When many people think of bipolar disorder, they may conjure images of super high highs and drastic low lows. In reality, it's much more complicated than that, especially because everyone experiences and expresses symptoms differently. There are some subtle signs of bipolar disorder that are easy to miss, and paying attention to them can potentially help you or someone you love get a proper diagnosis.
"There are many folks out there with bipolar disorder who may go unnoticed or undiagnosed because they haven’t experienced a full-blown manic episode," says psychotherapist Lillyana Morales, LMHC. "When getting diagnosed with bipolar disorder, it is important to remember that the diagnosis does not define who you are as a person, but rather it is a way to make sense of what you’ve been experiencing."
Stigma, too, plays a large role in people's lack of accurate knowledge about bipolar disorder and access to mental health care. It can be hard to develop a judgment-free understanding of your own experiences or those of someone close to you, but recognizing these nine subtle signs of bipolar disorder can help folks seek an accurate diagnosis and proper treatment.
1. Childhood Trauma
Even people who might be genetically predisposed to mood disorders are much more likely to develop bipolar disorder if they experienced chronic trauma as a child, according to a 2020 study of almost 900 people published in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry. Another study of over 700 people, published in 2019 in the Journal of Affective Disorders, found that people with bipolar disorder who have high levels of impulsivity are likely to have had traumatic childhood experiences.
These traumas can contribute to the stereotypes of people with bipolar disorder as impulsive and often making rash decisions. While these are symptoms many people with bipolar disorder struggle with, addressing them as rooted in trauma can help reduce stigma and other barriers to seeking and receiving adequate health care.
2. Racing Or Crowded Thoughts
The experience of thoughts racing or feeling too crowded is common among folks with various mood disorders, including bipolar. According to a 2020 study published in the journal L'Encephale, racing or crowded thoughts can contribute to people acting "randomly" irritable.
"Individuals with this symptom often report that they are bombarded with multiple thoughts and that they jump rapidly from one topic to another," says Glenn Hirsch, MD, psychiatrist at the Child Study Center at NYU Langone. This can manifest as rapid bursts of speech, for example. Asking questions about what's underlying these kinds of symptoms is an important step toward seeking and getting help, Morales says.
3. Increased Levels Of Substance Use
According to a 2005 study published in the American Journal of Managed Care, 56% of people diagnosed with bipolar have had a severe substance use issue at some point in their lives. "Substances become a maladaptive way of coping as a person may feel invincible or want to calm themselves during mania, or on the other end of the spectrum, may feel that substances can help them out of their depression," Morales tells Bustle. She says that when people with bipolar disorder and substance use issues are "still coming to work and for the most part getting things done despite their substance use, this can also go unnoticed."
4. Sleep Disturbances
Folks with bipolar disorder may sleep very little while feeling manic, or sleep a lot while depressed. This can be a tricky sign to detect, because people will often "describe getting much less sleep than is normal for them, but will also report not feeling tired the next day," says psychiatrist Dr. Scott Aaronson, MD, director of clinical research for The Retreat at Sheppard Pratt, a nonprofit mental health provider.
It's especially important for people with bipolar disorder to practice good sleep hygiene because sleep disturbances often trigger acute mood episodes. Morales says that "both your body and your mind require a consistent resting period to recharge and function at their best."
5. Fluctuations In Social Energy
Being extremely social and being withdrawn can both be quiet symptoms of bipolar disorder. According to a 2020 study published in the journal Psychiatry Research, people with bipolar disorder were more likely to withdraw socially when they experienced discrimination because of their diagnosis. That withdrawal can trigger intense mood episodes; according to a 2018 study published in the journal Annals of Clinical Psychiatry, socializing is among the most effective wellness strategies for people with bipolar disorder.
