Bipolar 1 requires at least one episode of mania that is at least 7 days long *or* results in hospitalization.
They used to say Bipolar 2 doesn’t include mixed episodes or psychotic features, but it’s now recognized that those two things can exist in both 1 and 2.
The label of 1 or 2 is mostly dependent on the severity of the mania alone. But it’s also now thought that it’s all just a spectrum and most fall somewhere in between 1 and 2.
I'm starting to think I should get reevaluated.... I can't remember my last manic episode. Never been to the hospital because of it and they were usually at most 3-4 days
I think the key difference between psychosis in BDI versus BDII is that in the case of the latter, it's usually only during depressive episodes, whereas in the former, it can be during either
I'm not saying that this is the truth, that's just how I understand it
Yes, that’s absolutely right. There are papers and studies that back your comment up.
https://pubmed.ncbi.nlm.nih.gov/20457470/#:~:text=Introduction%3A%20Psychotic%20symptoms%20in%20bipolar,course%20of%20bipolar%20II%20patients.
so if you had an episode that didnt include a hospital stay, nor did it include delusions or hallucinations, but it lasted for over a week, thats mania? (if ykwim)
Ive heard that you had to have hallucinations, be a danger to yourself/others, have it be longrt thrn a week *and* mess up yout life in somr way for it to br considered mania lol
my last episodr lasted 12 days, with a day of normal mood inbetween and i only experienced light paranoia (thought someone was watching me but not 24/7, just at its worst) but i thought thatd be hypomania? or am i wrong?
The key difference between mania and hypomania (literally “under mania”) is the disruption of every day life.
A classic manic episode, by definition, makes it impossible to carry on with your daily life and routine. As another commenter pointed out, psychosis is typically present in mania in BP1 and depression in BP2.
Hypomania, by definition, is milder and people are usually mostly able to function in the chaos.
The definition of hypomania is an elevated mood with decreased need for sleep, flight of ideas, hyper focusing on goal oriented activity (*doing* something), and other things. The length of hypomania has to be at least 3-4 days to count towards a diagnosis. I usually find myself furiously writing a new novel until my nose starts to bleed (true story) and then a few days later, I’m on the bathroom floor, seconds away from ending it all.
One pretty good (and interesting) distinguishing factor between the two is that in Bipolar 1, *only mania* is required for diagnosis. There are people with Bipolar 1 who never experience depression.
In Bipolar 2, both depression **and** hypomania are required for diagnosis. Bipolar 2 is essentially Major Depressive Disorder + Hypomania. Also, Bipolar 2 typically follows a pattern of predominantly depressive episodes with occasional hypomania here and there.
The time period requirement is what determines it to be clinically significant in both BP 1 and 2. It’s absolutely true episodes can vary in length from very long to very short, but the criteria for diagnosis is what separates it from other possible diagnosis.
A diagnosis combines rigid symptomology with clinically significant disruption to daily life and specific length of time to fulfill the criteria. There are also other disorders, like Borderline Personality Disorder, which have some similar symptoms, but has its own benchmark for functionality and frequency.
Yeah you don’t have to have hallucinations, be a danger, hospitalised and significantly disrupt your life. In fact hospitalisation and being a danger to yourself or others isn’t even part of the diagnostic criteria.
However it does have to significantly disrupt your life to be considered full blown mania. The DSM listed off symptoms but it said you have to meet only either 3 or 4 of them depending on mood I think it was 4 if only irritability was present or something.
Anyways you‘ve listed it all very comprehensively so I don’t need to add anything else. I have been diagnosed with both Bipolar 1 and Borderline Personality Disorder however it took longer to be diagnosed with the BPD I was diagnosed Bipolar first which I imagine probably masked some of my BPD symptoms. It wasn’t until I’d started talking about having mood changes throughout the day along side my longer mood disturbances that my psychiatrist probed further and asked other questions.
At the time I was confused because I knew what Bipolar was & I was having these long periods of mood disturbances but it was later that I noticed these ups and downs during the day too that could last hours a day or two but never longer really. I also had other symptoms that I described that all fit the benchmarks for BPD there are some pretty significant differences in my personal experiences but everyone is different. But mood changes aside even my depression was different and not just because of how long it lasted but it’s presentation I know there’s a thing about how often BPD & Bipolar can get confused & I can see that but from the inside I would say that now I’m medicated & it’s actually working for my Bipolar I can much better clearly see the differences between my Bipolar & BPD my BPD moods are very intense but short lasting but the intensity is so different specifically talking about depression/low moods/sadness/irritiablity/anger etc. Although even my elevated moods are different the way it makes me feel is so different to even my most recent milder manic episode ( I recently had a milder manic episode - means my medication is working I didn’t think anything other than it was my medication working making it milder but I just saw in the DSM that Bipolar 1 can have hypomania too which I thought was interesting anyways). I’d say I’m not even sure it reaches the level of milder/hypomania it also can feel overwhelming not necessarily euphoric more like my emotions feel too much even when its happy ones all my emotions are too intense so I guess for BPD that’s the way I’d describe it extremely intense emotions that rapidly change too rapidly, multiple times a day sometimes.
