Many of my clients who have a recent or long-standing diagnosis of bipolar disorder have a hard time understanding why they’ve been diagnosed with the condition in the first place. This is usually because they don’t understand the symptoms of mania, which is what distinguishes bipolar disorder from depression or other disorders. It’s essential that anyone with bipolar disorder has a clear understanding of the symptoms of a mania because recognizing the symptoms of mania will allow them to take preventative action to end of the manic episode as fast as possible. (Hopefully before they’ve gotten into any trouble!)
One of the most misunderstood aspects of Bipolar I Disorder is that a diagnosis only requires one episode of mania. A diagnosis is made is by assessing the symptoms of mania, and if someone has had enough symptoms at one time in their life, they have had a manic episode. If they’ve had one manic episode, a diagnosis of Bipolar I Disorder is warranted. That’s right, only one episode! It does not require an episode of depression. This seems to be a point of great confusion, because many of them think they need several episodes of mania and depression to be diagnosed.
Not to add further confusion, but Bipolar II Disorder is slightly different. This harder to identify condition requires a depressive episode, and at least one less manic episode called hypomania. Hypomania has the same symptoms of mania, but for a shorter period of time and less intensely. I think of Bipolar II disorder as leaning having more downs, but at least a little up.
So, what constitutes a manic episode? In order to understand that, you must know the symptoms of mania very clearly. I’ve found that most of my clients with Bipolar Disorder still have a hard time identifying the symptoms of mania, even after receiving counseling and doing some reading. Let’s make this very clear, once and for all.
Here Are the Symptoms of Mania in Bipolar Disorder:
The prerequisite requirement for a manic episode is that you must have had a distinct period of an abnormally elevated, expansive, or irritable mood and increased activity or energy. This usually feels euphoric but can switch quickly to an irritable state. The period should be markedly different from someone’s normal mood and activities and is often observable by others. This period must last 7 days (or 4 days in the case of Bipolar II Disorder), and be present most of the day, nearly every day.
Once this period has been established at some point in person’s history, you need to have exhibited three or more of the following symptoms, which have to have been present to a significant degree:
- Inflated self-esteem or grandiosity. This means thinking very highly of oneself, such as being incredibly powerful, intelligent, beautiful, attractive, having amazing insights and wisdom, extending to even thinking that you have superpowers. In the most extreme state, this can become psychotic, leading people to believe they are a religious figure such as Jesus, that they might be a superspy, psychic, or be physically invincible.
- Decreased need for sleep. This means feeling rested (or even energized) after a few hours of sleep, maybe as few as 3 or 4 hours. Some people may not sleep for several days at a time. In milder hypomanic states, it maybe 5-6 or hours. Often the sleep is an early morning disturbance; e.g. falling asleep at a reasonable hour but then popping out of bed in the middle of the night or early morning to tackle some exciting project. Other times it is having too much excitement and interest to want to go to bed, perhaps because of romance, shopping, or projects that seem impossible to stop doing. Less sleep counterintuitively increases mania. I call this “tired but wired”. (You may have noticed this kind of hyperactivity in children when they aren’t getting enough sleep.) Decreased sleep should be a warning sign for anyone with bipolar disorder that they are manic.
- More talkative than usual or pressure to keep talking. This is usually indicated by a faster rate of speech with few pauses. People can be difficult to interrupt. “Pressured” speech is what anyone might sound like if they were making a 911 call. This is an easily observable symptom by other people. This external behavior mirrors the internal experience of symptom number four.
- Flight of ideas or subjective experience that thoughts are racing. “Flight of ideas” means thoughts are tangential, unconnected, and difficult to follow for the person in a manic episode. Racing thoughts means that they are quicker, louder and more intrusive than they would ordinarily be. Some people experience this has an amazing experience of energized thinking that allows them to work towards their projects or goals rapidly. At other times, people begin to experience this as an unpleasant, anxiety provoking, obsessive behavior. “I can’t get my brain to turn off!”
- Distractibility. This can mean rapidly changing from one task to another for no rhyme or reason. It becomes impossible to prioritize activities and attention. They might begin doing one thing and quickly be pulled off and do something completely irrelevant. For example, they might go to the grocery store for milk and end at the party store next door buying a cart full of decorations for the party they just decided to have. It can also resemble ADHD like symptom of being distracted by anything in their environment, even when it’s not relevant to them, such as other people, sounds, and their own thoughts.
- Increase in “goal-directed activity”. This means intensely pursuing goals in work, school, hobbies, shopping, socializing, or sexual activity. Anything that any of us do the creates a feeling of reward and pleasure becomes incredibly enticing to the manic person. They are seeking a “dopamine high”. Relating back to symptom number five, it often means the goals are not priorities for the person and can take a lot of time and money directed towards things they would never ordinarily pursue. For most people, they have a common “go-to” activity they engage in, whether it’s sex, artwork, shopping, or partying during any of their manic episodes.
- Excessive involvement in activities that have a high potential for painful consequences. This might include unrestrained buying sprees, sexual indiscretions, or foolish business investments. These activities are irrational or impulsive and would not ordinarily line up with the individual’s values or goals. This is usually where people end up getting themselves in trouble. They end up in debt, divorced, injured, or in the hospital.
Hopefully, you’ve learned some things about the symptoms of a manic episode. If you have been recently diagnosed with bipolar disorder, it’s very important for you to review the previous episodes you’ve had and look for each of these symptoms. Doing this will help confirm your diagnosis if you’ve got some lingering doubt. You may also see certain themes that show up, which can be very important to discuss during counseling for bipolar disorder. Most importantly, if you or someone close to you can recognize that any of these symptoms are occurring, you can take action to end your manic episode sooner.