How to accept a bipolar disorder diagnosis

This article was co-authored by Rebecca Tenzer, MAT, MA, LCSW, CCTP, CGCS, CCATP, CCFP. Rebecca Tenzer is the owner and head clinician at Astute Counseling Services, a private counseling practice in Chicago, Illinois. With over 18 years of clinical and educational experience in the field of mental health, Rebecca specializes in the treatment of depression, anxiety, panic, trauma, grief, interpersonal relationships using a combination of Cognitive Behavioral therapy, Psychodynamic therapy, evidence-based practices. Rebecca holds a Bachelor of Arts (BA) in Sociology and Anthropology from DePauw University, a Master in Teaching (MAT) from Dominican University, and a Master of Social Work (MSW) from the University of Chicago. Rebecca has served as a member of the AmeriCorps and is also a Professor of Psychology at the collegiate level. Rebecca is trained as a Cognitive Behavioral Therapist (CBT), a Certified Clinical Trauma Professional (CCTP), a Certified Grief Counseling Specialist (CGCS), a Clinical Anxiety Treatment Professional (CCATP), and a Certified Compassion Fatigue Professional (CCFP). Rebecca is a member of the Cognitive Behavioral Therapy Society of America and The National Association of Social Workers.

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It can be hard to share personal issues with people, even if they are people that care about you. It can seem even more challenging if the personal issue is bipolar depression. You may be unsure how to approach the topic or when. You might be wondering which friends you should tell. If you prepare to talk to your friends, tell them with confidence, and follow-up on the conversation, you can tell your friends about your bipolar depression.

How to accept a bipolar disorder diagnosis

The symptoms of bipolar disorder aren’t always easy to spot. While some people experience dramatic highs and lows, for others the signs are much subtler. There is also a lot of misinformation about bipolar disorder, making it easy to misdiagnose or leave untreated, as well as different forms it can take. So how do you know whether you have bipolar or you’re just experiencing normal mood changes? Here are some tell-tale symptoms of bipolar disorder.

What are the Symptoms of Bipolar Disorder?

The symptoms of bipolar disorder vary according to the form the illness takes. A person with bipolar I disorder has typically experienced at least one manic episode, characterized by abnormally high energy, elevated ideas, disruptive or destructive behavior and grandiose ideas. Most people with bipolar I also experience bouts of depression.

Bipolar II is similar to bipolar I, but the “up” moods never meet the criteria for full mania. These episodes are referred to as hypomania. Most people with bipolar II disorder experience more depressive episodes than hypomanic ones.

The third form of bipolar disorder is called cyclothymia. Cyclothymia is characterized by rapid mood cycles between depression and hypomania that don’t fit the criteria for mania or major depression. Many people consider cyclothymia to be the “less severe” form of bipolar disorder, but it can still lead to erratic and unhealthy behavior and disrupt your quality of life. What’s more, people with bipolar II or cyclothymia have a heightened risk of developing bipolar type I. All forms of bipolar disorder can have potentially dangerous consequences if left untreated.

Bipolar Disorder Signs and Symptoms List

According to the fifth and most recent edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), which is prepared by the American Psychiatric Association and contains the formal requirements for diagnosing mental illnesses, there are certain diagnostic criteria for bipolar episodes.

According to the DSM-5, tell-tale signs of bipolar disorder symptoms include:

Manic episodes

  • Extremely high self-esteem or grandiosity
  • Reduced need for sleep
  • Talking more than usual, often loudly and quickly
  • Becoming distracted easily
  • Doing too many activities at once
  • Risky behavior, such as spending sprees, substance abuse, hypersexuality and reckless driving
  • Racing thoughts

Hypomanic episodes

According to the DSM-5 bipolar disorder symptoms list, a hypomanic episode is similar to a manic episode except the symptoms are milder, usually lasting a maximum of four days in a row. Most people in hypomania are still able to function perfectly well and do not require hospitalization.