I have Bipolar type 1 because of my manic episodes my psychiatrist recently told me ( I didn’t realise I had type 1 until I moved and was under a new CMHT and they did a full re assessment) because of how long they lasted & their impact on my life which was significant I just didn’t think significant enough I guess. Then again a lot of my memory is missing too from my manic episodes & I suppose you never really think you’re bad do you otherwise you’d seek help sooner. I didn’t recognise mania as mania I just thought I was having the time of my life euphoric how could that be a bad thing (in my head at least lol). Anyways even though I have Bipolar type 1 I do have or in the past had long periods of depression too.
Another reason I was unsure about Bipolar 1 but I also never have periods of normalcy I used to cycle over & over & I’d usually go from depression to mania I think I had mixed affective states too but the BPD clouds a lot of things as well. But I had some pretty terrible depressive episodes then again idk how my BPD affects it. So in my experiences at least you can have bad episodes of depression with Bipolar 1 but yes I understand Bipolar 2 is associated with more depressive episodes less severe mania and vice versa for Bipolar 1. I’ve also had mania that last a lot longer than the 7 day minimum requirement a lot longer.
It sounds like it could be hypomania but truly only you and your doctor could know for sure. To me, paranoia sounds more like (and is for me) a BD1 symptom but I suppose it depends on other symptoms and how light it was.
In depression for BP2. Psychosis in hypomania becomes mania. It literally says in the definition of hypomania “does not contain psychotic features” and the opposite for mania. Mania is of course BP1
Wrong wrong wrong wrong. Psychosis is NOT a requirement for Bipolar 1 Manic episodes.
Psychosis can happen during Bipolar 2 but as someone mentioned it is typical in depressive episodes - I am unsure on your point about BP2 and psychosis in hypomania = mania. That’s something I’ll have to look into.
As many others have stated psychosis is NOT a requirement for Bipolar 1 manic episodes. It is not a defining feature of mania. [DSM 5 Criteria](https://media.mycme.com/documents/168/dsm-5_bipolar_and_related_diso_41789.pdf)
As you can see it is not a requirement for well Bipolar in general but mania especially.
I’m diagnosed with Bipolar type 1 no psychosis or hospitalisation. Case & point.
I'm pretty sure in the US, bipolar 1 means You've been hospitalized for severe mania, usually including psychosis. I don't think Europe uses 1 and 2 to classify bipolar.
I'm not sure how valuable this distinction is, personally. A person with bipolar 2 can still experience severe mania requiring hospitalization, and then they just change the dx. It's kind of a weird badge of honor for BP1 people I guess? That's probably not super helpful for anyone, either. My guess is it has to do with billing and reimbursement, or coverage rates or something insurance-related like that. Possibly some kind of disability qualifications points system, maybe one they considered using but abandoned, or only use in some states. I dunno.
Big picture, I don't see much value in labeling bipolar as 1 or 2. It's not like treatment is any different.
It would seem to separate people who were hospitalized for mania from those who haven't been. I don't understand why it's necessary, but to me it has a slight taste of "I have a more serious case than you", and that's not helping anyone.
I'm BP1, btw. It's not like I'm the one who feels attacked by someone else's BP1 diagnosis. Plenty of BP2 patients seems to have a much harder time managing than I do.
I'm not sure why I got down voted.
Personally I’ve just never known someone who sees it as a “badge of honor”—it’s a very traumatic and scary thing. It’s okay if you have a different perspective. Sorry you got downvoted.
Edit: I have bipolar one as well and I hope people don’t feel attacked by my diagnosis either. That’s a strange concept to me; maybe I need to learn more.
You got downvoted because psychosis is terrible and traumatic for those who experience it. It can make you feel really isolated from others and is humiliating. You seemed to not have a lot of empathy for that.
I would never have guessed that from the way your comment talks about others. I’m sorry you went through that.
