By: Corrina Horne

Updated September 10, 2021

Medically Reviewed By: Aaron Horn

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What Is High Functioning Bipolar Disorder?

Signs, Symptoms, Diagnosis, and Treatment 

High Functioning Bipolar Disorder (HFBD)

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 today. 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, you might have High Functioning BD. 

Does HFBD Have A Spectrum?

HF Bipolar, Bipolar 1, Bipolar 2, And Other Bipolar Disorders

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 BD 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 1, 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 the disorder and is known for periods of mania that may require hospitalization. People during these periods of mania may be unable to sleep, unable to stop their heart from racing, or thoughts from racing, and may exhibit extreme behavior because of 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 disrupt day-to-day living. 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.

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How Is HFBD Treated And Managed?

High Functioning BD usually employs both standard treatments, 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.

Please consult with your doctor or primary care physician before considering any medication options.

In therapy, someone with high functioning 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 the need for your medication to keep yourself safe. You can also reach out to your loved ones for help and give 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 HFBD Differ From Other Types?

The term “high functioning bipolar disorder" is not identified in the Diagnostic and Statistical Manual of Mental Disorders  (DSM-5). It is instead a categorization created to identify any form of BD that is managed by the person with the condition somewhat effectively. Someone with Bipolar 1 or Bipolar 2 could be considered high functioning, as can people with Bipolar Disorder NEC and Cyclothymic Disorder. Conversely, people whose illnesses fall into these categories can also be considered low functioning. Each of these forms of disorder is marked by a series of manic and depressive episodes. 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. Many people with high-functioning bipolar disorder (BD) 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 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. Many illnesses that delineate high and low functions do so to indicate a condition’s severity. Bipolar disorder, though, uses the terms to indicate whether or not someone can function despite their condition or requires additional help or intervention to manage their symptoms, regardless of their condition’s actual severity.

What HFBD Can Look And Sound Like

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