Major depressive episodes

Major depressive episodes are periods of two weeks or more in which a person has at least five of the following symptoms, including one of the first two:

  • Intense sadness or despair, including feeling helpless and hopeless
  • Loss of interest and pleasure in usual activities
  • Feelings of guilt and worthlessness
  • Sleep problems, such as sleeping too little or too much
  • Feeling restless or agitated
  • Slowed movements
  • Changes in appetite
  • Extreme fatigue
  • Difficulty concentrating and making decisions
  • Recurring thoughts of death or suicide


To be diagnosed with cyclothymia (cyclothymic disorder), the symptoms of hypomania and depression must be present for two years or more, without becoming full bipolar disorder. During this period, the symptoms will have lasted for half the time and never stopped for more than two months.

Bipolar Disorder Symptoms: How To Know If You Have Bipolar

While educating yourself about bipolar disorder symptoms can be helpful, the only way to tell if you have bipolar is to receive a diagnosis from a medical professional. If you experience symptoms of bipolar disorder, you should see your doctor, even if you don’t have all of them. Your doctor will most likely refer you to a mental health specialist who will assess whether you fit the DSM-5 bipolar disorder symptoms criteria.

This article was co-authored by Ran D. Anbar, MD, FAAP. Dr. Ran D. Anbar is a pediatric medical counselor and is board certified in both pediatric pulmonology and general pediatrics, offering clinical hypnosis and counseling services at Center Point Medicine in La Jolla, California and Syracuse, New York. With over 30 years of medical training and practice, Dr. Anbar has also served as a professor of pediatrics and medicine and the Director of pediatric pulmonology at SUNY Upstate Medical University. Dr. Anbar holds a BS in Biology and Psychology from the University of California, San Diego and an MD from the University of Chicago Pritzker School of Medicine. Dr. Anbar completed his pediatric residency and pediatric pulmonary fellowship training at the Massachusetts General Hospital and Harvard Medical School and is also a past President, fellow and approved consultant of the American Society of Clinical Hypnosis.

There are 12 references cited in this article, which can be found at the bottom of the page.

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Hearing that you have bipolar disorder can be a difficult moment. You may not believe your doctor or think there is nothing wrong with you. Around two-thirds of people who are diagnosed with bipolar have trouble accepting the diagnosis [1] X Research source . Though it may take a long time, through educating yourself, seeking support, and committing to a treatment plan, you can learn to accept your diagnosis.

Accepting my diagnosis of bipolar 1 disorder did not come easy. It assigned a term to every act I ever committed, to every emotion I ever endured. At times, it made me question who I was from day one of my life. Not knowing I had an illness in itself made it hard for me to accept the disorder — you can’t accept something you don’t know you have. It took about a year for the realization that I was living with an illness to really sink in. I think having to take medication on a daily and nightly basis finally drove the point home. With time, I came to know more about my illness, and as the days in the psychiatric hospital where I was diagnosed fell behind me, I felt myself returning to my “normal” self again, or at least something that felt close to normal.

I began accepting my diagnosis.

Accepting having to take medication for the rest of my life is still something I struggle with today. I find myself 17 years later, my biological clock ticking and my desire to have a family more prominent than ever. Being on the kind of medication I am on complicates my situation tremendously. To wean myself off of my medication in order to bear a child poses an enormous risk. I could have another breakdown, fall back into cyclic anxiety and depression or be subjected to chaotic mania yet again.

Truth is, who really knows what would happen? It is a problem numerous women with mental illnesses and on medication must face. Do you accept your current situation, let go of your dream of having a baby in order to avoid all risks of endangering your sanity? Or do you take a chance, determine your love for a growing baby inside you will be enough to keep you from slipping away from reality? How much do you trust yourself to step aside and let logic win say, if you were to get pregnant and all your hormones are drowning out that logic?

Apart from accepting my diagnosis and the fact that I will need to take medication for the rest of my life, there is another kind of acceptance that comes to mind. It is accepting the realization that I am not immune to falling again. No matter how many times I get sick and get well again, no matter how great my life may seem to be going and how stable I seem to be, I have come to terms with the reality that another relapse or breakdown could very well occur. It’s an ongoing battle. But I know I can’t be afraid to live my life. Knowing there will always be trips and falls along the way, I immediately combat with the knowledge that I have the ability to overcome and soldier on. I have done so in the past, and I can do it again.

