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Mania - Why Bipolar Disorder Is Misunderstood

Everyone has ups and downs. But imagine the normal ups and downs stretched into a roller coaster of extreme highs and crushing lows that derails your life plans, empties your bank accounts, and blows up your relationships. Bipolar Disorder and its hallmark symptom, mania, are often misunderstood. Savvy Psychologist busts myths about Bipolar Disorder and outlines the real signs of mania.

By
Jade Wu, PhD
6-minute read
Episode #345
The Quick And Dirty

Bipolar Disorder is often misdiagnosed and misunderstood. Here are the 5 signs of this tricky illness:

  1. Euphoria
  2. Grandiosity
  3. Impulsive decisions
  4. Feeling no need for sleep
  5. Racing thoughts

“Bipolar” is a term that gets thrown around a lot, often in a demeaning way as shorthand for “indecisive” or “inconsistent,” such as, “She’s so bipolar--one day she wants to marry him, another day she wants to break up.” But indecision and Bipolar Disorder are not one and the same. True Bipolar Disorder -- which used to be called manic depression -- is a very serious psychological disorder that could completely upend a person’s life, changing the trajectory of their relationships, physical health, careers, and self-image (if not treated). And it’s not so easily overcome, simply through dancing and love, like for Bradley Cooper’s character in the movie Silver Linings Playbook.

So let’s bust some myths and paint Bipolar Disorder in a truer light, so we can better understand and support the people in our lives who may be struggling with it. After all, about 5% of the population has some form of Bipolar Disorder, so chances are that someone in your life could benefit from you having this knowledge.

What sets Bipolar Disorder apart

The hallmark of Bipolar Disorder, and the thing that sets it apart from plain old depression, is mania. This describes a days-long altered state of being that sends a person careening out of control. Here are five signs that someone is in the middle of a manic episode:

Mania Sign #1:  Euphoria

We’ve all felt giddy at one time or another. Maybe we got an unexpected bonus at work, or we got asked on a date by our crush -- there’s an extra spring in your step and you feel like you’re ready to smile at anything. Now amplify that feeling through a stadium concert sound system. You feel out-of-this-world high on life. You are literally shouting from the rooftops, because being on the ground is simply not enough to express how much you’re exploding with euphoria.

The hallmark of Bipolar Disorder is mania. This describes a days-long altered state of being that sends a person careening out of control.

Mania Sign #2:  Grandiosity

Nothing is impossible for you. No one is better qualified to start this new company. You’re a genius that nobody is smart enough to understand. You’re convinced that your 3:00am scribblings will go down in history as being on the level of Shakespeare. You have the confidence of Kanye ... on steroids.

Mania Sign #3:  Impulsive decisions and bad judgment

You find yourself doing risky, impulsive things, like buying a Land Rover on a whim when you live in Manhattan, sinking all your savings into Dogecoin, jumping from balcony to balcony in your apartment complex like Spiderman, or proposing to someone you just met on a long flight before the plane has even landed.

Mania Sign #4:  Feeling little to no need for sleep

You stay up all night to work on a project or roam around town, and you feel no need to rest. Even after staying up for a few days straight with very little sleep, you’re running on fumes but still feeling jazzed.

Mania Sign #5:  Racing thoughts and non-stop talking 

You’re the life of the party, even when it’s a party of two. You can’t stop talking, jumping from subject to loosely associated subject. You’re excited about everything, and anything can make you shout with laughter.

Mania comes in different forms

About 1% of the population has Bipolar Disorder Type 1, and 4% have Type 2. The main difference is that in Bipolar Disorder Type 2, the highs are less intense; instead of having full-blown manic episodes, people with this type of Bipolar Disorder have hypomanic episodes, which are less destructive. In fact, many people who have hypomanic episodes don’t even think of them as a problem. Some even look forward to their “energetic” periods, when they feel creative, inspired, optimistic … and their friends love them because they’re gregarious, funny, and more generous than they can afford to be at cocktail hour.