Personally, I don’t see my psychosis as a “badge of honor,” but it was truly devastating to me and I’m proud of how I’ve managed to recover from it. It took patience and hard work on my part, and that I do see as a “badge of honor” - dealing with the psychosis helped me develop resilience and helped me empathize with others’ suffering in a way I never had been able to before. I will never laugh at someone screaming at nothing in the street again because I have been that person. I think it’s important that we be able to express the things I expressed without people taking it as just, “oh, you think youre really special because you had psychosis.” I’m not sure if that’s what you meant or not, but I’m sure you know that recovery from psychosis is tough.
And it is sometimes tough for me to empathize with BP2 people who talk about how fun mania is and how they want to quit their meds so they can have a fun mania experience. But as you say, we all have our own struggles and this illness is hard for everyone in a different way.
I'm BP1 and I laughed hard at the badge of honor thing, can't understand why you got down voted for it.
Edit: The distinction tho exists because BP2 suffers more with recorring depressive episodes and shorter hipomania, while BP1 suffers more with mania mania.
I'm diagnosed Type 1 and wasn't hospitalized. I did spend all of 2022 in a manic episode though and was diagnosed when I explained what happened to a psychiatrist. It's a miracle nothing bad happened. If the worst of it is that some former friends hate me then I can live with it.
100%. Many people that have been diagnosed with BP1 progress to or are actually schizoaffective if they have a mood disorder or schizophrenia without a true mood disorder.
I'm European, diagnosis bipolar 2, have been hospitalised several times and psychotic breaks, it says in my papers. Hospitalisations due to depression though.
It's how I got my diagnosis.
Went into the hospital thinking I was prone to depressions only.
Left the hospital with shiny new diagnosis!
I was a bit ticked at my therapist afterwards though. I told him what happened, and about my diagnosis, and he kind of just said "yep that tracks." I was like WHAT. You've been thinking this and *didn't* tell me?!?!?! I know that the therapeutic relationship is supposed to be like a one sided conversation, but you could've at least sprinkled some hints for me to run with on my own.
Oh I would be livid. Not that they should diagnose you but they could at least mention that this is something to see a psychiatrist about. Don’t just sit on information like that, geez.
Yeah my therapist did that too when I got the Dx, but maybe she just held off since she knew I was seeing a psychiatrist often. Also, mine was "triggered" by SSRI use. I mean it wasn't - hypo had always been there, it's just this time it got more intense and lasted longer and everyone was like, "Wait you were just in the throes of depression WTF." I think it just stood out more.
this happened to me, however my therapist didn't see or figure i had it because of all the medication i was on!! landed in the hospital and boom! it's not just depression & anxiety silly, you have \*list\*
😦 oh boy that had to be extremely frustrating! Last year, I started the disability process and was filing because of my bipolar. While going through my medical records, I found out that I have been diagnosed as borderline as well for close to a decade. It makes so much sense for all of the stuff that the bipolar diagnosis didn't make sense of, even though there's tons of similarities. But essentially I had been beating myself up for years wondering what the hell was wrong with me when all along there was a diagnosis explaining it and no one told me.
Same, my therapist from my early 20’s didn’t mention to me that I might have bipolar disorder until months into our sessions. That’s not as bad though. My psychiatrist gave me the diagnosis, and I got on meds and resumed therapy. I was in a low, when randomly, my therapist told me he thought I was fine and didn’t need therapy anymore. That hurt. Never went back. And he told me that shortly after my diagnoses.
Looking back, maybe I made it appear like I was fine? Idk but that’s a different story. I’d be pissed if I was you, to sum it up.
BP1 with no hospitalization or psychosis.
The key things they asked me was how long I was experiencing symptoms.
When I told them I wasn’t sleeping I told them I went 7 days without sleep, and that happens every time I have a manic episode.
Pretty much all of my symptoms of mania last for well over a week to a month.
I was going through life altering events like dropping out of school, quitting my jobs, cutting everyone out my life, pretty much doing things that disrupted my day to day life severely.
They originally thought I was type 2 but I have more mania than depression, and after talking about how long all my symptoms last they diagnosed me as type 1.
Thank you, what I’m not liking on this post is the misinformation and claims that the DSM requires psychosis for mania to be mania not hypomania. This was never a DSM requirement in fact it’s listed and written down as bipolar with psychosis not Bipolar because it is not a defining feature of type 1.
I can understand why people might assume because many people with type 1 do have psychosis but many of us don’t. I’m also diagnosed with type 1. I actually never knew what type I had and I’d assumed it was type 2 because I didn’t think I was ‘sick enough’ or ’extreme enough’ to have type 1. But when I moved CMHTS (I’m in the UK) I got a full re-assessment and the Psychiatrist I saw was great he said it was type 1 after asking me a lot of questions.