And once I can accept that knowledge, knowing I have it in me to fight, there is no reason I cannot live a full amazing life even with this illness. I will keep soldiering on. I will keep fighting the fight. I have come this far.

When a partner denies their bipolar disorder diagnosis, it’s easy to get frustrated. But, take a moment and view the situation from their shoes––and adjust your approach accordingly.

How can I get my partner to accept their diagnosis? You can’t. It simply doesn’t work this way. Trying to get another person to do anything is not our job. Our job is to know what we need and let the other person know there is a choice if that person wants to be with us. I wrote Loving Someone with Bipolar Disorder in 2002. It is based off my experiences as a person who was in a ten year relationship with a person who has bipolar I. I then became a coach for partners. I would say that in the past 20 years, I have worked with tens of thousands of partners all over the world. Not one of them has been able to get a partner to accept the bipolar disorder diagnosis.

As you might know, I also have bipolar disorder and a psychotic disorder so my experience is from both sides.

People do what they want. It’s that simple. As partners, we want our partner to accept the bipolar diagnosis. It means that he will then get help! And she will take her meds! And our relationship will be better! Agreed. That is what it would mean for you. But what does this idea of acceptance mean for those of us with the illness?

I accept that I am disabled and will never get better.

I accept that I am flawed and no one will love me.

I accept that I can’t be a good parent.

I accept that I can’t earn a living.

I accept that this illness might take my life.

That is how we think when someone says, “Julie, just accept the bipolar and get on with it!” We have a brain disorder. It makes sense that the disorder itself would affect our ability to ‘accept’ our reality.

I want to change the way we talk about the illness with partners. What we are doing now isn’t working very well. Getting a partner to accept a diagnosis is too high a place to start.

How about getting a partner to work with you on the following:

– Let’s discuss our health care options together.

– Let’s be open about the genetic illnesses in our family tree so that we can be there for our kids.

-Let’s acknowledge that each one of us has a different experience in the relationship and learn to meet in the middle.

This is a start of what we now call acceptance. When you love someone with bipolar disorder, there is a very good chance you met that person when manic and now have to live with a depressed person. There is a really good chance that you went into the relationship with a fun loving party animal who now can’t get off the couch. Or, the illness developed over time and you had no idea what was going on.

This is shocking for you.

As a stable person with a well working brain, it’s totally natural that the bipolar disorder diagnosis would answer your questions. You have to go through an acceptance process as well. Hmm. The person I love has a genetic mental health disorder that is passed down through the family tree. Well, I love him, so we will deal with this together! Or, I love her and now is the time or action to get this under control.

Your acceptance (just like my acceptance when I first heard the words, “Your partner is in what we call a psychotic manic episode and has an illness called bipolar disorder. Is there any manic depression in the family?”) is on a different path than the acceptance people with bipolar disorder go through. We are the ones saddled with this diagnosis. It’s painful! It takes our dreams! It’s embarrassing and makes us feel less than!

All of this is ok. I am being very honest as this is the internet and we want things quickly. What isn’t quick is the process you are now going through. My concept of acceptance has changed over the years. What if we talk about meeting in the middle to manage an illness and let acceptance be a by product? If your loved one has a diagnosis, but is struggling with the diagnosis, this is totally normal. Focus on communication, symptom management and treating bipolar disorder pragmatically through lifestyle changes. Talk with your partner about what YOU need and invite your partner to join you as you each go through this journey on separate, but parallel roads.

If you have a partner who is denying the diagnosis, that is a different path. That is about illness and lack of insight, substance use or personality. If you are in this situation, the life long path towards accepting help comes through getting the person into treatment to calm down the symptoms. No, this is not easy, but it’s possible and there are resources here you can use to get your needs met while trying to get someone a correct diagnosis. I had to go through this before my partner and I could even begin to discuss how bipolar impacted our lives.

We don’t change other people. We don’t determine when and how they accept what is happening in the body and brain. But we can join someone. We can guide the person through our own behavior. We can tell them what we need in order for the relationship to continue. We can be clear on ourselves and what we are going through. This is the first step towards life with a partner who is open to getting stable.

How to accept a bipolar disorder diagnosis

Do I Have Bipolar Disorder?

