What Does High Functioning Bipolar Disorder Look Like?
Updated February 24, 2020
Reviewer Aaron Horn
The term "bipolar disorder" is often used flippantly to describe someone who is particularly moody or someone who frequently runs hot and cold. This is not an isolated phenomenon; numerous legitimate mental health conditions have been whitewashed in this way, as in the case of Obsessive-Compulsive Disorder, the acronym of which has been co-opted to describe someone who is excessively tidy or neurotic. Despite its common use, however, Bipolar Disorder is a legitimate mental health condition that operates on a spectrum and often requires therapy or pharmaceutical intervention to manage symptoms.
What Exactly Is Bipolar Disorder?
Bipolar Disorder is a mood disorder diagnosed when an individual experiences manic highs and depressive lows in succession. These highs and lows will depend on the person who experiences them. For instance, some people experience intense highs of productivity for 7-10 days, then fall into a depressive episode, characterized by difficulty even getting out of bed in the morning. Others have milder symptoms, with a week or two of improved mood and positivity, followed quickly by a week or two of depressed mood and increased negativity.
Bipolar Disorder only qualifies as such if the highs and lows are beyond the scope of what would be considered a "normal" shift in perspective from week to week-or day to day-and episodes are outside of the patient's control. If, for instance, you find yourself experiencing highs and lows, but you are effectively able to reason yourself into a more neutral middle ground with little difficulty, it is not Bipolar Disorder, but a natural series of mood fluctuations. Severe mood swings in recurring patterns is what we commonly recognize as bipolar Disorder.
What Is The Bipolar Spectrum?
Four types of Bipolar Disorder are recognized, although only two of the four are given the actual name of "Bipolar." The spectrum was created to delineate the different faces that Bipolar adopted to create more effective treatment methods for the differing levels of severity. Someone who experiences Bipolar 1 may require literal hospitalization during periods of mania, while someone who is on the less severe end of the spectrum may require antidepressants for depressive episodes, without being largely affected by periods of mania.
The four types of Bipolar Disorder are Bipolar 1, Bipolar 2, Bipolar Disorder Not Elsewhere Classified, and Cyclothymic Disorder. Each type has its own unique set of symptoms and its level of severity, and each type is likely to have different treatment options and preferences.
Bipolar 1 is the most severe form of Bipolar Disorder and is known for periods of mania that may reach pitches so intense that hospitalization is required. People during these periods of mania may be unable to sleep, unable to stop their heart from racing, or thoughts from racing, and may be driven almost to madness with the energy coursing through them. Mania may be treated in the hospital, in more severe cases, or with sedative medications, in less severe cases. Manic periods last at least a week (but may go longer) in Bipolar 1, followed by depressive episodes that can last two weeks or more.
Bipolar 2 is often misdiagnosed as depression, as its manic episodes are usually hypomanic in nature; this means that the mania is not necessarily visible to others, or even the person with the disorder, as mania may be reflected in simple cheerfulness or a feeling of normalcy. Depressive episodes in Bipolar 2 may be more severe, though, and may include thoughts of suicide. Misdiagnosis can further complicate these symptoms, as treating only the depressive aspect of Bipolar Disorder can create feelings of confusion and isolation in patients.
Bipolar Disorder (Not Elsewhere Classified) is so named for its Bipolar appearance, without the severity or duration attributed to Bipolar Disorder. While people who have Bipolar Disorder experience each swing of symptoms for one week or longer, people with this form of the condition might experience highs and lows that cycle back and forth between days, rather than weeks.
Cyclothymic Disorder is the least severe of the types of Bipolar Disorders, with mood swings and mood changes being the operative symptoms, though these changes are not considered severe enough to derail natural living thoroughly. Cyclothymic Disorder does not necessarily progress into more intense forms of Bipolar Disorder; instead, it is a separate categorization within the spectrum and can exist on its own without growing worse.
How Is Bipolar Disorder Treated?