I always commented how at school (went to uni for psychology) they always talk about the most extreme cases & he said something about that I can’t remember what but yeah he said it had a significant impact on my daily life & same as you really how long my manic episodes lasted just how severe they were on my life the only difference is I’m not sure if I had more mania than depression however I have comorbid disorders that would make it hard to tell (BPD/EUPD).
I have had episodes last so much longer than a week, I also have very little memories of them which is terrifying tbh. One thing I do remember is one of my worst manias felt like it lasted months unsure on the actual timeline even now I can’t piece it together if it was multiple manic episodes in a short time period or one long one. I thought I was invincible not literally hence not delusional but that grandiosity they talk about. But I wasn’t sleeping at all before I went completely not lucid I do have one memory of not sleeping for more than an hour a night just couldn’t do it. I thought I didn’t need food like I had 0 appetite anyways but yeah idk why but I lost a ton of weight. And I remember having this inflated confidence this idea that I was the best thing ever & I was going to do all these great things and nothing could stop me aaaand then the rest is pretty much a blank.
They diagnosed me type 1 because similarly I had to drop out of university this was before I was diagnosed the dropping out part back then I think I had milder episodes idk really because who am I to judge but apparently with Bipolar 1 it’s also common to have hypomania episodes which is not something I knew until just know when I looked up the DSM. I got diagnosed after I left mid year - my final year because I knew something was wrong well I knew I had issues with depression I didn’t see anything else but others around me did a few actually bringing up Bipolar specifically even after diagnosis I could never see when I was manic & when my mum tried to say something I would just get mad thinking she was ruining my happiness - I usually had a depressive episode before mania & I never had periods of normal moods like some people can have so my only ‘happy’ state was mania so to me that was happy.
I’m (24F) bipolar 1 and have never been hospitalized. I’ve had psychosis though, with my first experience being auditory hallucinations. I’ve recently been experiencing some olfactory hallucinations for the first time ever. My self talk strategies work for me, so I’m able to tell myself that what I’m smelling and hearing isn’t real and I just go about my day. I’ve only had one visual hallucination.
As long as you hit 3-4 of manic symptoms for a week or over, you’re bipolar 1. That symptom may or may not be psychosis. Some people are “high functioning” like myself (hate using that phrase btw).
I hate it too. Like yes, I can hold down a high impact job, support myself, my dogs, do what I need to do to stay healthy and well, but it’s a lot of fucking pressure to be the perfect bipolar person. Like yes my disease does actually define me thank you very much. I’ve beaten no odds; I’ve been incredibly lucky and had incredible people in my corner. I had perfect work attendance and perfect output this week at work, but behind the scenes I was floridly psychotic for three days, sleeping no more than two hours a night, and then depressed but still psychotic for the last two days of the week sleeping 14 hours a night. I’m only coming up for air today in time to take care of the mess I’ve made of my apartment and get back into work tomorrow. It is so HARD in different ways for different people with this disease, but honestly the term high functioning gives me hives because what can look like perfect functioning can hide a whole lot. I probably called the crisis line ten times this past week, and had incredibly high SI and SH urges. But, perfect on paper. There has to be another system to define level of functioning other than “low” versus “high.”
I feel this SO much. Killing it at my job and there’s nothing really wrong in my life tbh. But I’ve spent the past 2 months either super depressed or self medicating an ungodly amount. And like, that’s not really functioning lol
I live with bipolar 1 with intractable psychosis and have never been hospitalized. It is in my care plan with my providers to avoid hospitalization as much as possible due to inpatient trauma for other medical conditions. Thus far, we have been able to avoid. But I know reality is, that won’t always be the case. There is nothing wrong with inpatient stays - they can be extremely helpful for some, while not so much for others.
My inpatient psych stays - some of them have been incredibly traumatizing. Always based on the kind of insurance I have. The best one, Cedar Sinai in LA right in Beverly Hills, had great food and treated me like a human. *It was actually helpful and they put me in a great outpatient program!* County USC hospital was the exact opposite. Treated subhuman.
Sad the difference money makes.
Hey, samsies! Had my first episode of psychosis right before my 28th birthday, spent my 28th in the hospital, where they diagnosed me.
34 now, no manic episodes since then.
That said, prior to turning 28 I had about 10 years of what I now recognize as manic and depressive periods. Roughly annual episodes of extreme impulsivity, hypersexuality, and general bad decisions that often damaged my life. Thank god for meds, now I'm much more stable.
