Having Bipolar Disorder Does Not Make You Crazy

The National Institute of Mental Health defines bipolar disorder as a mental illness “characterized by dramatic shifts in mood, energy, and activity levels that affect a person’s ability to carry out day-to-day tasks.” Symptoms of a manic episode can include more activity than normal, a tendency to talk more than normal, racing thoughts, and a need for less sleep, while symptoms of a depressive episode (in those who experience one) may include low mood, feelings of hopelessness, fatigue, and differences in sleep patterns.

Keep reading to learn more about bipolar disorder, why it doesn’t make a person crazy, and where to find help from a therapist who specializes in this disorder.

Having bipolar disorder does not make you crazy

It can be normal to experience mood swings at times. However, if these mood swings tend to affect multiple areas of your life (like work, school, relationships, etc.), then you may wonder if you are one of the many people experiencing bipolar disorder.  

Mania and hypomania refer to the episodes during which a person is on a “high,” when they are full of energy and feel they can conquer the world. This is when many people with bipolar disorder exhibit symptoms that may be noticeable to others. On the other hand, a depressive episode can make a person feel like they are in a state of despair, with low mood and no interest in activities they normally enjoy.

Severe depression or mania can lead to a psychotic episode, during which an individual may experience delusions, hallucinations, or disorganized thinking. The term “psychotic” doesn’t mean a person is crazy; it’s simply a medical term for temporary symptoms for which treatments are available.  

Labeling yourself or anyone else with this disorder as “crazy” can be stigmatizing and prevent those people from seeking help from a therapist who understands what they’re going through.

Symptoms of a manic or depressive episode

People living with bipolar disorder sometimes experience depressive, manic, or hypomanic episodes. Even though mania and hypomania are categorized as two separate kinds of episodes, they typically have very similar characteristics, but hypomania tends to be less impairing. 

As with depressive episodes, manic episodes can lead to psychosis and hospitalization. In order to be diagnosed with a hypomanic or manic episode, at least three or more of the following symptoms typically have to be present:

• Having very high energy levels and being overly active and agitated
• Feeling unusually upbeat, happy, or cheerful
• Being extremely talkative and fast-paced
• Being distracted
• Having a sense of euphoria, of being invincible
• Needing less sleep than normal
• Having racing thought
• Demonstrating reckless, irresponsible behavior (e.g., spending a lot of money, going on a shopping spree, having unprotected sex, or using drugs and alcohol in excess)

The manic episodes described above are often followed by periods of depression. Bipolar depression is defined as periods of time where five or more of the depressive symptoms below are present:

• Feelings of, sadness, loneliness, and hopelessness
• A tendency to cry for no reason
• Lack of interest in activities and things that usually bring pleasure (e.g., listening to music or playing sports)
• Irregularity with sleep patterns, either sleeping too much or not enough
• Fluctuating weight and appetite, gaining or losing weight without trying to
• Loss of energy
• Difficulty concentrating
• Slow, lethargic movements
• Lack of self-confidence and feelings of worthlessness or guilt
• Suicidal thoughts or attempts

Categories and types

The DSM-5 includes a section titled “Bipolar and Related Disorders,” which includes several diagnoses, including the following:

Bipolar I disorder

To be diagnosed with bipolar I disorder, a person must have experienced at least one manic episode lasting for at least seven days. They may also experience depressive episodes, but this isn’t necessary for a diagnosis. It is also possible to experience depressive and manic symptoms at once, which are often called mixed episodes.

Bipolar II disorder

People with bipolar II disorder tend to experience both depressive and hypomanic episodes, but not full-blown manic episodes.  Despite not experiencing full manic episodes, people living with bipolar II disorder may experience chronic depression.

Cyclothymic disorder

To be diagnosed with cyclothymic disorder, a person must have experienced mild depression and hypomania for at least two years, without any asymptomatic period lasting longer than eight weeks.

What intense mood swings really mean

Intense mood swings can occur as a person with bipolar disorder experiences different episodes. In some cases, a person may experience mixed episodes with manic and depressive features. Regardless of the type, these episodes are medical—they are not character flaws.

