Two bipolar disorders are recognized by the American Psychological Association. These are categorized as Bipolar 1 and Bipolar 2. Both disorders have in common severe mood swings. Decades of research have produced medications that are effective in relieving these mood fluctuations. Psychosis is not a typical symptom of bipolar disorder as it is a mood disorder, not a psychotic disorder. However, in severe cases, unmedicated Individuals with either form of bipolar disorder may experience psychotic symptoms during the most extreme mood states.
An Emotional See-Saw
You can think of bipolar disorder as an emotional see-saw. On one side is depression, and on the other mania. When the see-saw is level, your moods are level. When it tips to one side, one mood increases and the other decreases. For some people with bipolar disorder the "see-saw" only fluctuates a little -- just enough to ruin a day, a week or a month. For others, it swings all the way up -- creating an extreme mood state that interferes with perception, thinking and decision-making. If the mood becomes extreme enough, sensory processing can become impaired, creating the experience of false sensory input or delusional thought content.
Severe Mood States
Those with severe forms of Bipolar 1 are at risk of experiencing psychosis during extreme depression or mania. Those with severe Bipolar 2 disorder might only experience psychosis during a depressive episode. Since Bipolar 2 disorder does not contain manic episodes, this extreme mood is never experienced to bring about severe impairment in sensory and cognitive processing. Instead, those with Bipolar 2 experience hypomania. A hypomanic episode is marked by a distinct increase in energy and cognitive activity without the extremes seen in a manic episode.
The Experience of Psychosis
The vast majority of psychosis experienced in bipolar disorder are auditory hallucinations. People report these as unusual or unidentifiable sounds or voices. Most report that the voices heard are not those of people they are familiar with and that the messages (when they can be made out) are negative commentary on the individual. Infrequently, people report that these voices attempt to have conversations with the person. For the most part, however, the sounds and voices are reported as nonsensical and vague at best. Another common experience is that of delusional thoughts. These convincing ideas have no logical foundation in reality, but have a powerful influence on the person's behavior. Those who suffer from this experience report a range of experiences, from relatively harmless thoughts like thinking your spouse is lying about how much ice cream he ate at lunch, to severe and dangerous thoughts about your life being in danger.
References
- American Psychological Association; The Diagnostic and Statistical Manual of Mental Disorders; 2000.
- James Hansell & Lisa Damour; Abnormal Psychology; 2005.
- Francis Mark Mondimore, M.D.; Bipolar Disorder: A guide for Patients and Families; 2002.
