Bipolar disorder, often misunderstood and mischaracterized, is a complex mental health condition that affects millions of people worldwide. Here, we’ll delve into how a person with bipolar disorder thinks, exploring the intricate patterns of thought during manic, depressive, and mixed episodes. By gaining a better understanding of bipolar disorder, we can foster empathy and provide better support for those affected.

‘The impact of bipolar disorder exists on a spectrum so the extremity of how it affects the person will vary. People can have stability and lead a normal life, and then all of a sudden something can switch and they can become depressed, unable to function, struggle with day to day tasks or become extremely elated, more productive or sociable than usual, in a way where their sound judgement may be impaired. When they experience these extremes and become unwell they are often unable to prioritise their work, health, relationships and other important parts of life. It's really important that they receive the right support and treatment.' - Dr Suriti Govindji, Consultant Psychiatrist

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about bipolar disorder or any similar mood challenges, we can help. 

What is Bipolar Disorder?

Before diving into the specifics of thought processes, it’s essential to understand what bipolar disorder is. Bipolar disorder, formerly known as manic-depressive illness, is characterised by significant mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood swings can affect sleep, energy levels, behaviour, and the ability to think clearly. The NHS recognises two types of bipolar disorder: Bipolar I disorder refers to those who have significant incidents of mania or “highs,” while those with Bipolar II have much less “severe” highs or hypomania, sometimes called “mild mania.”

'The intensity of an episode depends on whether the person retains insight and are aware they are becoming unwell. They may either reach out for support which is great as they get help early on, however they may already be too withdrawn or excitable to reach out and then that perpetuates and negatively affects them and the problem. For this reason it is often helpful for those with the condition to be surrounded by people they trust and can support them when they aren’t quite themselves.' - Dr Suriti Govindji, Consultant Psychiatrist

Thought processes during manic episodes

Manic episodes are one of the hallmarks of bipolar disorder. These periods are marked by heightened energy levels, euphoria, and often, erratic behaviour. During a manic episode, the thought processes of a person with bipolar can be quite distinct:

'If they are becoming elated their thinking may be sped up and they may feel excitable and sociable with lots of plans. They may behave in a way that is out of character for them and perhaps do things they feel embarrassed about later.’ - Dr Suriti Govindji, Consultant Psychiatrist

Racing thoughts

Racing thoughts are a common feature of mania. Imagine your mind racing at a hundred miles per hour, jumping from one idea to another without pause. This mental whirlwind can make it challenging to focus on a single task. According to the American Psychiatric Association, these rapid thoughts can be overwhelming and may lead to speech that is pressured or difficult to interrupt.

Inflated self-esteem

During mania, individuals often experience an inflated sense of self-esteem or grandiosity. They might believe they possess unique talents or abilities far beyond their usual capacity. This heightened confidence can lead to ambitious plans and risky behaviours. For example, someone might suddenly decide to invest large sums of money in a business venture without prior planning.

Impulsivity

Impulsivity is another hallmark of manic episodes. Decisions are made quickly and often without much consideration of the consequences. This spontaneity can manifest in various ways, such as impulsive spending, sudden travel plans, or engaging in risky activities like reckless driving or substance abuse. The lack of inhibition during these periods can have serious repercussions.

Decreased need for sleep

People experiencing mania often feel that sleep is unnecessary. Their minds are so active that they can function on very little rest. This decreased need for sleep can exacerbate other symptoms of mania, leading to further cognitive and behavioural disturbances.

Thought processes during depressive episodes

Depressive episodes present an entirely different set of challenges. These periods are marked by overwhelming feelings of sadness, hopelessness, and fatigue. The thought processes during depressive episodes can be just as intense as those during mania, but in a profoundly different way:

'Depressive episodes involve feeling withdrawn and pessimistic. The person may struggle to do daily self care such as maintaining good nutrition' - Dr Suriti Govindji, Consultant Psychiatrist

Persistent sadness

A pervasive sense of sadness often overshadows every aspect of life during a depressive episode. This isn’t just feeling down; it’s a deep emotional pain that can be debilitating. According to the Mayo Clinic, this persistent sadness can make everyday activities feel insurmountable.

Negative thought patterns

Negative thinking is a cornerstone of depressive episodes. Individuals may feel worthless, hopeless, and burdened by guilt or regret over past actions. This negative thought spiral can lead to a sense of despair that feels inescapable. Cognitive distortions, such as catastrophizing or black-and-white thinking, often dominate the mental landscape.

Lack of interests

Activities that once brought joy now seem pointless. This lack of interest, known as anhedonia, extends to hobbies, social interactions, and even basic self-care. The inability to find pleasure in previously enjoyable activities further compounds the feelings of sadness and isolation.