While everyone experiences emotional highs and lows, people with bipolar disorder are on the extreme ends of the spectrum. Bipolar disorder, once called manic depression, can manifest differently for various people, but its characteristics include depressive episodes interspersed with bouts of seemingly boundless energy and excitement. As many as 4.4% of U.S. adults experience bipolar disorder, while an estimated 82.9% of people with bipolar disorder may struggle with severe impairment. What does this mental health condition entail, and what are your options if you suspect you have it?

What Is Bipolar Disorder?

Bipolar is an illness of dramatic mood swings. When depression strikes, you may feel hopeless, empty and find it challenging to muster up enthusiasm for most activities. Suicidal thoughts are also common in these phases. During manic periods, you might feel euphoric, animated or invincible. These ups and downs can play havoc with your energy levels, judgment, appetite, sleep quality and decision-making skills.

Manic and depressive episodes can include psychotic symptoms, including delusions and hallucinations. Some people also experience mixed episodes, which simultaneously have characteristics of mania and depression.

Depending on your symptoms and their severity, a mental health professional may diagnose you with bipolar I, bipolar II or cyclothymia. All three of these types cause drastic, erratic changes in your overall mood and behavior. While there is no cure for bipolar disorder, a long-term treatment plan can help you regulate your emotions and improve your quality of life.

What Causes Bipolar Disorder?

While bipolar symptoms can affect people in any stage of life, the disorder often manifests in adolescence or early adulthood. Though the specific causes remain unknown, your risk of developing bipolar disorder may be higher if your parents have it. However, bipolar disorder’s genetic component remains unclear. Bipolar episodes may also occur during pregnancy or change with the seasons.

Some initial research indicates that people with bipolar disorder may have a different brain structure than those who don’t. Additional research into these differences can help mental health professionals understand bipolar disorder and determine effective treatments.

Some people’s lifestyle choices and environmental factors might influence whether they have bipolar disorder. For example, stressful or traumatic events can trigger disease symptoms. Often, people with bipolar disorder also have other illnesses, such as PTSD, ADHD, anxiety, an eating disorder or substance use issues. Sometimes, these co-occurring disorders can complicate your diagnosis and make it more challenging to develop a successful treatment plan.

How to Get Help for Bipolar Disorder

Keeping up with your mood swings, sleep patterns and daily behavior in a journal or a tracking app may help make your ups and downs more predictable. Knowing when a manic or depressive episode might be coming on can give you a better sense of control.

Other ways to treat and manage bipolar disorder may include:

  • Prescription medications like antidepressants and antipsychotics
  • Specific, evidence-based therapeutic techniques, such as cognitive behavioral therapy
  • Mood-boosting activities, including meditation, goal-setting and exercise

Seeking Treatment for Co-Occurring Disorders

Beach House is a leading treatment facility located in beautiful Juno Beach, Florida. At our state-of-the-art campus, you can receive a full continuum of care, from medically managed detox to inpatient rehab and outpatient services. Here, we have built a unique culture that supports the recovery process by surrounding clients with love and compassion.

At our beautifully appointed, resort-like campus, residents can enjoy the benefits of beachfront living while forming a therapeutic alliance with their treatment team. To learn more about finding freedom from addiction and mental health disorders at Beach House, please reach out to our admissions counselors anytime, 24 hours a day, seven days a week.

Bipolar disorder, once known as manic-depressive disorder or manic depression, is a form of depression in which periods of deep depression alternate with periods of hyperactivity and uncontrolled elation (mania).

People with bipolar disorder differ from those with other depressive disorders in that their moods swing from depression to mania, often with periods of relatively normal mood between the two extremes.

The disorder usually begins with a depressive episode in adolescence or early adulthood. The first manic phase may not follow until several years later. The length of the cycle, from the heights of mania to deep depression, varies from person to person. The risk of suicide is high among people with bipolar disorder; an estimated 1 of 4 people attempt suicide, and 1 of 10 succeed.

Heredity is an important factor in bipolar disorder. Close relatives of people suffering from bipolar disorder are much more likely to develop it, or some other form of depression, than the general population. Environmental factors, such as troubled family relationships, may aggravate this disorder.


