1. Myth: Bipolar Disorder Only Affects Mood
It’s true that bipolar disorder causes extreme mood swings, but this is only one part of the condition, says Howard Weeks, MD, a psychiatrist at University of Utah Health in Salt Lake City.
“When people experience severe depression, it takes a physical toll on the body, and likewise with mania,” says Dr. Weeks. Manic episodes can cause increased activity or energy (including sexual desire) and a decreased need for sleep. And depressive episodes can cause significant unintentional weight loss or gain, a lack of energy, excessive sleep, and suicidal thoughts and 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 is a psychological state in which a person loses touch with reality. Symptoms can include disorganized thinking or behavior, delusions, or hallucinations, as well as a decline in functioning. Outward signs can include speech changes, appearing emotionally blunted or inexpressive, and lacking energy.
2. Myth: Bipolar Disorder Is Easy to Diagnose
It’s actually not uncommon for bipolar disorder to be mistaken for another health condition. For instance, according to one research review, 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 research review, the authors noted that women with bipolar disorder were more likely to experience the illness with depressive episodes dominating, compared with men.
“It is often true that patients seek help from doctors for depression symptoms more so than for manic symptoms,” Weeks says.
“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 speech or being unusually talkative
- Decreased need for sleep
- Extreme grandiosity and distorted sense of self-importance
- Racing thoughts
- Distractibility
- Increased goal-directed activity
- Engaging in activities with potentially undesirable outcomes, such as gambling or unsafe sex
A wrong diagnosis 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.
3. Myth: Bipolar Disorder Looks the Same in Everyone Who Has It
- Bipolar I People with this form of the condition have had at least one manic episode lasting a week or longer. In some cases, the mania is so severe that it requires hospitalization, says Catherine Athans, PhD, a licensed marriage and family therapist in private practice in Los Altos, California. If mania goes untreated, a person’s quality of life suffers, and it can lead to major consequences such as job loss, she says.
- Bipolar II Individuals with bipolar II 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 usually last at least two weeks, he says.
- Cyclothymia This is the least severe 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 I or II.
4. Myth: People With Bipolar Disorder Are Either Manic or Depressed — Nothing in Between
Although bipolar disorder is best known for extreme mood swings, people with this condition can have also moods that are in between, meaning they are neither depressed or manic, says Center. These are sometimes referred to as “neutral moods.”
How frequently a person experiences 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. Rapid cycling means that you experience at least four mood episodes in a 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 says.
5. Myth: Bipolar Disorder Is Not Life-Threatening
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 up to 50 percent make a nonfatal suicide attempt, according to research.
Suicide risk is most often associated with depressive episodes, for several possible reasons:
- Depressive episodes can be long-lasting and occur many times over the course of an illness. A longer illness duration may 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; research shows that depressive episodes often follow mania.
- Involuntary hospitalization for a manic episode can be a traumatic experience for many people and is associated with a heightened suicide risk in the three months after discharge.
6. Myth: Mania Increases Productivity
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, [they realize] the work or activities they did are not as good as they thought,” says Weeks.
7. Myth: People With Bipolar Disorder Can’t Live Healthy, Fulfilling Lives
Although 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. In addition to mood stabilizers, other medications someone 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 is also considered a cornerstone of treatment; it can help people learn to manage stress in healthy ways and recognize the triggers that precede manic and hypomanic episodes, says 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.
Along with medication and therapy, finding positive ways to channel energy and reduce stress can help people with bipolar disorder manage their condition. Here are some recommendations:
- 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, affect how well medications work, and even trigger mood 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 also help you relax and manage stress, such as yoga or meditation.
The Takeaway
- Bipolar disorder, a group of conditions that cause shifting mood states, is frequently misunderstood.
- The symptoms and experience of this illness can vary from person to person, and myths surrounding it contain inaccurate information and often contribute to stigma.
- While bipolar disorder can be challenging to manage, it’s possible to find an effective treatment regimen and live a healthy, fulfilling life with the condition.