On the other hand, a full-blown manic episode has a direct negative impact on a person’s functioning. Impulsivity and other symptoms can become such a problem that it lands a person in the hospital. This is actually one of the options for fulfilling a diagnostic criterion for manic episode -- either hospitalization due to the aforementioned symptoms or that they have lasted at least seven days.

Mania isn’t necessarily happy; it can be irritable and explosive as well.  Extreme irritability may turn into aggression, but it’s important to remember this doesn’t necessarily mean danger to others. In fact, a 2001 study in The Lancet found that people with mental illness are far more likely to be the victims of homicide or fatal accidents than the perpetrators.

Depression is the other side of the coin

On the opposite end of the spectrum from mania is depression, which also involves days-long or weeks-long bouts of severe mood change. This one is probably more familiar -- the crushing feelings of hopelessness and emptiness, the sense that things will never get better, the feeling of physically slogging through mud even for the most basic activities like brushing your teeth … it’s as if a heavy, wet blanket has been draped over you, obscuring the light and anything else bright or hopeful.

On the opposite end of the spectrum from mania is depression, which also involves days-long or weeks-long bouts of severe mood change.

People with Bipolar Disorder not only have to come down from the euphoria of mania, but also to climb out of the depths of depression, both monumental efforts. But contrary to popular belief, it’s not that they cycle between mania and depression from moment to moment, hour to hour, or even from day to day. In a rarer mood disorder called cyclothymia, there might be frequent back-and-forths between mania and depression, but this is not the case in Bipolar Disorder.

In Bipolar Disorder, there are long periods of normalcy, where the person feels like their own self and is able to enjoy life’s pleasures, maintain healthy relationships, and build a fulfilling career ... but these “euthymic” periods are punctuated by the explosive, days-long episodes of mania that can empty bank accounts or end relationships, and deep episodes of depression that grind everything to a halt. 

Bipolar Disorder is not always easy to diagnose

More than 50% of cases of Bipolar Disorder make themselves known by age 25, often in the late teens or early adult years. But Bipolar Disorder sometimes escapes diagnosis for years and is discovered later in life. Consider a hypothetical woman named Angela:

Angela is 42 and has a son. She’s been married 4 times, twice to her son’s father.  She’s been super-social for the past week, chatting with everyone she sees whether she knows them or not, and says she feels “Great with a capital G!” After cleaning her whole house top to bottom last Wednesday, she took her son to soccer practice and, instead of watching from the sidelines, joined in on the kids’ game. She then tried to kiss the coach. Over the last few days, however, she’s been in bed most of the day. She has no energy and feels like a zombie. She does manage to get up when her son comes home from school, but making dinner, if it happens, is exhausting.

The depressive side of bipolar disorder, where we leave Angela, looks just like regular depression (a.k.a., unipolar depression) by mental health professionals. Bipolar disorder often gets misdiagnosed as unipolar depression because this is when people seek help, and in that moment of dark depression, it may feel like this is the only state they’ve ever experienced. But in people with true Bipolar Disorder, medications for unipolar depression, ironically, can trigger a manic episode.

And unfortunately, Bipolar Disorder gets misdiagnosed more often than not. In fact, a 2008 study out of Brown University found that 57% of adults diagnosed with Bipolar Disorder turned out not to have the condition. So if you or a loved one has been diagnosed, consider seeking a second opinion. 

And if Bipolar Disorder is your true diagnosis, have hope; even though it isn’t curable, it is treatable, and I have personally witnessed students and mothers and artists reclaiming their lives and going on to thrive. And with celebrities from Demi Lovato to Catherine Zeta-Jones coming forward with their own diagnoses, stigma is crumbling, too.

Sources +
All content here is for informational purposes only. This content does not replace the professional judgment of your own mental health provider. Please consult a licensed mental health professional for all individual questions and issues.

About the Author

Jade Wu, PhD Savvy Psychologist

Dr. Jade Wu was the host of the Savvy Psychologist podcast between 2019 and 2021. She is a licensed clinical psychologist. She received her Ph.D. from Boston University and completed a clinical residency and fellowship at Duke University School of Medicine.