Bipolar disorder is a recurring disease that goes in cycles. One part of the cycle is marked by symptoms of mania, the other by symptoms of depression. These “mood episodes” are often intense. During the manic phase, an individual can be cheerful, outgoing, talkative, and energetic. Until the mania gets out of control, he or she can be extremely productive and wonderful company.

During a manic episode an individual may:

  • feel very energetic
  • talk a lot about different things
  • have trouble sleeping or relaxing
  • jump from thought to thought or project to project
  • develop exaggerated self-confidence or thoughts of power and wealth
  • do risky things like abuse alcohol or other drugs, recklessly spend or invest money, engage in reckless sex

During a depressive episode an individual may:

  • feel down or worried
  • lose interest in activities or relationships
  • have trouble concentrating
  • have trouble sleeping
  • think about death or suicide

The symptoms of bipolar disorder are not always easy to distinguish from other serious conditions. Mania can be difficult to tell from schizophrenia. People who take amphetamines or corticosteroid drugs or people with overactive thyroid glands have symptoms similar to those of people with the manic phase of bipolar disorder. Some people have bipolar disorder for months, if not years, before it is diagnosed.

Untreated, the manic phase can last as long as 3 months. As the mania fades, the individual may have a period of normal mood and behavior that lasts for weeks, or even years. Eventually, the depressive phase of the illness sets in.

About 10% to 20% of people with bipolar disorder develop what is known as rapid cycling, with more than four episodes of mania and depression a year. The chance that there will be future attacks rises with each new episode.

Treatment options

If you or someone you are close to is experiencing the symptoms of bipolar disorder, medical attention is urgently needed. A person in a period of mania often does not know that he or she is behaving strangely and in need of medical attention. A complete evaluation by a psychiatrist is critical to arriving at an accurate diagnosis, which is the first step toward an appropriate treatment plan. Sometimes, manic people are so out of control that they pose a threat to themselves and others and need to be hospitalized.

Bipolar disorder is highly treatable. The most commonly used medications are mood stabilizers such as lithium, antiseizure drugs, and atypical antipsychotics. Antidepressants and sleep medications may also be used. These medications are usually most effective when they are combined with psychosocial treatment.

Even with treatment, though, relapse is common. In one study, people who were treated with lithium and continued to take it averaged 1½ weeks a year when they were severely ill, whereas people who stopped taking the medicine averaged 13 weeks a year of severe illness.


Lithium is the most frequently used mood stabilizer. It prevents the mania and, to a lesser extent, the depression, although how it does this isn’t known.

Seventy percent of people with bipolar disorder who take lithium experience fewer and less-intense manic episodes. In about 20% of people with bipolar disorder, lithium completely relieves symptoms.

However, lithium is not a cure. The mood cycle often emerges if treatment is stopped, even after many years of treatment. Lithium use must also be monitored carefully. Its side effects include weight gain, hand tremors, drowsiness, excessive thirst, and frequent urination.

Because lithium can injure the heart, kidneys, or thyroid gland, it’s important to have a physical examination and blood tests before taking it. The dose is usually increased gradually until the drug begins to work, and is then periodically adjusted. Blood levels of lithium are checked regularly; it is ineffective if the level is too low and risky if the level is too high.

Antiseizure medications

Antiseizure drugs may be used instead of lithium, especially when the mood cycle is very rapid. These medications can have mood-stabilizing effects and may be especially useful for treating someone in the midst of a bipolar episode and also for preventing further episodes of it. Antiseizure medications commonly used for treating bipolar disorder include:

  • valproate (Depakote, Depakene)
  • carbamazepine (Tegretol)
  • oxcarbazepine (Trileptal)
  • lamotrigine (Lamictal)

Like lithium, antiseizure drugs can have unwanted side effects.

Atypical antipsychotics

Second-generation antipsychotics, also called atypical antipsychotics, can also be used to treat manic episodes of bipolar disorder. Examples of these medications include:

  • risperidone (Risperdal)
  • aripiprazole (Abilify)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • ziprasidone (Geodon, Zeldox)
  • olanzapine plus fluoxetine (Symbyax)
  • asenapine (Saphris)

Antidepressants and sleep aids

An antidepressant may help individuals cope with the depressive phase of bipolar disorder. Sleep aids may be needed during the manic phase.