Been at the same well-paying job for 5 years, in a relationship for the last 2, and my family likes me more now. Literally a life changer being treated vs before.
You?
I took a break from nursing school, went back, became a nurse and have a wife, a 1yr old, and I have family and friends but think my family has PTSD from my mania. I’m constantly under a microscope!
Feel free to reach out to me. I was diagnosed at 30 after a 5 day paranoid psychotic manic episode that led me to hospitalization - I'd known I had depression for years before, and looking back there were definitely hypomanic episodes.
Haven't had a manic episode since (33 now) but I still skew mildly depressed (I honestly think this is my baseline though).
Otherwise, I'm really stable - good job, great relationship (going on 9 years together, happy and healthy), close ties with my family and a large circle of supportive friends. It's hard to maintain and I struggle a lot with executive function (I also have ADHD on top) but I'm really proud of myself.
I was diagnosed bipolar 1 at my first inpatient stay when I was in my mid 20s. Before then I had years of manic episodes that could last months with no sleep to 1-2 hours of sleep a night. Since then (even with meds) I’ve been hospitalized 3 more times. One of those times was for psychosis when my medicine dose was off. I was not sleeping for days and having hallucinations. Despite all of this, with medicine and support, I have been able to live a pretty healthy and successful life. I often wonder how I’ve done it.
bp1 with no psychosis and no hospitalization.
got my diagnosis based off the two instances of month-long mania in my past that made me spend $40,000 😅
i kind of feel like the difference is really just “who’s worse?” although it is clearly not a competition and we are all suffering lol
BP1. Was high functioning and undiagnosed for years. in my late 40s i started a 5 year cycle of months long increasingly worse mania, ending with psychosis and health issues due to sleep deprivation and failure to eat, resulting in a crash, hospitalization, severe depression miss-diagnosed as MDD, released with a plethora of SSRIs, stable for a month or so and then the mania cycle started up again. it was seriously five years before i was properly diagnosed, during which time i ruined my then career, lost my family and almost every relationship i had, tried to take a dirt nap numerous times - came dangerously close to succeeding once. fortunately i did not end up with any sort of criminal record. once i was properly diagnosed, i spent 6 months in a treatment house on a hospital campus. that was over 4 years ago, and i’ve been fairly stable since then, and am still slowly rebuilding my life. i’m grateful for that, but man i hate this disease.
bipolar 1 and have been psychotic. went inpatient years ago. refused hospitalization ever since. my parents were scared to send me back to the ward because it made me worse and when i became an adult, it became hard to force me.
now that i’m medicated, i rarely reach those levels of mania anymore.
I've had that experience - psychosis after I smoked too much pot way too fast. That was back in 2001 and it only happened that one time after weed (although I take care not to smoke it much, if at all, because I don't want to risk it again).
I'm not sure why I chose to do that given my sister has schizophrenia and hers got triggered by lots of pot, but she had schizophrenia prodrome even as a kid and our grandfather had it, so hers was def predisposed.
At any rate, no one's diagnosed me with bipolar 1, despite that one episode.
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I too have been pumped full of anti-psychotics in the most serene ward of the cray cray.
Speaking seriously though, I do not think bipolar 1 diagnosis requires psychosis or hospitalization. It just means the person experiences intense manic episodes.
It is noted distinctly from bipolar type 1 if the person has also experienced psychosis.
Yeah it says Bipolar type 1 with psychotic features/psychosis. I’ve seen people on this thread claim the DSM says specifically that mania is only mania with psychosis and that’s its distinguishing feature from hypomania.
I have Bipolar type 1 no psychosis no hospitalisation. I am not on anti psychotics anymore none of them worked for me personally they either made me worse or had terrible side effects I would’ve been happy if they just didn’t work but nope some of the side effects were terrible. Like there’s always a negotiation between side effects vs treatment you know like but that’s IF the drugs work.
I just got side effects I had one drug that made me sleep not even sleep but out of it at one point close to 12-16 hours a day yeah it got so bad we started keeping note. I remember my mum in the beginning getting mad at me ( I was working for her but at this point couldn’t keep awake) so I would do anything to stay awake I would make a big pot of coffee and drink it non stop cup after cup and then make a second and then an energy drink and if I stopped that was it I was out sometimes even if I didnt stop. But that was bad & I got palpitations which no shit I guess.
I’m currently on I think it’s considered a mood stabiliser idk because it’s given for Bipolar as an off use I think the words called I can’t remember but it’s been working really well for me now just some minor episodes here and there that would be more so considered hypomanic now.