Bipolar Disorder usually employs both standard treatment, such as Cognitive Behavioral Therapy, and pharmaceutical intervention, in the form of antidepressants, sleep aids, antipsychotic medication, and sedative aids. Because the symptoms of Bipolar Disorder swing from one high to another, treatment often requires a period of adjustment with medication, to find a balance between manic and depressive symptoms, and may vary widely throughout a person's life.
In therapy, someone with Bipolar Disorder might be encouraged to identify who they are - apart from their illness. Because Bipolar Disorder affects your moods and your interactions with others, you can fall into the trap of thinking that you are flawed, you are broken, or you are unlovable. Therapy is an important aspect of treatment because it provides something medicine alone cannot: the ability to separate yourself from your symptoms and determine who you are. When you do this, you can recognize the onset of your symptoms more effectively, and keep yourself safe by recognizing the need for your medication, reaching out to your loved ones for help, and giving yourself the space to process what is going on in your body and mind.
Therapy is also helpful for people who are unsure of their symptoms. Because Bipolar Disorder functions on a spectrum, identifying your symptoms can be difficult if you rely entirely upon other people's definitions and examples. Therapy can help you sort out what symptoms are due to Bipolar Disorder, and what mood shifts and changes are natural responses to stimuli and everyday events. This can help you gain confidence both in your day-to-day doings and in the management of your disorder.
How Does High-Functioning Bipolar Disorder Differ From Other Types?
The term "High-Functioning" in Bipolar Disorder is not one that is identified in the DSM but is instead a categorization created to identify any form of Bipolar that is managed by the person with the condition somewhat effectively. Someone with Bipolar 1 and Bipolar 2 could be considered high-functioning, as can people with Bipolar Disorder NEC and Cyclothymic Disorder-and people whose illnesses fall into these categories can also be considered low-functioning. Each of these forms of Bipolar is marked by a series of manic and depressive episodes, but what makes someone "high-functioning" is their ability to cope with and adapt to the onset of an episode.
While the term "high-functioning" carries with it a connotation of being better or healthier, this is not necessarily the case. Because many people with high-functioning Bipolar Disorder have simply learned how to cope by hiding their condition, and keeping themselves together as long as possible, people with high-functioning BD might actually experience more stress and symptoms of anxiety, because they feel they must constantly be "on" and ready to pretend that their symptoms are not affecting them as intensely as they are.
High-functioning does not necessarily indicate that someone on the Bipolar spectrum is better or healthier-it simply means that these people have learned how to manage their symptoms to create the appearance of normality, even when normality is far from their experience. While many illnesses that delineate high and low functions do so to indicate a condition's severity, Bipolar Disorder uses the terms to indicate whether or not someone is able to function in spite of their condition, or requires additional help or intervention to manage their symptoms, regardless of their condition's actual severity.
What High-Functioning Bipolar Disorder Looks Like
Despite the consistent suggestion that high-functioning Bipolar Disorder is tantamount to a less severe illness, someone who is on the Bipolar spectrum and is high functioning is merely someone who has learned how to manage their illness and create the appearance of normalcy, even if symptoms are severe and intense enough to warrant a diagnosis of Bipolar 1. The term is one that does not have a place in medical literature but is instead a means of describing people within the disorder who might not appear to have severe symptoms.
People with high-functioning Bipolar Disorder may be at greater risk than those who do not; because these individuals can manage and even hide their conditions as well as they are, they may be overlooked for treatment. One therapist even expressed concern that his patient would be turned away from a hospital, despite hallucinations and severe depressive episodes, because she can appear "normal." High-functioning Bipolar Disorder, then, is not a goal of treatment but is another facet of the disorder that may need to be addressed and modified.
Seeking treatment for Bipolar Disorder can be frightening, and identifying your symptoms may be difficult, particularly in the case of hypomania. If, however, you find yourself experiencing periods of depression that you cannot pull yourself out of, or periods of mania that seem to be disrupting your life, speaking with a therapist could help you determine what exactly your symptoms indicate, and how you can move toward health and wellness. Not all mood swings or manic and depressive episodes are indicative of Bipolar Disorder but may signal the presence of something in need of help or healing.