Electroconvulsive therapy

Electroconvulsive therapy, also known shock therapy, can be an effective treatment for severe manic or depressive episodes, especially among individuals having serious suicidal or psychotic symptoms, or when medical therapy is not working.


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Dealing with the emotional and psychological impact of the bipolar diagnosis

Posted July 14, 2017


  • What Is Bipolar Disorder?
  • Find a therapist to treat bipolar disorder

When you have a close connection with someone diagnosed with the disorder, it’s so easy to rapidly want to move towards solutions and positive adaptations. If people are struggling with depression or recurrent mood instability, you want to see them do better. You want to convince them that they will gradually get better. You want to offer hope and positive attitudinal change. And, if you’re the in the early stages of living with bipolarity, then you may find yourself on the receiving end of a lot of support and positive encouragement and support.

Modification of negative thinking, development of positive attitude, and optimism about future are frequently encouraged in those who live with bipolar disorder. After all, it’s not good to persistently mope or feel bad for one’s situation. Those negative thoughts can absolutely lower the bottom end of a bipolar depressive episode. It’s like adding weight to someone who is already having a hard time with gravity. Attention to positive thinking is also very much reinforced by many contemporary treatment approaches rooted in cognitive-behavioral therapy. After all, CBT is the most commonly used treatment approach for depressive disorders.

But there’s something that accompanies the bipolar diagnosis that can often be missed in the efforts to help someone manage the early phases of their bipolarity. I’m referring to attunement to the painful losses that come with the illness. It’s the experience of saying to the person with bipolar disorder – “I know you’re hurting … I can see your pain … I understand it’s not something you can’t easily rise above … and while you’re in it, I can still accept you and be present to what your feeling.”

Too often this kind of attunement… the experience of being present to another’s pain, is missed. We’re too quick to try to circumvent the painful stuff and progress towards that which feels more positive.

I recently saw a 34- year-old female I’ll refer to as Emma. Emma was diagnosed three months ago with bipolar disorder during a five-day hospitalization for very high-level hypomania. She was agitated and only sleeping a few hours nightly. Cognition was racing, planning was unrealistic and impulsive desires to act on her grand plans were quite strong. While she was still able to marginally get through her days (she wasn’t fully out-of-control), both her psychiatrist and her husband thought it would be best if she spent some time in the hospital in order to receive appropriate medication and essentially come down from her elevated mood intensity. Emma complied, but not without a sense of defeat. She also found that once her hypomania broke, she quickly dropped into depressed mood.

A challenging aspect of Emma’s experience involved the reality that she grew up with a mother diagnosed with bipolar disorder. Throughout Emma’s development she strived to achieve and accomplish all that she could as a bold statement to self and others – “I am not my mother …I have the strength and determination to hold on to my high functioning stability.”

This worked for Emma up through her early career years in computer science. She accrued a lot of evidence to support her counter-identification (not being her mother); and until her mid-30s, she thought she gotten there. She thought she had escaped bipolarity. When her maternal genetics finally arrived on the scene, her own bipolarity expressed its presence through a host of symptoms that were reminiscent of her mother’s experience during Emma’s childhood.

Emma’s hypomanic derailment hit her quite hard. It wasn’t just that she was sidelined and depressed, but more that she was in the grip of something that was likely stick around well into her adulthood. She didn’t have the option of rising above it and leaving it behind. The more Emma let this in, the more her grief and emotional pain came to the foreground. Essentially, she had to begin to say goodbye to the image of the life she was reaching for in order to allow herself to accept the bipolar reality she was faced with.


  • What Is Bipolar Disorder?
  • Find a therapist to treat bipolar disorder

Early on in her therapy, Emma conveyed that our discussions in therapy were inconsistent with the approach being taken by others in her support system. Her husband, her friends, even her psychiatric provider, were all oriented towards encouragement and positive change. If Emma was deeply saddened, she was encouraged not to dwell in it. The individuals in her support system were all saying – “With enough strength and motivation; you can get back to that high functioning place you’ve occupied.”