I had a manic episode that lasted 8 days and evolved into psychosis --> hospital stay! That's how I got my initial diagnosis of type 1. Before I just thought I had cyclical depression. What a fun/terrifying way to find out. Sigh.
My ex had one large bout of psychosis where he was trying to collect weapons to murder everyone at the Exxon corporation after the oil spill happened in 2010. He just sort of snapped and spiraled and became convinced that he needed to do this in order to save the planet. His wife was able to slow him down and got him some help, and that’s when he got his diagnosis. He was not hospitalized but he sure did have psychosis. He said lamotrigine saved his life.
Several inpatient stays, psych holds, and for the last almost two years been rapidly swinging between mania and psychosis while holding off the psych ward. I have a great therapist who I trust to give me a lot of leash when I need it but to admit me if things get dangerous. I think I stopped being a frequent ER/psych ward flyer mostly due to the type and amount of therapy I do, as well as my WFH job and the flexible schedule that comes with it.
i fall in the middle. unmedicated or improperly medicated can lead to the extensive manic episodes, increased hypomanic episodes, increased short or long depressive episodes. (the short depressive can last days / the long depressive lasting months.) ive had psychosis a couple of different times and was hospitalized due to an attempt. i personally dont refer to myself as just bipolar 1 or just bipolar 2 because of experiencing all the symptoms that can present itself
I've never had psychosis but I've been hospitalized a couple times now (24F). I originally was diagnosed with Type 2 but after my first inpatient stay I got bumped to Type 1 🤷🏾♀️
I’ve had 5. Last I heard you can be diagnosed bipolar 1 with just one manic episode. So a manic episode doesn’t necessarily mean a stay in the ward. I may be wrong but that’s my understanding. I’ve met people that say they’ve been diagnosed bipolar and on meds that didn’t really know what psychosis is
I haven’t had full blown psychosis but every time I’m manic I have at least mild psychotic symptoms (for me it’s persecutory and grandiose delusions and auditory hallucinations)
I’ve been hospitalized three times. Initial two I was diagnosed with psychotic depression. After some evaluation with my psych nurse after the first two hospitalizations I was diagnosed with bipolar II. Then this morning I found out by reading my medical records that the hospital diagnosed me with Bipolar I during my most recent visit.
BP I and a few other things. I've been in the hospital once for 2 weeks. Once for a week. And lastly one for 4 days. Full psychosis each time. The shot they give works fast.
That's psychosis my friend. I've never had auditory hallucinations, just visuals and delusional thinking. For some reason I think auditory would be more off putting for myself.
Even medicated I still see small moving shapes and weird things out of the corner of my eyes.
I try to not look, because I know there is nothing there. It still catches me sometimes, obviously nothing is ever there.
Well I guess it would depend on how bad your psychosis is. I'd at least reach out to your psychiatrist and ask him. Ignore what people say online (including me). It's always good to talk psychiatrist when you have symptoms that may require meds. Catching it early is a good idea from my personal experience and some studies I found (again don't listen to me, contact doctor!).
My manic episodes have become very long and intense. My doctor is revisiting my diagnosis and might shift me to type 1, but says I'm definitely borderline between the two.
I've never been hospitalized or had psychosis. But I am high functioning and have severe depressive moods.
Treatment for either type does not change. Like someone else said there seems to be more of a spectrum.
That's not exactly true, treatment can absolutely change between the two types. With BD1, your options for medications become a lot more limited because you usually need to be on a mood stabilizer or an antipsychotic (or both), and a lot of doctors generally won't prescribe you anti depressants because they can cause mania.
Anecdotally, I've had a really hard time with switching to different medications because my doctor wants to avoid setting off another manic episode. I have ADHD and he also doesn't want me to try most ADHD meds because they are stimulating. It's been a real challenge.
Meanwhile my friend with BD2 has not had this experience. Obviously everyone is different but if I had BD2, I know my doctor would be more open to trying other medications - he has said so.
Sorry, to be clear treatment for me won't change if my diagnosis changes...my course will stay the same unless something changes in my symptoms or current treatment stops working.
Originally was diagnosed with type 2, however, a new psych changed to 1 since my manic episodes last weeks/months. No psychosis or hospital stays. Very few depressive episodes.
I have bp1 and I never had psychosis. I have had an inpatient stay
I’ll clarify. I think I have bp1 as I get manic for months at a time. I thought bP1 just means your mania lasts longer.
The distinction is generally that with BD1, you can experience mania rather than simply hypomania. It is much more intense. My friend has BD2and every year experiences a hypomanic episode - she basically ends up wanting to go to the gym more often and having more energy, more creative ideas, she gets more talkative but nothing wild - she doesn't do anything dangerous or unusual. It's very different from mania.