6. Complicated Relationships With Sexuality
Many people associate bipolar disorder with recklessness about sex that results in unplanned pregnancies and high rates of STIs. However, nearly half of participants with bipolar disorder reported not having an active sex life in a 2020 study published in Revista Colombiana de Psiquiatria. The vast majority of all participants (those with and without an active sex life) said that their psychiatrists never engaged them in conversations about sexual health as part of their treatment. Because people often don't think to associate sexuality with mental health, checking in with yourself about your relationship with sex can be very helpful.
7. Less Stereotypical Symptoms As You Age
Older adults with bipolar disorder (over the age of 55) are less likely than younger adults with bipolar disorder to experience high levels of anxiety and depression, according to a 2019 study published in the Journal of Geriatric Psychiatry and Neurology. Because these symptoms are common in people with bipolar disorder, folks who have not yet been diagnosed may be less likely to get adequate diagnoses and care later in life, so looking out for subtle signs may be even more important.
8. Heightened Responses To Weather
A 2020 study published in the journal Frontiers in Psychiatry found that people with bipolar disorder may be more influenced by weather patterns than most. The study observed that people with bipolar disorder who were exposed to less sunlight, high temperatures, and combinations thereof were more likely to experience sleep disruptions and social changes that are associated with suicide attempts. It can be hard to notice these patterns when weather changes are so subtle, but keeping a log of your mood and weather can help.
9. Low Levels Of Self-Esteem
People with bipolar disorder may set high, possibly unattainable goals while experiencing mania. However, low self-esteem is extremely common for those with bipolar disorder, according to a 2020 study published in the journal Psychology and Psychotherapy. Setting high goals when someone feels invincible can make folks feel more particularly unworthy if they fall short of these goals.
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Illness (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.
Bertschy, G. (2020) Racing and crowded thoughts in mood disorders: A data-oriented theoretical reappraisal. L'Encephale, https://www.ncbi.nlm.nih.gov/pubmed/32151457.
Pascual-Sanchez, A. (2020) Understanding social withdrawal in euthymic bipolar patients: The role of stigma. Psychiatry Research, https://www.ncbi.nlm.nih.gov/pubmed/31923743.
Richard-Lepouriel, H. (2019) Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder. Journal of Affective Disorders, https://www.ncbi.nlm.nih.gov/pubmed/30336349.
Smilowitz, S. (2019) Age-related differences in medication adherence, symptoms, and stigma in poorly adherent adults with bipolar disorder. Journal of Geriatric Psychiatry and Neurology, https://www.ncbi.nlm.nih.gov/pubmed/31542988.
Di Nicola, M. (2020) Sensitivity to climate and weather changes in euthymic bipolar subjects: Association with suicide attempts. Frontiers in Psychiatry, https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00095/full#h5.
Atuk, E. (2020) Relationship between dysfunctional beliefs, self-esteem, extreme appraisals, and symptoms of mania and depression over time in bipolar disorder. Psychology and Psychotherapy, https://www.ncbi.nlm.nih.gov/pubmed/32096332.
Bastos, C.R. (2020) The role of CACNA1C gene and childhood trauma interaction on bipolar disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, https://www.ncbi.nlm.nih.gov/pubmed/32169562.
Posada Correa, A.M. (2020) Sexual and reproductive health in patients with schizophrenia and bipolar disorder. Revista Colombiana de Psiquiatria, https://www.ncbi.nlm.nih.gov/pubmed/32081203.
Rosenblat, J.D. (2018) Frequency of use and perceived helpfulness of wellness strategies for bipolar and unipolar depression. Annals of Clinical Psychiatry, https://www.ncbi.nlm.nih.gov/pubmed/30372507.
Hirschfeld, R. (2005) Bipolar disorder costs and comorbidity. American Journal of Managed Care, https://www.ajmc.com/journals/supplement/2005/2005-06-vol11-n3suppl/jun05-2074ps85-s90.
Lillyana Morales, LMHC, MA in Mental Health Counseling, psychotherapist
Glenn Hirsch, MD, psychiatrist, Child Study Center at NYU Langone
Dr. Scott Aaronson, MD, psychiatrist, director of clinical research for The Retreat at Sheppard Pratt
This article was originally published on