Bipolar disorder is a mental health condition that involves significant shifts in mood, energy, and activity levels. Physical symptoms may include changes in appetite, trouble sleeping, depression, irritability, and risky behaviors—such as impulsive sexual activity. These shifts can be intense and differ from a person’s typical behavior, making daily functioning difficult.

Without treatment, bipolar disorder often worsens over time. However, with proper diagnosis and ongoing treatment, people can manage symptoms effectively and live full, healthy lives.

Mental Health Symptoms

Affective Symptoms

Bipolar disorder is an affective condition, meaning it causes dramatic mood changes. The most common symptoms are manic and depressive episodes—periods of feeling intensely “up” or “down.”

Mania

A manic episode includes elevated or irritable moods, high energy, and impulsive behavior, usually lasting at least one week.

Signs of mania may include:

  • Needing little sleep yet feeling full of energy

  • Feeling restless or constantly moving

  • Talking rapidly or jumping between topics

  • Racing thoughts or difficulty concentrating

  • Engaging in risky behaviors, such as reckless driving or excessive spending

  • Increased sexual drive or risky sexual activity

  • Delusions or hallucinations in severe cases

  • Difficulty thinking clearly

These symptoms are a sharp contrast to a person’s usual self and can interfere with work, relationships, and safety. In severe cases, hospitalization may be required.

Hypomania

Hypomania is a milder form of mania. The person may still function well but exhibit noticeable changes in energy, mood, or behavior.

Common signs include:

  • Elevated or euphoric mood

  • Feeling unusually happy or confident

  • Boosted energy and creativity

Unlike full mania, hypomania does not usually require hospitalization, but others may notice the unusual behavior.

Depression

A depressive episode typically lasts at least two weeks and involves persistent sadness or disinterest in activities.

Symptoms may include:

  • Withdrawing from social contact

  • Feeling constantly tired or low on energy

  • Sleeping too much or too little

  • Eating too much or too little

  • Slowed speech or movement

  • Hallucinations in severe cases

  • Thoughts of self-harm or suicide

Irritability and Mixed Episodes

Sometimes, manic and depressive symptoms occur at the same time—known as a mixed episode. Irritability is a common sign and can severely affect personal relationships.

Mixed feelings may include:

  • Feeling empty and hopeless

  • High energy with sadness or frustration

  • Mood swings that are confusing or unpredictable

Behavioral Symptoms

Bipolar disorder affects behavior in many ways beyond mood.

Erratic Behavior

During manic phases, people may have inflated self-esteem and behave impulsively, without considering consequences.

Examples include:

  • Going on spending sprees

  • Engaging in unsafe sexual behaviors

  • Overeating or substance use

Inability To Complete Tasks

Mania can make people feel capable of doing everything at once, often starting big projects they never finish. In contrast, depression can make it hard to do even simple tasks.

Workplace Struggles

Bipolar disorder can interfere with job performance. Many people report difficulties with attendance, task completion, and relationships with coworkers. Challenges may include:

  • Conflict with others

  • Feeling isolated

  • Experiencing stigma

Alcohol and Drug Misuse

Substance use can occur as a way to manage mood symptoms—alcohol to slow down manic energy or to lift mood during depression. People with bipolar disorder are at higher risk for substance use problems, particularly alcohol misuse.

Sexual Behavior Issues

Bipolar disorder can cause dramatic changes in sexual behavior. Some individuals engage in risky sexual behavior, while others may lose interest in sex altogether.

Examples of risky sexual behavior:

  • Having unprotected sex

  • Engaging in sex with multiple partners

  • Using sex to cope with mood changes

  • Exchanging sex for money or favors

Rapid Speech

During mania, people may speak rapidly and nonstop, jumping from one idea to another. This pressured speech is often difficult to interrupt and is different from normal conversation. During depression, speech is usually slower and quieter.

Sleep Disturbances

Bipolar disorder often disrupts sleep. In mania, a person may feel rested after only a few hours of sleep, while during depression, they may sleep excessively or struggle with insomnia.

Cognitive Symptoms

Bipolar disorder also affects thinking and perception.

Time Distortion

Many individuals with bipolar disorder have an altered sense of time. It may feel like time is moving too fast or too slow, making it hard to meet deadlines or keep schedules.

Grandiosity

Grandiosity is an inflated sense of self-worth or importance. In manic phases, a person may believe they are extraordinarily talented or powerful, which can hinder practical decision-making.

Flight of Ideas

This symptom involves rapid, uncontrolled thoughts that may seem disjointed or overwhelming. It often accompanies rapid speech and makes it difficult to focus or communicate clearly.

Physical Symptoms

Bipolar disorder can cause physical symptoms, especially during manic or depressive episodes. It can impact several body systems, such as the digestive or cardiovascular systems.

Physical symptoms may include:

  • Abdominal discomfort

  • Muscle aches or joint pain

  • Appetite and weight changes

  • Diarrhea or nausea

  • Rapid heartbeat or high blood pressure

  • Chronic fatigue or weakness

Gender Differences in Symptoms

Bipolar I disorder affects men and women equally, but there are some differences:

Women tend to:

  • Experience more depressive and mixed episodes

  • Be diagnosed later in life

  • Have more rapid cycling episodes (four or more in a year)

  • Be diagnosed more often with bipolar II disorder

Men tend to:

  • Experience more manic episodes than women

Symptoms in Children and Teens

Bipolar disorder can occur in children and teens. While symptoms may look different than in adults, common signs include:

  • Intense irritability

  • Persistent low energy

  • Sadness or hopelessness

  • Difficulty sleeping or concentrating

  • Talking rapidly

  • Physical complaints like headaches

  • Changes in eating habits

These behaviors should stand out as different from the child’s usual behavior and also from what is typical for their age group.

When To Seek Help

Bipolar disorder is a chronic condition that requires ongoing treatment. Early recognition and intervention can lead to better outcomes.

Seek help immediately if you or someone you know experiences:

  • Inability to care for oneself

  • Hallucinations (seeing or hearing things)

  • Severe hopelessness or suicidal thoughts

  • Symptoms of mania or hypomania

  • Difficulty taking prescribed medications

  • Worsening mental health

In a crisis, call emergency services or go to the nearest hospital if there is a risk of self-harm or suicide.

Questions To Ask Your Provider

If you suspect you have bipolar disorder or are managing it, consider asking your healthcare provider:

  • How do sleep and stress affect my symptoms?

  • What are early warning signs of a manic or depressive episode?

  • What treatment options are available, and what are their side effects?

A Quick Review

Bipolar disorder causes fluctuations in mood, energy, and behavior. It can affect people of all ages but is often diagnosed in early adulthood. Symptoms include episodes of mania, depression, irritability, and behavioral or cognitive changes. Understanding these signs is key to getting a timely diagnosis and effective treatment.