode that lasts a minimum of 4 days.
  • At least one depressive episode lasting a minimum of 2 weeks.
  • Symptoms that are unrelated to other medical disorders or substance misuse.
  • Visible mood changes when experiencing a hypomania episode when compared to a depressive episode.

Diagnosis of Cyclothymia

A diagnosis of cyclothymia requires:

  • Alternating episodes of hypomania and depression for at least 2 or more years.
  • Symptoms appearing for at least half of the 2 year period.
  • Symptoms not being absent for more than 2 months at a time.
  • Symptoms that don’t meet the full criteria for being diagnosed as bipolar I or bipolar II.
  • Symptoms causing distress or impacting daily functioning
  • Symptoms that are unrelated to other medical disorders or substance misuse.

Diagnosing bipolar disorder involves going through an evaluation of all the symptoms that come with experiencing a manic, hypomanic and depressive episode. Understanding the differences of Bipolar I, Bipolar II, and Cyclothymia makes it easier for individuals to get on the right treatment plan to manage symptoms effectively.

Bipolar Disorder Treatment

Managing bipolar disorder symptoms effectively involves a period of trial and error of trying different treatment options and treatment combinations. Although none of the following treatments guarantee the total disappearance of symptoms, they may improve the quality of life to a certain degree. Here are some treatment options for bipolar disorder:

Medication

Most individuals diagnosed with bipolar disorder use a combination of different medications to manage the symptoms of bipolar disorder. It’s common to go through a period of trial and error until finding the right combination of medication that works for them.

Medications that may be recommended by healthcare providers include (2, 33):

  • Mood stabilizers, like lithium (sold under the brand name Lithobid).
  • Antidepressant-antipsychotics, like fluoxetine-olanzapine (known as Symbyax).
  • Benzodiazepines, a type of short-term anti-anxiety medication.
  • Antipsychotics, such as olanzapine (marketed as Zyprexa).

It’s more common for individuals with bipolar disorder to seek help during a depressive episode rather than when they’re experiencing a manic or hypomanic episode. That’s why it’s important for healthcare specialists to go through a deep medical history assessment to accurately diagnose the condition.

Patients should:

  • Talk to their doctor about the potential side effects of the medication they are about to go on.
  • Discuss the benefits of the medication they’re about to go on.
  • Report any concerns they have when it comes to the side effects that the medication has.
  • Inform their doctor if they are on any other medication or are taking any supplements.
  • Take the prescribed medication consistently (it usually takes several weeks for some medication to show visible results)

If you or your loved one wants to discontinue medication for bipolar disorder, it’s important to talk to your doctor first. Stopping the medication without medical surveillance may trigger symptoms appearing again.

Psychotherapy

Psychotherapy, or better known as talk therapy, can play a big role in helping people with bipolar disorder. Different types of psychotherapy use different techniques to help individuals not only manage their symptoms, but also help with mood regulations, a more positive outlook on life, and changing negative behaviors. Some forms of psychotherapy for bipolar disorder include:

  • Cognitive Behavioral Therapy (CBT): CBT aims at treating depression, helps with insomnia and is known for its success in helping people with bipolar disorder. Combining CBT with other treatment methods may help tremendously in managing bipolar symptoms (34).
  • Psychoeducation: This type of talk therapy provides more knowledge to individuals around bipolar disorder. It also offers coping mechanisms on how to handle symptoms better (35, 36).
  • Interpersonal and Social Rhythm Therapy: This therapy’s main focus is to teach individuals on bettering their sleeping patterns, eating habits and overall daily routines. By maintaining a balanced routine, bipolar symptoms have a higher chance to subside in the long run (37).

By adding psychotherapy as part of a treatment plan for bipolar disorder, individuals may improve their chances of reducing symptoms associated with the condition.

Other Treatment Options

Some other treatment methods are also known to show promising results in improving and managing bipolar disorder:

  • Light therapy: Light therapy is primarily used for treating those affected by seasonal affective disorder (SAD) (38). However, it has also been beneficial for people that suffer from SAD and bipolar disorder simultaneously (39).
  • Electroconvulsive therapy (ECT): This is a brain stimulation therapy that is seen as a last resort treatment option for individuals that fail to respond well to other forms of treatment for bipolar disorder. ECT is usually performed in cases where the person is at high risk of suicide or experiencing catatonia, a state of unresponsiveness (40).