In some respects this message was accurate. Emma was a very capable young woman. However, what was being overlooked was the fact that her high achieving self was overdetermined. More than simply being an expression of her strengths, her strong functioning was a much-needed escape from something she feared. Once that defensive structure broke, she found herself flooded by memories and feelings that took her back into painful identifications that she thought had been left in the past.

Bipolar Disorder Essential Reads

Why Is Lithium Good for Both Batteries and Bipolar Disorder?

Can You Be Hypomanic Without Losing Control?

Feeling the pain of one’s losses isn’t an attractive option. It’s like the dental appointment we dread but know we should attend. The surprise for those who do attend to their grief is that the progression into painful emotion can actually be relieving, at least more so than remaining invested in resistance to the pain.

Emma found that once she was able to feel the emotional impact of the bipolar diagnosis, the gradually ensuing acceptance allowed for a different kind of forward progression. She was able to say to self and others – “OK, I’ve been knocked over by something I couldn’t vanquish. My strengths and my capabilities do have limitations. Now it’s time to figure out how I integrate this newly emerging part of myself into my forward progression.”

The point of Emma’s vignette is to convey the simple truth that once we can deeply accept what is, we can progress forward with positive adaptation. The painful response to the diagnosis is present for all who find that their life trajectory has become altered by a chronic illness. Limitation is limitation. It’s unwanted and difficult to come to terms with, regardless of how it manifests.

Issues of mourning and loss are but one aspect of adaptation to chronic illness. I don’t mean to convey that we only do well through embracing our weakness. That tactic doesn’t work. For most, the connection to strength and resilience is essential to living well. But such isn’t effective if the approach reflects a one-sided attachment to potency without also allowing for the very real human quality of vulnerability and weakness. Only by allowing both to coexist can one find a sustainable approach the task of living with chronic illness, be it bipolarity or anything else that has long-term enduring impact on our well-being.

Very often in bipolar disorder, people with hypomania may not realize it’s a problem. They may even enjoy it, finding it to be a productive time. Or they may fear that taking medicine will make them depressed and they’ll miss feeling good. Others struggle with depression, not getting the help that could relieve their suffering.

For a variety of reasons, people with bipolar disorder won’t go to a doctor for help. They shrug off a friend or family member’s concern. Others view their illness as a distraction or a weakness, and they don’t want to give in to it. Still others put their health at a very low priority compared with other things in their lives.

Often, fear is the reason for not seeing a doctor. That’s especially true if there is a family history of emotional problems. People in denial are protected from their worst fears. They can stay comfortable in their everyday routines — even though relationships and careers can be at stake.

If you’re concerned about a loved one who could have bipolar disorder, talk to them about seeing a doctor. Sometimes, simply suggesting a health checkup is the best approach. With other people, it works best to be direct about your concern regarding a mood disorder. Include these points in the discussion:

  • It’s not your fault. You have not caused this disorder. Genetics and stressful life events put people at greater vulnerability for bipolar disorder.
  • Millions of Americans have bipolar disorder. It can develop at any point in a person’s life — though it usually develops in young adulthood — and is responsible for enormous suffering.
  • Bipolar disorder is a real disease. Just like heart disease or diabetes, it requires medical treatment.
  • There’s a medical explanation for bipolar disorder. Disruptions in brain chemistry and nerve cell pathways are involved. The brain circuits — those that control emotion — are not working the way they should. Because of this, people experience certain moods and energy levels more intensely, for longer periods of time, and more frequently.
  • Good treatments are available. These treatments have been tested and found to be effective for many, many people with bipolar disorder. Medications can help stabilize your moods. Through therapy, you can discuss feelings, thoughts, and behaviors that cause problems in your social and work life. You can learn how to master these so you can function better and live a more satisfying life.
  • By not getting treatment, you risk having worse mood episodes — and even becoming suicidal when depressed. You risk damaging your relationships with friends and family. You could put your job at risk. And your long-term physical health can also be affected, since emotional disturbances affect other systems in the body. This is very serious.