Fatigue and sleep changes

Energy levels plummet during depressive episodes, making even simple tasks feel exhausting. Sleep patterns often change drastically; some individuals may experience insomnia, while others may sleep excessively. These disruptions in sleep can worsen cognitive and emotional symptoms.

Mixed episodes: a dual challenge

Mixed episodes, where symptoms of mania and depression occur simultaneously, add another layer of complexity to bipolar disorder. During these periods, an individual might feel agitated yet deeply sad, energetic yet hopeless. The thought processes during mixed episodes can be particularly confusing:

Agitation and irritability

Individuals may experience high energy levels combined with intense irritability. This agitation can lead to frustration and anger, often directed at themselves or others. The combination of depressive feelings with manic energy can result in a volatile emotional state.

Conflicting thoughts

Conflicting thoughts are common during mixed episodes. A person might have grandiose ideas typical of mania but simultaneously feel the worthlessness associated with depression. This internal conflict can be exhausting and mentally draining.

Increased risk of suicide

Unfortunately, mixed episodes are associated with a higher risk of suicidal thoughts and behaviours. The combination of depressive despair and manic impulsivity can lead to dangerous actions. According to the World Health Organization, individuals with bipolar disorder are at a higher risk of suicide compared to the general population.

Understanding cognitive effects

In addition to mood swings, bipolar disorder also affects cognitive functions. These cognitive effects can impact various aspects of thinking and functioning:

Memory Impairment

Memory problems are common in bipolar disorder, particularly during severe mood episodes. Individuals may struggle with short-term memory, finding it difficult to recall recent events or information. According to a study published in the Journal of Affective Disorders, these memory impairments can persist even during periods of mood stability.

Executive functioning

Executive functioning, which includes skills like planning, decision-making, and problem-solving, can be impaired in individuals with bipolar disorder. These difficulties can affect daily life, making it harder to manage responsibilities effectively. The National Institute of Mental Health highlights the importance of addressing these cognitive challenges in treatment.

Coping strategies and treatment

Understanding how a person with bipolar disorder thinks is essential, but it’s equally important to recognise the strategies and treatments available to help manage these thought processes:

Medication

Medication is often a cornerstone of bipolar disorder treatment. Mood stabilisers, antipsychotics, and antidepressants can help regulate mood swings and improve cognitive function. It’s crucial for individuals to work closely with the right psychiatric support in order to find the right medication regimen.

Therapy

Therapeutic approaches, such as cognitive-behavioural therapy (CBT) and psychoeducation, can be highly effective. CBT helps individuals identify and challenge negative thought patterns, while psychoeducation provides valuable information about managing the condition. Engaging in therapy can equip individuals with tools to navigate their thought processes more effectively.

Lifestyle changes

Lifestyle changes can also play a significant role in managing bipolar disorder. Regular exercise, a balanced diet, and a consistent sleep schedule can help stabilise mood and improve overall well-being. Mindfulness practices, such as meditation and yoga, can reduce stress and enhance emotional regulation.

Support systems

Having a robust support system is vital. Friends, family, and support groups can provide understanding and encouragement. Open communication about experiences and challenges can foster empathy and reduce feelings of isolation.

The importance of empathy and understanding

Empathy and understanding are crucial when supporting someone with bipolar disorder. Here are some ways to offer meaningful support:

Listen actively

Active listening involves giving your full attention and showing empathy through your responses. Let your loved one express their feelings without immediate judgement or advice. Sometimes, just being heard can make a significant difference.

Be patient

Mood swings can be unpredictable and challenging to navigate. Patience and understanding go a long way in providing stability and reassurance. Recognise that the person is dealing with a complex condition and may need time to process their emotions.

Encourage professional help

Treatment involving medication and therapy is vital for managing bipolar disorder. Encourage your loved one to seek professional guidance and support them in following through with it. Attend appointments if possible, and be a source of encouragement throughout their treatment journey.

Bipolar disorder is a complex condition, but with the right support and treatment, individuals can lead fulfilling lives. If you have a loved one with bipolar disorder, remember that your support matters immensely. Educate yourself, be patient, and encourage professional help.

Understanding how a person with bipolar disorder thinks requires compassion, patience, and a willingness to learn. At Augmentive, we believe advice and support for those with bipolar disorder should always be bespoke and tailored to the individual to help with their specific symptoms, traits and patterns. So whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private bipolar assessment to help with finding a psychiatrist near you to support you on your journey. 

If you have a question about mental health, like if an anxiety piercing can really help, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.