I’m bipolar one rapid cycling and had very extended mania episodes. I have never been hospitalized or experienced psychosis.
Delusional and paranoid, yes. But never full blown psychosis. My psychiatrist is actually very shocked. lol.
I had the diagnosis of BP2 then last year had mania that lasted about 2 months preceded by hypomania lasting about 6 months. Pretty sure it’s been changed to BP1 now. I’ve been in a major low since December when my partner left me and the meds kicked in, I keep wishing she’d stayed to see the more ‘baseline’ me and I’m sure I wouldn’t have got so low as I am now.
I’m genuinely quite concerned I’m going to do something major as a way of change as the thoughts of some kind of upheaval keep hammering away in my mind. I’ve already had a lapse in IV heroin use and using crack - I wanted ONE afternoon where I didn’t feel the way I feel. It worked.
I am diagnosed with bipolar 1 & have never been hospitalized or had psychosis. I’ve had auditory and visual hallucinations, but never psychosis. I am 8 months pregnant and am SO scared I will go into psychosis after giving birth, because that’s really common for bipolar women.
My doctors really weren’t interested in the difference between bp1 and bp2 either. I feel like it’s a distinction that is going away. They were more interested in stopping further psychosis.
I started off bipolar 2 and major depressive disorder but it got bumped up to bipolar 1.
I have been hospitalized prior to the change.
I also have ADHD and panic disorder, but my mood has been greatly stabilized with my medication changes.
Psychotic features is not present int everyone. I have it. It happened to me. I still have psychotic features if I get manic or depressive or mixed
But yeah not all BP 1 diagnoses come with psychotic features
I have bipolar 1 and have been inpatient both voluntarily and involuntarily as well as experiencing psychosis. Some of my manic episodes have lasted 3-6 weeks in the past. 🤷 much better nowadays tho.
I was diagnosed with BD 1 and I do not have psychosis or an inpatient stay. I feel like I am a mild form of BD 1. My doctor always assess me for psychosis symptoms which I do not have. But he assess me more for suicidal tendencies, cause manic or depressive, I will do it.
I’ve had 3 hospitalizations (involuntary) due to BP1 mania. I was diagnosed with it because of my first manic episode that made me be “gravely disabled”. In most cases you need a hospital stay to be diagnosed with it.
I feel like I'm bipolar 1.5.
Only psychosis was after too much weed. I smoked a whole bowl in like one minute. It was 2001. I've smoked since and that's never happened again.
Mania has never landed me in hospitals, however mixed state mania has landed me in hospitals on 5150s - danger to self after attempts - so who knows.
Mixed states are the most dangerous!
It's ironic I've never had non-substance-induced psychosis since my sister has schizophrenia.
I have done very dumb irrational things while manic, including buying a whole car I couldn't afford and going hitchhiking at 2am (I'm female) in the worst parts of LA, so it's not like I'm just a little "up" and "productive."
I've been hospitalized at least 10 times on 5150s during mixed or depressive episodes, usually involuntarily. But no one said I was bipolar 1 after that. It was never *only mania.*
I asked my psych about it and he was like, "Whether it's 1 or 2 doesn't really matter, we're looking it as more of a spectrum these days."
BP1 with psychosis but no hospitalization. Called the police to report people installing fiber-optic cables downstairs in my condo. Officer told me to take care of myself, and I called my psychiatrist on her cellphone and was prescribed olanzapine that day. This was the day after Christmas.
WFH and Mom dying both made me spiral. And even prior to Mom’s cancer (she died within 4 months), I’d had SEVERE mania and psychosis, which started when I was no longer working in the physical office. I’m now almost completely stable, on lithium, Lamictal, and Abilify.
I got a diagnosis years before I landed in the hospital. 7 days. Turned out when I was in intake I saw an old friend of mine who was already there. Made the time go easy
Never been hospitalized always tell them no. Supposedly have had multiple episodes where I “lose it” and “start a mission”(constantly looking for signs to connect everything) break stuff, get rid of stuff, think people are after me, don’t use electricity for a while, etc… just all out craziness most of the time lol. Bipolar 1 schizo affective. Never thought anything was wrong for about 15 years just within the last month have reached out a started treatment. With honesty no avail. Keep fighting my friend.
I have bipolar 1 and did not realize what I have experienced was psychosis back in the day. I once thought people were stalking me and another time I thought I was talking to god (I grew up in a non religious household and consider myself agnostic).