Trust is crucial in shaking someone’s denial and in motivating them to get help. Trust is also important once treatment for bipolar disorder starts. Through the eyes of a trustworthy friend or family member, a person with bipolar disorder can know when treatment is working — when things are getting better, and when they’re not. If your interest is sincere, you can be of great help to your friend or family member.


Diagnostic and Statistical Manual of Mental Disorders, 5th edition, American Psychiatric Association.
The Nations Voice on Mental Illness.
Depression and Bipolar Support Alliance (DBSA).
American Psychiatric Association.
National Institute of Mental Health.
Practice Guideline for the Treatment of Patients with Bipolar Disorder Second Edition.
WebMD Medical Reference: “Bipolar Disorder.”
Muller-Oerlinghausen, B. The Lancet, Jan. 19, 2002.
Kaufman, K. Annals of Clinical Psychiatry, June, 2003.
Compton, M. Depression and Bipolar Disorder, ACP Medicine.

Bipolar disorder, also known as manic depression, is a chronically recurring condition involving moods that swing between the highs of mania and the lows of depression. Depression is by far the most pervasive feature of the illness. The manic phase usually involves a mix of irritability, anger, and depression, with or without euphoria. When euphoria is present, it may manifest as unusual energy and overconfidence, playing out in bouts of overspending or promiscuity, among other behaviors.

The disorder most often starts in young adulthood, but can also occur in children and adolescents. Misdiagnosis is common; the condition is often confused with attention-deficit/hyperactivity disorder, schizophrenia, or borderline personality disorder. Biological factors probably create vulnerability to the disorder within certain individuals, and experiences such as sleep deprivation can kick off manic episodes.

There are two primary types of bipolar disorder: Bipolar I and Bipolar II. A major depressive episode may or may not accompany bipolar I, but does accompany bipolar II. People with bipolar I have had at least one manic episode, which may be very severe and require hospital care. People with bipolar II normally have a major depressive episode that lasts at least two weeks along with hypomania, a mania that is mild to moderate and does not normally require hospital care.


  • Signs of Bipolar Disorder
  • Causes of Bipolar Disorder
  • Treatment for Bipolar Disorder
  • Living with Bipolar Disorder

Signs of Bipolar Disorder

How to accept a bipolar disorder diagnosis

The defining feature of bipolar disorder is mania. It can be the triggering episode of the disorder, followed by a depressive episode, or it can first manifest after years of depressive episodes. The switch between mania and depression can be abrupt, and moods can oscillate rapidly. But while an episode of mania is what distinguishes bipolar disorder from depression, a person may spend far more time in a depressed state than in a manic or hypomanic one.

Hypomania can be deceptive; it is often experienced as a surge in energy that can feel good and even enhance productivity and creativity. As a result, a person experiencing it may deny that anything is wrong. There is great variability in manic symptoms, but features may include increased energy, activity, and restlessness; euphoric mood and extreme optimism; extreme irritability; racing thoughts, unusually fast speech, or thoughts that jump from one idea to another; distractibility and lack of concentration; decreased need for sleep; an unrealistic belief in one’s abilities and ideas; poor judgment; reckless behavior including spending sprees and dangerous driving, or risky and increased sexual drive; provocative, intrusive, or aggressive behavior; and denial that anything is wrong.

The duration of elevated moods and the frequency with which they alternate with depressive moods can vary enormously from person to person. Frequent fluctuation, known as rapid cycling, is not uncommon and is defined as at least four episodes per year.

Just as there is considerable variability in manic symptoms, there is great variability in the degree and duration of depressive symptoms in bipolar disorder. Features generally include lasting sad, anxious, or empty mood; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; a loss of interest or pleasure in activities once enjoyed, including sex; decreased energy and feelings of fatigue or of being “slowed down”; difficulty concentrating, remembering, or making decisions; restlessness or irritability; oversleeping or an inability to sleep or stay asleep; change in appetite and/or unintended weight loss or gain; chronic pain or other persistent physical symptoms not accounted for by illness or injury; and thoughts of death or suicide, or suicide attempts.

The symptoms of mania and depression often occur together in “mixed” episodes. Symptoms of a mixed state can include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. At these times, a person can feel sad yet highly energized.