Considering these therapies may shed some light in improving symptoms of bipolar disorder when other treatment options are not showing effectiveness.

Natural Remedies

Natural remedies for bipolar disorder are known to provide some relief. However, it is crucial to speak to a doctor before making them a part of your treatment plan as they can interfere with other medication. One of the most promising natural remedies of aiding people with bipolar disorder is:

  • Omega-3: Some research held in 2021 has found that omega-3 supplements have decreased the severity of symptoms in bipolar I disorder (41).

Keep in mind that before starting Omega-3 supplements, other supplements or herbal remedies it’s important to talk to your healthcare provider first. The makes sure that the natural remedies don’t interfere with other treatments you’re on.

Lifestyle Changes

An important part of an effective treatment plan for bipolar disorder is maintaining a healthy lifestyle. Practicing healthy habits in your daily routine can help manage symptoms. However, the effectiveness of these lifestyle adjustments varies from person to person. Here are some beneficial adjustments:

  • Balanced diet: Consuming a balanced diet consisting of whole grains, meat, fish, vegetables, fruits, nuts and seeds can help maintain overall health. A balanced diet helps prevent deficiencies that can lead to worsened symptoms of bipolar disorder (42).
  • Exercising regularly: Engaging in regular exercise may show some benefits in managing bipolar symptoms.
  • Continuous therapy: Regularly attending therapy sessions has proven to be beneficial for people that live with bipolar disorder (43).
  • Managing weight: Managing a healthy weight may have a positive impact on wellbeing and might reduce some symptoms.

Although lifestyle changes might provide some benefits, researchers believe that it’s not sufficient without combining them with other forms of treatment.

Bipolar Disorder Prevention

Mood episodes cannot be prevented entirely and bipolar disorder is recognized as a lifelong condition. However, the positive side is that people with bipolar disorder can live a fulfilling life by sticking to the right treatment plan. Recognising the symptoms of bipolar disorder is important to intervene and seek help before symptoms worsen.

Building a Support Team

Managing bipolar disorder often involves building a support team that includes:

  • Your primary care physician
  • A therapist or counselor
  • A psychiatrist
  • Other specialists like sleep experts or alternative therapists
  • Support groups

Finding Effective Treatments

Effective treatment for bipolar disorder is not standard. Since every person experiences bipolar disorder differently, it usually takes some trial and error before an individual finds the right treatment plan for them. Finding the right treatment plan might take anywhere from a couple of months to several years. The reason behind this is because everyone reacts differently to the medication and therapy available. What may work for one person may not work for the other. This makes it important to always keep open communication with your care team to find the best treatment plan that works in your favor.

Conclusion

Living with bipolar disorder can come with its own challenges. It’s important to treat ourselves or people that suffer with the condition with kindness and support. Keep in mind that the condition isn’t a weakness or a personal failure. Also, remember that not responding well to a treatment plan is normal. Practicing patience and acceptance is the best method to make the journey more manageable.

In conclusion, the effective way to manage symptoms of bipolar disorder is through early diagnosis, having a support system and care team, exploring different treatment options and being patient. Although there is no known way to fully cure the disorder, there are plenty of steps that can help an individual live a more fulfilling life and increase overall wellbeing.

Sindy Hoxha

Sindy Hoxha is a writer and editor with years of experience in the field. She has worked as a writer for several...Read more

Anna Kravtsov, D.O., Psychiatrist

Anna Kravtsov is a Board-certified general adult psychiatrist with 9+ years of clinical experience. She graduated phi beta kappa from Rutgers University...Read more

Evidence Based

This article is based on scientific evidence, and written, fact-checked & medically reviewed by health experts.

Throughout this article, you’ll find scientific references (highly trusted peer-reviewed scientific papers, links denoted by the numbers in the parentheses (1, 2, 3)).