Understanding Bipolar Disorder

By David Hennessy, Clinical Psychologist, Varsity Lakes, Gold Coast, QLD

What Is Bipolar Disorder?

Bipolar disorder is a mood disorder involving significant changes in mood, energy, activity levels, sleep, and behaviour that extend beyond ordinary fluctuations in emotional state [1,2].

People living with bipolar disorder may experience periods of elevated mood, increased energy, reduced need for sleep, and increased activity. They may also experience periods of depression, low energy, reduced motivation, and difficulty functioning. Some people experience mixed features, where symptoms of elevated and depressed mood occur together [1,2].

Importantly, bipolar disorder is not simply a pattern of changing moods. The mood episodes seen in bipolar disorder are generally more intense, last longer, and have a greater impact on functioning than everyday emotional ups and downs [1].

Bipolar disorder affects people differently. Consequently, no two individuals experience the condition in exactly the same way.

Bipolar Disorder Is Primarily A Medical Condition

Current evidence-based treatment guidelines identify bipolar disorder as a condition that is primarily managed through medical treatment, usually involving a psychiatrist, medication management, and ongoing involvement from a general practitioner [3–5].

Psychology can play an important role. However, psychological therapy is an adjunct to medical treatment rather than a replacement for it [3–5].

For many people, the most effective approach involves collaboration between psychiatrists, general practitioners, psychologists, family members, and other health professionals.

Bipolar I Disorder

Bipolar I Disorder involves at least one manic episode [2].

A manic episode typically includes:

• Elevated, expansive, or irritable mood
• Increased activity or energy
• Reduced need for sleep
• Increased confidence or grandiosity
• Rapid speech
• Racing thoughts
• Increased goal-directed behaviour
• Increased impulsivity or risk-taking

Symptoms are significant enough to cause substantial impairment in functioning, require hospitalisation, or involve psychotic symptoms [2].

An Important Diagnostic Fact

A common misconception is that depression is required for a diagnosis of Bipolar I Disorder.

This is incorrect.

According to DSM-5-TR criteria, a single manic episode is sufficient to meet diagnostic criteria for Bipolar I Disorder when other criteria are met [2].

Many people with Bipolar I Disorder experience depressive episodes during their lives. However, depression is not required for diagnosis.

Bipolar II Disorder

Bipolar II Disorder involves:

• At least one hypomanic episode
• At least one major depressive episode

Unlike mania, hypomania does not cause the same degree of functional impairment and does not involve psychosis [2].

Because depressive episodes are often more prominent, Bipolar II Disorder may initially be mistaken for recurrent depression.

Consequently, accurate assessment becomes particularly important.

What Is Mania?

Mania involves a sustained period of elevated, expansive, or irritable mood accompanied by increased energy and activity [2].

People experiencing mania may:

• Sleep very little while feeling energetic
• Take on multiple projects simultaneously
• Spend large amounts of money
• Make impulsive decisions
• Feel unusually confident or powerful
• Speak rapidly
• Experience racing thoughts
• Become easily distracted

Although mania can initially feel productive or enjoyable, it can also lead to significant difficulties in relationships, finances, employment, physical safety, and mental health [1,2].

What Is Hypomania?

Hypomania involves many of the same symptoms as mania but is generally less severe [2].

Some people experience hypomania as a period of:

• Increased productivity
• Increased sociability
• Increased confidence
• Increased creativity
• Reduced need for sleep

However, hypomania can still create difficulties and may increase the risk of later depressive episodes.

Mixed Features

Some individuals experience symptoms of elevated mood and depression at the same time.

For example, someone may experience:

• Increased energy
• Racing thoughts
• Agitation
• Reduced sleep

while simultaneously experiencing:

• Hopelessness
• Low mood
• Guilt
• Thoughts of death

Mixed presentations can be particularly distressing and often require careful medical management [1,3].

Why Bipolar Disorder Is Sometimes Mistaken For Depression

Many people seek professional help during depressive episodes rather than elevated mood states.

As a result, clinicians may initially observe symptoms of depression without having access to a complete history of mood elevation.

For this reason, comprehensive assessment is important whenever depression appears recurrent, unusually severe, or accompanied by periods of increased energy, reduced need for sleep, impulsivity, or elevated mood [1,2].

The Role Of Psychology

Psychology does not replace psychiatric treatment or medication.

However, research suggests psychological interventions can assist people to:

• Understand bipolar disorder
• Identify relapse warning signs
• Improve treatment adherence
• Maintain stable routines
• Improve sleep habits
• Strengthen coping skills
• Manage stress
• Improve communication and relationships
• Adjust to the impact of the diagnosis [4,6]

Psychology often works best when integrated into broader multidisciplinary care.

Common Myths About Bipolar Disorder

Myth: Bipolar Disorder Means Constant Mood Swings

Mood episodes generally last days, weeks, or longer. Bipolar disorder is not simply frequent changes in mood throughout a single day [2].

Myth: Everyone With Bipolar Disorder Experiences Depression

Many people do. However, Bipolar I Disorder can be diagnosed following a manic episode alone [2].

Myth: Medication Is Optional For Everyone With Bipolar Disorder

Most treatment guidelines recommend ongoing medical management as a central component of treatment, particularly for Bipolar I Disorder [3–5].

Myth: People With Bipolar Disorder Cannot Live Successful Lives

Many people with bipolar disorder maintain meaningful relationships, careers, education, and fulfilling lives with appropriate support and treatment.

Related Topics

• Psychology Support for Bipolar Disorder
• Mood Disorders
• Therapy for Depression
• The Difference Between Feeling Driven and Choosing Action
• Book an Appointment

Frequently Asked Questions

Is Bipolar Disorder A Mental Health Condition Or A Medical Condition?

It is both. Bipolar disorder is classified as a mental health condition, but evidence-based treatment typically involves medical management alongside psychological support.

Does Bipolar I Disorder Require Depression?

No. A manic episode alone can meet diagnostic criteria for Bipolar I Disorder if other criteria are present.

What Is The Difference Between Mania And Hypomania?

Mania causes more severe impairment and may involve psychosis or hospitalisation. Hypomania is less severe and does not involve psychosis.

Can Psychology Replace Medication For Bipolar Disorder?

Psychology is generally considered an adjunct to medical treatment rather than a replacement for medication, particularly in Bipolar I Disorder.

Can Bipolar Disorder Be Misdiagnosed As Depression?

Yes. Many people first seek help during depressive episodes, which can make accurate diagnosis more challenging.

References

[1] Malhi, G. S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., Singh, A., & Murray, G. (2021). The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry, 55(1), 7–117. https://doi.org/10.1177/0004867420979353

[2] American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.

[3] Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., Alda, M., MacQueen, G. M., Milev, R. V., Ravindran, A., O’Donovan, C., McIntosh, D., Lam, R. W., Vazquez, G., Kapczinski, F., McIntyre, R. S., … Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97–170. https://doi.org/10.1111/bdi.12609

[4] National Institute for Health and Care Excellence. (2023). Bipolar Disorder: Assessment and Management (CG185). https://www.nice.org.uk/guidance/cg185

[5] World Health Organization. (2024). Bipolar Disorder. https://www.who.int/news-room/fact-sheets/detail/bipolar-disorder

[6] Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J., McLaren, R., Geddes, J. R., Cipriani, A., & Cuijpers, P. (2021). Adjunctive psychotherapy for bipolar disorder: A systematic review and component network meta-analysis. JAMA Psychiatry, 78(2), 141–150. https://doi.org/10.1001/jamapsychiatry.2020.2993