Individuals with bipolar disorder experience mood episodes, or intense emotional states lasting several days or weeks. These episodes can be manic (abnormally happy, irritable, or energetic), hypomanic (a less severe form of mania), or depressive (deeply sad), states the American Psychiatric Association (APA). Mood episodes often lead to extreme behavior changes, which can in turn cause relationship problems and disruptions to one’s daily routine, especially with work or school. Myths and stereotypes about bipolar disorder abound, and they can make living with the condition even harder for the people who have it and their loved ones. Knowing the truth about bipolar disorder can save lives. Here are seven common myths about bipolar disorder and the facts that everyone should know.
Myth 1: Bipolar Disorder Only Affects Mood
Fact: It’s true that bipolar disorder causes extreme mood swings, but this is only one part of the condition, says Howard Weeks, MD, chief medical officer at Pathlight Mood and Anxiety Center in Salt Lake City. “When people experience severe depression, it takes a physical toll on the body, and likewise with mania,” adds Dr. Weeks. Per the Mayo Clinic, manic episodes can cause increased activity or energy and decreased need for sleep. And depressive episodes can cause significant, unintentional weight loss and fatigue, lack of energy, and suicidal behaviors. Either one can potentially lead someone to injure themselves or put themselves in harm’s way. “When you are severely depressed or manic, you don’t think clearly and can behave in ways you wouldn’t normally. People can even have psychotic episodes with severe depression or with severe mania,” says Weeks. Psychosis happens when a person loses touch with reality, often evidenced by abnormal thinking, delusions, or hallucinations, as well as a decline in functioning. Outward signs can include speech changes, appearing emotionally blunted or inexpressive, and lacking energy, according to a review published in January 2022 in StatPearls.
Myth 2: Bipolar Disorder Is Easy to Diagnose
Fact: It’s not uncommon for bipolar disorder to be mistaken for another health condition. For instance, according to a review published in January 2021 in the International Journal of Bipolar Disorders, bipolar disorder is often misdiagnosed as major depressive disorder (MDD) in women. Some people with bipolar disorder have more depressive episodes than manic episodes, which can make the diagnosis easy to miss, says Weeks. In the January 2021 review, the researchers noted that women with bipolar disorder are more likely to experience predominantly depressive episodes compared with men. Furthermore, adds Weeks, “It is often true that patients seek help from doctors for depression symptoms more so than for manic symptoms. Part of the reason is that when someone is just starting to become manic, they may feel more productive, and thus their perception is that they aren’t experiencing any problems needing medical help.” He encourages anyone seeking help for depression to tell a health professional if they’ve experienced any of the following, which can be signs of manic episodes:
Rapid speechDecreased need for sleepExtreme grandiosity and distorted sense of self-importanceRacing thoughtsDistractibilityIncreased goal-directed activityEngaging in activities with potentially undesirable outcomes, such as gambling or unsafe sex
A misdiagnosis can have serious consequences for people with bipolar disorder. For instance, if an individual with bipolar disorder is misdiagnosed with MDD and they’re prescribed an antidepressant, the medication may actually worsen bipolar symptoms for some people. “This can cause someone to go into a manic or hypomanic episode,” says Hayden Center Jr., PhD, a licensed professional counselor and member of the counseling core faculty at the University of Phoenix College of Social and Behavioral Sciences.
Myth 3: Bipolar Disorder Looks the Same in Everyone Who Has It
Fact: Bipolar disorder can look different for each person, depending in part on the type of bipolar disorder they have:
Bipolar 1 People with this form of bipolar disorder have had at least one manic episode lasting a week or longer. In some cases, mania is so severe that it requires hospitalization, says Catherine Athans, PhD, a licensed marriage and family therapist in Los Altos, California. If mania goes untreated, a person’s quality of life suffers and can lead to major consequences such as job loss, she adds.Bipolar 2 Individuals with bipolar 2 have experienced at least one depressive episode and at least one hypomanic episode, which involves similar but less severe symptoms than a full-blown manic episode and doesn’t require hospitalization, says Dr. Center. Hypomanic episodes last at least four days, and depressive episodes last at least two weeks, he adds.Cyclothymia This is the mildest form of bipolar disorder. It’s characterized by hypomanic and depressive symptoms for at least two years that occur more frequently but are less severe than those of bipolar 1 or 2, per the APA.
