The experience of bipolar disorder can be summarized by the vacillating, dizzying highs of mania and the crushing, murky lows of depression. The focus of this blog post is to highlight an extreme byproduct of bipolar disorder: psychosis.
Someone who experiences mania for the first time without a diagnosis or any prior history might think they are extra productive, super confident, and utterly invincible. These feelings lead to little to no sleep, thoughts of grandeur, excessive spending possibly, and more irregular behaviors. The dangers of staying in this heightened state are many, but when mixed with things like stress, substance abuse, and trauma, a person can tip over into psychosis.
This complex dynamic between bipolar disorder and psychosis can make an already difficult condition even more challenging to navigate. To understand this connection, let’s explore the key elements linking these experiences.
Panic Amid the Chaos: A First Look at Bipolar Disorder and Psychosis
The Oxford Dictionary defines psychosis as, “a severe mental condition in which thought and emotions are so affected that contact is lost with external reality.” It is this loss of contact with reality that tells if a person experiencing mania has also reached a clinically psychotic state.
For anyone dealing with bipolar disorder, the cycle between mania and depression is disorienting. Imagine, then, the added confusion when panic sets in—not just from the swings themselves but from losing touch with reality. This is what happens when bipolar disorder manic episodes are paired with psychotic features.
A person experiencing psychosis may find themselves trapped in a whirlpool of fear and misunderstanding, where they cannot differentiate between what is real and what is imagined. Panic becomes the overriding emotion. People often describe feeling chased by thoughts, images, or sounds that aren’t there, leading to behaviors that are out of character, unpredictable, and often harmful.
Psychosis and Mania
When we talk about bipolar disorder, especially in its most extreme forms, we’re not just talking about mood swings. In some cases, mania can evolve into something far more severe—bipolar mania with psychotic features. This type of mania doesn’t just involve elation, irritability, or hyperactivity; it can also include episodes of psychosis, where, as mentioned above, individuals lose touch with reality.
For some, it means hearing voices or seeing things that aren’t there. For others, it involves delusions—firmly held false beliefs. Imagine believing you are the president of a country, when in fact you are sitting in your living room. Or perhaps you think you’ve been chosen by a higher power to save the world. These delusions and hallucinations are entirely real to the person experiencing them, even though those around them may be baffled by what’s happening. Witness accounts recount how clinically psychotic people believe cryptic messages are coming from the government in the forms of lights, colors, numbers, and even recorded videos on the internet. One can only imagine the chaotic rabbit hole a person experiencing psychosis may go down and find it difficult to come back.
What’s important to recognize is that bipolar mania with psychotic features is not uncommon. It’s a significant symptom for many individuals living with bipolar disorder.
Psychosis and Depression
While psychosis occurs more commonly with manic episodes, it sometimes occurs during severe depressive episodes. In other words, an individual might cycle between major depressive episodes and manic episodes, sometimes with psychotic features on both ends of the spectrum.
During these major depressive episodes, individuals may experience deep hopelessness, guilt, or worthlessness. When psychosis enters the picture, these feelings can evolve into delusions of persecution or hallucinations that reinforce negative thoughts. For instance, a person might believe that they are responsible for a catastrophic event or that voices are urging them to commit harmful acts. They may see or hear traumatic memories play in front of them, sending them into a state of fear and panic as if they were experiencing the event all over again.
The severity of these mood swings and their psychotic features can make bipolar disorder particularly unpredictable and dangerous. It’s not just about moving from mania to depression; it’s about dealing with the potential of losing touch with reality during both phases, a fact that makes this condition much more than a simple mood disorder.
Guardrails to Protect Against Psychosis
For those living with bipolar disorder, especially when psychosis is part of the equation, effective management is key. Medication, including mood stabilizers and antipsychotics, plays a central role in conventional psychiatric care. Psychotherapy, too, can help individuals recognize triggers and develop coping strategies for dealing with episodes of mania, depression, and psychosis.
- This person must listen to the psychotic individual and identify those aspects of the person’s thinking that reflect a disconnect with reality.
- Then ask if the person has always had these thoughts or if they are recent. If they are recent, then consider emphasizing that they didn’t see things their current way before. This will identify that there is some change in the person that others are noticing.
- Express concern for the individual and invite them to consider the changes in their life due to the state they are in.
- Reassure that you will be there to figure things out with them as opposed to suggesting that they need help. This may turn them away and cause them to reject help.
The tricky challenge is to somehow get the person who is deeply caught in a false reality to realize on their own they have lost connection with reality. This is where a trusted person, psychiatrist, and therapist can effectively work together. In the meantime, the safest route is to get the person under the right medication or even admit them to a hospital to prevent harm to themselves and others.
Conclusion
The connection between bipolar disorder and psychosis is complicated and multifaceted. While not everyone with bipolar disorder will experience psychotic features, those who do face a unique set of challenges. Severe mood swings between major depressive episodes and manic episodes are difficult enough, but when combined with the loss of reality that psychosis brings, the struggle becomes much more profound.
Getting the person to acknowledge they have reached a psychotic state is a difficult but crucial step. By recognizing the signs, understanding the symptoms, and offering compassionate care, we can help individuals manage this complex condition and regain control of their lives.
