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Severe Psychosis & Bipolar Disorder – Are They Linked? 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. At BP Harmony, we advise people in the psychotic individual’s life (ie their community) to find a person whose opinion the individual respects and to consider the following steps:  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

Can Eyes Reveal The Truth About Bipolar Disorder General Eye Characteristics during Depression Is there such a thing as having bipolar eyes? At the root of the question for individuals with bipolar is a search for a guaranteed marker for the diagnosis. This article dives into general tendencies of the eyes during mania and depression; however, I find it difficult to say that these patterns provide any such hallmarks at all. Even current medical experts who write for lifestyle magazines say that evidence for “bipolar eyes” is inconclusive. Moreover, I cannot find a reputable medical journal that reports on the issue. Finally, in my years working with psychiatrists, none of my doctors checked my eyes when I was experiencing mania or depression.  Hence, I’m inclined to take the position that “bipolar eyes” are a myth. General characteristics can offer some guidance to help you or your loved one identify imbalances. It is by no means a necessary characteristic for someone experiencing mania, depression, and everything in between.  For more, in depth, guidance on bipolar disorder, consider purchasing our book or masterclass to support us.  Bipolar Depression is a complex experience that is unique to each individual who experiences it. While I experienced brain fog, poor memory, migraines, feelings of worthlessness, suicidal ideation, and anxiety, others mention feeling loss of appetite, asexuality, loss of energy, a great void of nothingness. Here is a list of general eye characteristics for someone experiencing a depressive episode: Avoiding Eye ContactDue to the inner pain and turmoil a person feels, one avoids eye contact not to expose the great storm within. Often there are feelings of shame and worthlessness for not being able to uphold life’s responsibilities. Looking DownwardI have often heard people say depression makes everything in the body feel heavy. The body turns downward in the classic sad posture. The imagination narrows. One feels that even looking upward is a heavy task. Blank StareOne of the most common features of depression is rumination. The depressed person is often plagued by one or multiple negative thought loops. The person becomes so consumed by this snare that their eyes zone out, staring for long intervals at no particular object. Physical Symptoms Due to Poor Sleep Dark circles or shadows under the eyes A hollow or depressed appearance beneath the lower eyelid Visible blood vessels under the eyes A tired or aged appearance Bags or puffiness under the eyes Squinted Eyes General Eye Characteristics during Mania Dilated PupilsThis can happen due to the adrenaline and the subsequent feelings of euphoria that occur in mania. It can also be due to the lack of sleep, substance abuse, and fits of rage and hysteria. Sparkling Eyes, or eyes that appear more liquid than usualThe world becomes a fascinating place during mania. Your senses feel like they are on overdrive. There is a pleasurable tingling all over your brain. With such a feeling, you look at the world and others with a sense of wonder and amazement. It can be fun for the individual but unsettling for others to witness. Eyes that Change Color or Become BlackI have read anecdotal reports of people’s eyes changing colors during manic episodes; however, I could not find a medical journal that mentions this. Some people report that a manic person’s eyes dilate so much that the entire eye appears to be black. Again, there are many reasons for the eyes to dilate, so it doesn’t necessarily mean a person is manic if their eye color changes or their pupils dilate. Understanding it All You might have noticed that many of these general characteristics of “bipolar eyes,” can be found in other states of health. Our pupils dilate in the dark in order to let in more light. Our eyes can look narrow when we have a migraine. Bags can form under the eyes due to sinus pressure or allergies.  My conclusion again regarding “bipolar eyes,” is that science has not yet made a conclusive connection between eyes and bipolar disorder.  The above general characteristics occur with salient symptoms of mania such as thoughts of grandeur, hypersexuality, and insomnia. Nonetheless, if you or your loved one shows a patterned change in their eyes during periods of mania or depression, then note it down and discuss with a qualified health professional what it means. However, if the physician does not give it much credence, lean in on your intuition to use it as a clue to help yourself maintain balance. For more, in depth, guidance on bipolar disorder, consider purchasing our book or masterclass to support us.