Bipolar disorder vs. other mental health conditions

Bipolar disorder can have some features in common with other mental health conditions, such as depression, anxiety, and personality disorders. However, to be diagnosed with bipolar disorder, a person must meet a specific set of criteria outlined in the DSM-5. A person living with bipolar disorder may exhibit certain symptoms similar to those of anxiety, but they may not meet the criteria for an anxiety disorder. Also, people living with bipolar disorder may experience intense emotions, which can be common in borderline personality disorder, but the criteria for these disorders are distinct. Only a licensed medical or mental health professional can diagnose bipolar disorder or other mental disorders.  

What bipolar disorder symptoms actually look like day to day 

People living with bipolar disorder can lead fulfilling, productive lives, despite sometimes experiencing depressive, manic, or hypomanic episodes. Manic episodes may make a person feel highly energetic, productive, and unstoppable, with some people working long into the night with little need for sleep. On the other hand, depressive episodes can lead to low mood, intense fatigue, and loss of interest in activities that a person normally enjoys. 

Despite the challenges posed by various episodes, there are treatments that can reduce symptoms. Between episodes, people living with bipolar disorder may function well and perform their work and personal responsibilities with no problem on a daily basis, which underscores the fact this disorder doesn’t make a person crazy.

What causes this mental illness?

Researchers have yet to determine exactly what causes someone to develop bipolar disorder, but they believe that genetics, differences in brain structure, and environmental factors may play a role.

Biology

Studies have shown irregularities in how neurotransmitters (brain chemicals) function in people with bipolar disorder. Differences in brain structure or size may also play a role.

Genetics

Bipolar disorder is usually more common in people who have relatives with the disorder. While scientists believe that genes have something to do with developing the illness, they have yet to determine which genes and how. Having a  family history of bipolar disorder may increase risk, but it does not guarantee that a person will develop the disorder.

Environmental factors

Researchers believe that an individual’s environment can also play a role in bipolar disorder. For example, abuse and other traumatic, stressful events may increase a person’s risk of developing the disorder, in addition to possibly worsening bipolar symptoms when the disorder is already present. Also, abusing drugs and alcohol can put someone at a higher risk of developing the illness.

Treatment options

Treatment of bipolar disorder often involves medication, such as mood stabilizers or antidepressants. Along with medication, talk therapy is often recommended for the person with bipolar disorder as well as their loved ones, as bipolar disorder can be challenging for everyone involved. In some severe cases (e.g., psychosis, attempted suicide), the patient may need to be hospitalized for a period of time.

A note about treatment

After receiving treatment for bipolar disorder, an individual may start to feel better, which may lead them to think they are cured and therefore no longer need to take their medications. However, this can be dangerous because when medication is stopped, the symptoms often return. Following the treatment plan outlined by a doctor is often the best way to reduce symptoms and improve daily functioning.

Some people with bipolar disorder may also be experiencing other mental illnesses or challenges with substance use. A medical health professional can also diagnose and treat those illnesses in conjunction with treatment for bipolar disorder. 

Everyday strategies to manage stress with bipolar disorder

In addition to medication and therapy, individuals living with bipolar disorder may benefit from implementing strategies to manage stress. Stress reduction may lead to fewer episodes and better management of any comorbid mental health conditions. A few strategies that may help include:

• Engaging in regular physical exercise
• Going to bed and getting up at the same time each day
• Implementing mindfulness or another meditation practice
• Spending regular time with friends or family who provide moral support

Online therapy for bipolar disorder

If you are experiencing symptoms of bipolar disorder and feel hesitant to attend in-person therapy, know that help is still available through online therapy. Online therapy offers an effective, convenient way to meet with a mental health professional from the comfort of your own home. You can connect with a therapist in a way that feels right for you, such as: 

• Audio
• Video
• Live chat

In recent years, numerous studies have shown online therapy to be effective. One study found that online cognitive behavioral therapy (CBT) was effective for bipolar disorder, depression, social anxiety disorder, phobias, and substance use disorder, among other disorders. While only a psychiatrist or other health care provider can prescribe the medication a person with bipolar disorder may need, an online therapist can provide a safe space for individuals to process their feelings and receive support as they adjust to life with bipolar disorder.