Bipolar disorder manifests in extreme changes in energy and activity levels, sleep patterns, and behavior. Like any other serious mental illness, symptoms of bipolar disorder will vary greatly among patient populations. Not only do patients vary in the symptoms that they exhibit, but variations in the intensity of common symptoms further differentiate bipolar patients. This disease is not easy to diagnose during initial onset as the mania and depression can be mistaken for the normal highs and lows we all experience in daily life.
Because bipolar disorder co-occurs with substance abuse in a vast number of cases, some of these patients will be thought to suffer only from addiction and can go for years without being properly diagnosed.
A manic episode can last from several days to several months. Those with type I bipolar disorder will experience the most intense or serious symptoms; those with type II or cyclothymia may exhibit some of the same symptoms as type I, but with less intensity. The symptom most commonly associated with a manic episode is reckless behavior, which typically includes poor impulse control and impaired judgment. The behavior can have long-term consequences that continue to cause problems even after the mania has ended. Examples include binge eating, drinking or drug use, sexual promiscuity, and spending sprees.
Lesser known symptoms of bipolar disorder in the manic phase include agitation, inflated self-esteem, reduced need for sleep, obvious elevated mood including hyperactivity, heightened energy levels, lack of self-control, and racing thoughts, excessive involvement in social activities, quick temper, grandiosity, and becoming easily distracted.
On the other end of the spectrum, bipolar patients will also experience periods of depression. Each patient will experience a different level of depression, from severe or moderate depression to mild depression or low mood (dysthymia)
Symptoms of depression in a bipolar patient include daily low mood; trouble concentrating, remembering, or making decisions; changes in eating habits (overeating or loss of appetite); fatigue; feelings of worthlessness, low self-esteem, persistent sadness, and/or thoughts of death; sleep disturbances; suicidal thoughts; withdrawal from social activities and/or personal relationships; and lack of interest in activities that he or she once enjoyed, including sex.
Some of the bipolar symptoms observed during the depressive stage are the polar opposite of symptoms exhibited during the manic phase. To make things even more complicated, there can be an overlap of symptoms in each of the phases, with manic and depressive symptoms occurring together or directly after one another in a “mixed” state. During a mixed state, the patient may be agitated, have trouble sleeping, experience major changes in appetite, or have suicidal thoughts. A “mixed” state can also cause a person to feel very sad or hopeless, yet have an overabundance of energy.
In some severe cases, bipolar disorder can be accompanied by psychotic symptoms, such as hallucinations or delusions. For someone in a manic phase, psychotic symptoms include thinking that they are a celebrity, wealthy, or a super hero. Conversely, psychotic symptoms during a depressive phase include irrationally thinking of themselves as poor, unsuccessful, or a criminal. Because these symptoms can also occur in schizophrenia, another disorder that manifests in both hallucinations and delusions, some patients with bipolar disorder can be misdiagnosed as schizophrenic.