Understanding Bipolar Disorder
A comprehensive guide to symptoms, episode types, and recognition based on DSM-5 diagnostic criteria.
What is Bipolar Disorder?
Bipolar disorder is a mental health condition characterized by extreme shifts in mood, energy, activity levels, and concentration. These shifts are far more severe than the normal ups and downs that everyone experiences.
Unlike ordinary mood swings, bipolar episodes can last for days, weeks, or even months, and significantly impact a person's ability to carry out day-to-day tasks, maintain relationships, and function at work or school.
0%
of U.S. adults affected annually
0%
lifetime prevalence
Late teens
typical onset age
Source: National Institute of Mental Health (NIMH), National Comorbidity Survey Replication
Types of Bipolar Disorder
Bipolar I Disorder
Characterized by manic episodes that last at least 7 days or require hospitalization.
- At least one manic episode (7+ days)
- May include hypomanic or depressive episodes
- Depressive episodes not required for diagnosis
- Manic episodes cause significant impairment
Bipolar II Disorder
Characterized by hypomanic episodes and major depressive episodes, but no full manic episodes.
- At least one hypomanic episode (4+ days)
- At least one major depressive episode
- No full manic episodes ever
- Often misdiagnosed as major depression
Cyclothymic Disorder
Chronic fluctuating mood with hypomanic and depressive symptoms over at least 2 years.
- Symptoms for at least 2 years (1 year for adolescents)
- Hypomanic symptoms not meeting full criteria
- Depressive symptoms not meeting full criteria
- Symptoms present at least half the time
Other Specified / Unspecified
Bipolar symptoms that don't fit the above categories but cause significant impairment.
- Doesn't meet full criteria for other types
- Causes clinically significant distress
- Impacts social or occupational functioning
- Requires clinical evaluation
Episode States
Bipolar disorder involves distinct mood episodes. Understanding these states is crucial for recognition and management. Circadia tracks all five episode states.
Elevated Energy & Mood
Duration: 7+ days (or any if hospitalized)
DSM-5 Criteria:
- Elevated, expansive, or irritable mood
- Abnormally increased goal-directed activity
- 3+ symptoms (4+ if only irritable)
- Marked impairment or hospitalization
DIG FAST Mnemonic:
- • Distractibility
- • Indiscretion (risky behavior)
- • Grandiosity
- • Flight of ideas
- • Activity increase
- • Sleep deficit
- • Talkativeness
~50% include psychotic features (delusions or hallucinations). Life expectancy reduced by 9.2 years. 82.9% experience serious impairment.
Elevated but Functional
Duration: 4+ consecutive days
Key Distinctions from Mania:
- Does NOT cause marked impairment
- Does NOT require hospitalization
- Never includes psychotic features
- Observable change by others
Common Symptoms:
- • Decreased need for sleep
- • Racing thoughts
- • Increased productivity/creativity
- • Heightened sociability
- • Inflated self-esteem
Often feels good (egosyntonic)—patients rarely seek help for these periods. This is why 69% of bipolar patients are initially misdiagnosed and diagnosis takes 7-10 years on average.*Cyclothymia has subsyndromal hypomanic symptoms.
Low Mood & Energy
Duration: 2+ weeks
DSM-5 Criteria:
- 5+ symptoms nearly every day
- Must include depressed mood OR anhedonia
- Significant distress or impairment
- Not due to substances/medical conditions
Common Symptoms:
- • Persistent sadness or emptiness
- • Loss of interest in activities
- • Sleep changes (insomnia/hypersomnia)
- • Fatigue or loss of energy
- • Difficulty concentrating
- • Thoughts of death or suicide
Bipolar II: Depression to hypomania ratio is 39:1. Depression is usually the presenting complaint. 75% of symptomatic time in bipolar disorder is spent depressed. *Cyclothymia has subsyndromal depressive symptoms.
Simultaneous Opposites
Duration: Varies by primary episode
DSM-5 Criteria:
- Full criteria for one episode type
- Plus 3+ symptoms of opposite pole
- Present during majority of episode
- Higher risk state
Example Combinations:
- • Racing thoughts + hopelessness
- • High energy + depressed mood
- • Irritability + fatigue
- • Grandiosity + worthlessness
- • Decreased sleep + psychomotor retardation
Higher suicide risk. Mixed features are associated with increased suicide attempts and more difficult treatment response. Antidepressant monotherapy is contraindicated in mixed states.
Balanced & Stable
Duration: Between episodes — the treatment goal
Key Characteristics:
- Baseline mood state
- No episode criteria currently met
- Primary goal of maintenance treatment
- Not necessarily symptom-free
Signs of Stability:
- • Stable mood regulation
- • Normal energy levels
- • Regular sleep patterns
- • Clear thinking and concentration
- • Functional at work/relationships
- • Emotional regulation intact
Symptom-function gap: Patients can achieve syndromal recovery yet functional recovery may lag behind. Subsyndromal symptoms and cognitive deficits may persist during euthymia, affecting quality of life.
Warning Signs & Triggers
Early Warning Signs
Approaching Mania/Hypomania:
- • Decreased need for sleep without fatigue
- • Increased energy and restlessness
- • Racing thoughts
- • Starting many projects
- • Increased spending or impulsivity
Approaching Depression:
- • Sleeping more than usual
- • Withdrawing from activities
- • Difficulty concentrating
- • Negative self-talk
- • Loss of appetite or overeating
Common Triggers
- Sleep disruption — Irregular sleep is one of the strongest triggers
- High stress — Work, relationships, major life changes
- Substance use — Alcohol, caffeine, recreational drugs
- Medication changes — Stopping or changing doses
- Seasonal changes — Particularly spring and fall
Sleep & Bipolar Disorder
Sleep disturbance is one of the most reliable predictors of mood episodes in bipolar disorder. Research consistently shows that changes in sleep patterns often precede and can trigger episode shifts.
Mania Risk
Significantly reduced sleep without feeling tired is a hallmark of emerging mania. This is both a symptom AND a trigger.
Depression Risk
Hypersomnia (excessive sleeping) is common in depressive episodes and can perpetuate the depressive cycle.
Why Circadia Prioritizes Sleep
Unlike generic mood trackers, Circadia treats sleep as a primary indicator of mood stability. By monitoring your sleep patterns alongside mood data, Circadia can help identify potential episode shifts before they fully develop, giving you time to intervene.
When to Seek Help
If you recognize these patterns in yourself or a loved one, professional evaluation is important. Bipolar disorder is highly treatable, and early intervention leads to better outcomes.
Consider seeking professional help if you experience:
- Mood swings that feel out of control
- Periods of little sleep with high energy
- Depression that doesn't respond to treatment
- Impulsive decisions with serious consequences
- Racing thoughts that won't slow down
- Family history of bipolar disorder
Learn More
Explore comprehensive guides on each bipolar disorder type and the diagnostic criteria.
If you're in crisis or need immediate support, please reach out:
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