What Does High Functioning Bipolar Disorder Look Like?

By: Corrina Horne

Updated September 10, 2021

Medically Reviewed By: Aaron Horn

BD is often used flippantly to describe someone who is particularly moody or someone who frequently runs hot and cold. However, even HFBD is a serious condition. HFBD is a legitimate mental health condition that often requires pharmaceutical intervention.
 
BetterHelp Online Therapy has licensed online therapists who have expertise in mental health and mood disorders, and they can help you manage the symptoms. They can offer a nonjudgmental space for you to learn to view yourself with positivity and how to set and reach your goals. With the help of a therapist, you will be able to tease out what you’re experiencing and the best treatment options for you.
 
HFBD 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. HFBD describes someone who is naturally able to manage their symptoms well; it does not describe the severity of their disorder. Someone with HFBD is still living with changes in mood and energy levels. Continue reading this article to learn more about HFBD such as its symptoms and the toll it can take on every aspect of one's life, such as in work and relationships. 

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What Is High Functioning Bipolar Disorder?

Signs, Symptoms, Diagnosis, and Treatment 

High Functioning Bipolar Disorder (HFBD)

HFBD 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. HFBD describes someone who is naturally able to manage their symptoms well; it does not describe the severity of their disorder. Someone with HFBD is still living with changes in mood and energy levels.

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

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 someone who has learned how to manage their illness. They create the appearance of normalcy, even if symptoms are severe and intense enough to warrant a diagnosis of Bipolar 1. The term 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 have this. Because these individuals can manage and even hide their conditions well, they may be overlooked for treatment. 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 an in-person or online therapist could help. A therapist can help you determine what exactly your symptoms indicate and how you can move toward health and wellness.
 
If you’re curious about online therapy, a study found that online therapy to be effective in the treatment of bipolar disorder in a collaborative-care program. Four hundred participants with bipolar disorder received treatment via videoconferencing. Rates of participation were similar to those at a facility that treats people with bipolar disorder. Improvement in several clinical indices was found in participants who completed the program. Online therapy can also be useful for people who experience depression and anxiety.

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BetterHelp Can Support You With HFBD

BetterHelp has licensed online therapists who have expertise in bipolar disorder and can help you manage the symptoms. They can offer a nonjudgmental space for you to learn to view yourself with positivity and how to set and reach your goals. 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. With the help of a therapist, you will be able to tease out what you’re experiencing and the best treatment options for you. Below are some reviews of BetterHelp counselors from people experiencing similar issues.

BetterHelp Therapist Reviews

“Dr. Von Tersch is wonderful! I’ve been working with her for about a year now and I’ve seen drastic improvements in my mood and mental health!”
 
“Sarah has been amazing. I came to her at one of my lowest moments when I had no hope things would start looking up. With Sarah’s help, I have started feeling close to myself again. Nothing is an overnight fix, but I am so glad I met her.”
 

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