Severe Psychosis & Bipolar Disorder – Are They Linked?
Living with bipolar disorder often means dealing with extreme mood swings. People with this condition can feel the fast, dizzy excitement of mania and the deep, heavy sadness of depression. In this blog post, we will talk about one serious effect of bipolar disorder: psychosis.
When someone has their first manic episode and doesn’t know they have bipolar disorder, they might feel very energetic, super confident, and like nothing can stop them. These feelings can make them sleep very little, believe they are more important than they really are, spend too much money, and act in unusual ways. Staying in this high-energy state can be dangerous. If you add stress, drug or alcohol use, or trauma, the person could develop psychosis.
The relationship between bipolar disorder and psychosis makes life even harder for people with this condition. To understand this better, let’s look at the main ways these two experiences connect.
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Panic Amid the Chaos: A First Look at Bipolar Disorder and Psychosis
The Oxford Dictionary says psychosis is “a severe mental condition in which thought and emotions are so affected that contact is lost with external reality.” This means that if someone with mania loses touch with what is real, they have reached a psychotic state.
For people with bipolar disorder, going back and forth between mania and depression can feel confusing and overwhelming. Now, imagine how much scarier it gets when they also start to lose touch with reality. This is what happens when someone has a manic episode with psychotic features.
When a person experiences psychosis, they might feel stuck in a storm of fear and confusion. They can’t always tell the difference between what is real and what is not. Panic often takes over. Some people say they feel chased by thoughts, images, or sounds that aren’t really there. This can cause them to act in ways that are unusual, unpredictable, and sometimes dangerous.
Psychosis and Mania
When we talk about bipolar disorder, especially in its most serious forms, we are talking about more than just mood swings. Sometimes, mania can become much more severe and include psychotic features. This means someone with mania might not only feel overly happy, irritable, or full of energy, but they could also lose touch with reality.
For some people, this means they hear voices or see things that aren’t really there (hallucinations). Others might have delusions, which are strong beliefs that aren’t true. For example, a person might believe they are the president while sitting in their living room, or think they have been chosen to save the world. These hallucinations and delusions feel completely real to the person, even if others around them are confused or worried. Some people with psychosis believe they see secret messages in lights, colors, numbers, or even videos online. This can make their thoughts and actions feel confusing and out of control, and it can be very hard for them to come back to reality.
It’s important to know that bipolar mania with psychotic features is not rare. More than half of people with bipolar disorder will experience psychosis at some point in their lives.
Psychosis and Depression
Psychosis usually happens more often during manic episodes, but it can also show up during very bad depressive episodes. This means a person with bipolar disorder might go back and forth between deep depression and mania, and sometimes have psychotic symptoms during both.
When someone is in a major depressive episode, they might feel extremely hopeless, guilty, or worthless. If psychosis happens at the same time, these feelings can turn into strong false beliefs or seeing and hearing things that make the negative thoughts worse. For example, a person might believe they caused something terrible to happen, or they might hear voices telling them to do something harmful. Sometimes, they may even see or hear memories that are so real, it feels like they are living through the scary event again, which can cause a lot of fear and panic.
These strong mood swings and psychotic symptoms can make bipolar disorder very unpredictable and dangerous. It’s not just about feeling really happy or really sad; it’s also about the risk of losing touch with reality during both mania and depression, which makes bipolar disorder much more serious than just a mood problem.
Guardrails to Protect Against Psychosis
For people living with bipolar disorder, especially when psychosis is involved, it’s very important to manage the condition well. Doctors usually treat bipolar disorder with medication like mood stabilizers (such as lithium or valproate) and antipsychotics. These medicines help control mood swings and psychotic symptoms. Psychotherapy (talk therapy) is also helpful. It teaches people how to spot triggers, handle stress, and develop coping skills for dealing with mania, depression, and psychosis.
Family and friends play a big role in helping someone with psychosis. Experts suggest that a person the individual trusts should:
- Listen carefully and notice if their thoughts don’t match reality.
- Ask if these thoughts are new or if they’ve always had them. If the thoughts are new, gently point out that things have changed.
- Show concern and invite the person to think about how their life has changed.
- Offer support by saying you’ll help them figure things out together, instead of just saying they need help. Telling someone they need help might make them push others away.
It can be very hard for someone deep in psychosis to realize they’re not seeing reality. That’s why it’s important for a trusted person, psychiatrist, and therapist to work together. If the person is at risk of hurting themselves or others, it’s safest to get them proper medical care right away—sometimes this means going to the hospital.
Conclusion
The link between bipolar disorder and psychosis is complex. Not everyone with bipolar disorder will have psychotic symptoms, but for those who do, the challenges are even greater. People with bipolar disorder already deal with severe mood swings, moving between deep depression and high-energy mania. When psychosis happens—meaning they lose touch with reality—the struggle becomes much harder.
It can be very difficult to help someone realize they are experiencing psychosis, but this step is very important. By learning to spot the warning signs, understanding the symptoms, and offering caring support, we can help people manage this tough condition and take back control of their lives.
