How do people with bipolar disorder think

Psychiatry, Psychosomatics & Psychotherapy

With bipolar illness, those affected fluctuate between periods of mania in which they are overactive, euphoric, or irritable. In between there can be phases of less pronounced mania (hypomania) or depression. In addition to the depressive and manic poles, 20 to 60% of the sick also experience so-called mixed states, in which symptoms of both depression and mania occur. Bipolar diseases can have quite different forms and courses from individual to individual. That is why the clinical picture cannot always be clearly assigned and recognized.

Bipolar illnesses are particularly pronounced and severe when psychotic symptoms occur, i.e. the patient perceives himself and the environment in a distorted manner due to a disruption of the sense of reality. They are more common in mania than in depression. Over two-thirds of all patients with manias show individual psychotic symptoms, including boundless overestimation of themselves, paranoia, delusions and hallucinations.
The following table summarizes and compares possible symptoms of a manic and a depressive episode:

Symptoms of bipolar episodes


High mood or irritable mood

Melancholy, depressed mood

Emotional excitement with euphoria or irritability

Inhibited emotions, feeling numb, fears, pessimism

Acceleration of thinking, language, motor skills and action

Slowing down and inhibition of thinking, language, motor skills and action

increased risk behavior and need for contact, impulsiveness, reduction of social inhibitions, aggressiveness, carelessness

Withdrawal behavior

excessive enterprise

Loss of interest, joylessness and lack of motivation,

Drive increase, excess energy, need for employment

Lack of drive, reduced vitality, lack of energy, physical malaise, loss of libido

increased creativity

Lack of ideas, impaired concentration and attention

decreased need for sleep

Sleep disturbances or increased need for sleep, waking up early, feeling restless after sleeping at night, low in the morning

increased self-confidence and self-esteem

Self-doubt, feelings of guilt, feelings of insufficiency, discouragement, weariness with life, thoughts of suicide

In some patients, in their manic phase, irritability and mistrust can be observed instead of euphoria.

In hypomania, the symptoms appear - usually only for a few days - as in mania, although they are much less pronounced. The person concerned is still able to grasp the reality and his personal situation. Hypomania can appear as a brief and temporary increase in normal mood, but it can also be a harbinger of pronounced mania. As a rule, it is necessary to intervene therapeutically as soon as possible, even in the case of hypomania, since it is often the beginning of a mania and is usually followed by depression after a mania.

In most cases, however, those affected do not come to the doctor in the manic phase. You don't feel sick. Pointing out to someone else's obviously troubled mood can lead to aggression and stubborn denial. Especially if someone has previously suffered from a depressive phase, the mania can understandably be perceived by him as a release.