Myth 4: People With Bipolar Disorder Are Either Manic or Depressed — Nothing in Between
Fact: Although bipolar disorder is best known for extreme mood swings, people with this condition can have moods in between, too, meaning they are neither depressed or manic, says Center. The APA calls these periods “neutral moods.” How frequently a person experiences either mood episodes or neutral moods depends on the individual. Some people with bipolar disorder experience “rapid cycling, and others are slower to shift from mood to mood,” says Dr. Athans. According to the Depression and Bipolar Support Alliance (DBSA), rapid cycling means that an individual with bipolar disorder has experienced at least four mood episodes in one year. Mood episodes usually begin with mild symptoms that worsen over time, which can make it difficult to recognize when an episode is starting, Center says. “A major focus of treatment is helping an individual learn to identify the signs that they are entering into a depressive or manic state,” he adds.
Myth 5: Bipolar Disorder Is Not Life-Threatening
Fact: Individuals with bipolar disorder have a greater risk of suicide than the general population, says Center. As many as 19 percent of people with this condition die by suicide, and as many as 60 percent attempt suicide, according to research published in Bipolar Disorders. Suicide risk is most often associated with depressive episodes for several reasons, the DBSA states:
Depressive episodes can be long lasting. Long-term feelings of sadness and hopelessness can raise suicide risk.There are often delays in getting the right diagnosis — it can take up to six to eight years on average. The longer someone goes without the right diagnosis and treatment, the worse their condition can become.It’s common to feel shame, guilt, embarrassment, or regret after a manic episode, often causing an individual to slip into a depressive episode.Involuntary hospitalization for a manic episode can be a traumatic experience for many people and is associated with a heightened suicide risk shortly after discharge.
Myth 6: Mania Increases Productivity
Fact: It can be hard for people with bipolar disorder to recognize when they’re having a manic episode. In the early stages of mania, a person may have a lot of energy and be very happy, says Center. They may also feel like they need significantly less sleep than normal and have an elevated sense of self-importance. “When someone is manic, they don’t know anything else. They feel all-powerful. They feel like they are the smartest person in the room,” says Athans. But mania doesn’t increase productivity in positive ways. While mania can feel good or exciting in the early stages, those good feelings often don’t last, and they’re replaced by confusion, irritability, and racing thoughts, says Center. Manic episodes may also lead to sleep deprivation and risky behaviors, such as shopping sprees, gambling, or reckless sexual behaviors. “Often they feel like they are productive, but after the mania resolves, the work or activities they did are not as good as they thought,” says Weeks.
Myth 7: People With Bipolar Disorder Can’t Live Healthy, Fulfilling Lives
Fact: Though bipolar disorder can be difficult to manage, there are effective treatments that enable people with this condition to function well and live successful lives. “This is usually accomplished with taking mood-stabilizing medication and attending psychotherapy or counseling,” says Center. People with bipolar disorder need to take medication throughout their lives to reduce their risk of future mood episodes, according to the Mayo Clinic. In addition to mood stabilizers, other medications an individual might need include antipsychotic treatments and anti-anxiety medications. Finding the right medication for you can be a trial-and-error process — if one treatment doesn’t work for you, there are others you can try. Psychotherapy can help people learn to manage stress in healthy ways and recognize the triggers that precede manic and hypomanic episodes, adds Center. A form of therapy called interpersonal and social rhythm therapy can help people with bipolar disorder establish consistent daily routines, which can help them better manage their moods, the Mayo Clinic reports. Along with medication and therapy, finding positive ways to channel energy and reduce stress can help people with bipolar disorder manage their condition. Some examples are:
Join a support group for people with bipolar disorder, such as those offered by the Depression and Bipolar Support Alliance.Exercise regularly to help keep your mood stable and lower stress. Your doctor can help you decide how much activity each day is right for you.Avoid using drugs and alcohol, which can make you more prone to risky behaviors during manic or hypomanic episodes and worsen depressive episodes.Try to go to sleep and wake up around the same time every day. A consistent sleep schedule can help you maintain a stable mood.Try new hobbies that help you relax, such as yoga or meditation.