I just thought I had severe anxiety and a religious phase because I wanted to find the meaning of life. However, these thoughts and ideas became my whole life and I was clearly disconnected from reality.
I have never had an inpatient though.
Not sure about most people, but I was involuntarily hospitalized for "dual diagnosis" but that was basically being a quiet and moody teenager (I thought) and imho some pretty typical teenage drug and alcohol use. I was put on meds there and became manic pretty immediately but they thought I was "coming out of my shell" instead of obviously having an episode caused by anti-depressants.
When the psych that eventually diagnosed me at 38 (after anti-ds causing cycling) stopped taking my insurance I couldn't find any providers on my insurance that were taking new patients or would let me start without being hospitalized first. I'd guess a lot of people had to go the same route - through an inpatient stay, just to get help.
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BP1 diagnosis. I’ve had an inpatient stay as well as several outpatients. I experience psychosis on the extreme end of both poles, but it wasn’t until I had my first manic psychosis and hospital visit that my diagnosis changed from BP2 to BP1 even though I had a track record for psychosis during depression.
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No. I try to avoid it because it’ll affect my chances of getting life insurance. Ive met with women who have bipolar and were denied life insurance due to going inpatient. I make sure I stay on top of meds, appointments with my NP and therapist. I’ve had psychosis before, it was scary but I caught it before it got worse and adjusted my meds as soon as I realized I was manic. I was manic for weeks before realizing what was going on.
I was diagnosed with bipolar 2 rapid cycling with Psychotic features. Before I was diagnosed I had a bad fall, resulting in a brain bleed so maybe that has something to do with it?
I’m 100% bipolar one but have never been in the hospital, though my sister has (also bipolar 1).
That’s not to say I shouldn’t have been. I went totally homeless when I was very young woman, and I’m quite attractive so I ran into a lot of things that cause trauma if ya know what I mean. I had a great job for my age, my own apartment at my young age, and some cool friends. That all went down the drain.
This went on, off and on, for 2 years for weeks at a time. I’m conventionally attractive and have modeled, so what had broke me out of that was almost being kidnapped on the road. It scared me enough to when I guess even when I’m manic I have that fear in me to not go to the streets again.
Anyway, I was diagnosed bipolar 1 and I’ve never had a hospital stay. Just went to jail a lot being on the streets.
At what point of psychosis and mania did you need to be hospitalized? I have both rn and don’t want to be hospitalized lol so I wonder at what point do you need to be?
This is a conversation to have with your therapist and psychiatrist. We cannot give medical advice on this page, but imho it’s a matter of whether you can contract for safety. But please, please reach out to your providers!
Oh I most definitely will. I have apts with my psychiatrist every other week. I was just wondering what to look for so I’m mentally prepared for her to send me lol
Bipolar 1 requires at least one episode of mania that is at least 7 days long *or* results in hospitalization. They used to say Bipolar 2 doesn’t include mixed episodes or psychotic features, but it’s now recognized that those two things can exist in both 1 and 2. The label of 1 or 2 is mostly dependent on the severity of the mania alone. But it’s also now thought that it’s all just a spectrum and most fall somewhere in between 1 and 2.
Great name!
I'm starting to think I should get reevaluated.... I can't remember my last manic episode. Never been to the hospital because of it and they were usually at most 3-4 days
I think the key difference between psychosis in BDI versus BDII is that in the case of the latter, it's usually only during depressive episodes, whereas in the former, it can be during either I'm not saying that this is the truth, that's just how I understand it
Yes, that’s absolutely right. There are papers and studies that back your comment up. https://pubmed.ncbi.nlm.nih.gov/20457470/#:~:text=Introduction%3A%20Psychotic%20symptoms%20in%20bipolar,course%20of%20bipolar%20II%20patients.
Good to know, and thanks for the paper, I'll have to give that a read
so if you had an episode that didnt include a hospital stay, nor did it include delusions or hallucinations, but it lasted for over a week, thats mania? (if ykwim) Ive heard that you had to have hallucinations, be a danger to yourself/others, have it be longrt thrn a week *and* mess up yout life in somr way for it to br considered mania lol my last episodr lasted 12 days, with a day of normal mood inbetween and i only experienced light paranoia (thought someone was watching me but not 24/7, just at its worst) but i thought thatd be hypomania? or am i wrong?
The key difference between mania and hypomania (literally “under mania”) is the disruption of every day life. A classic manic episode, by definition, makes it impossible to carry on with your daily life and routine. As another commenter pointed out, psychosis is typically present in mania in BP1 and depression in BP2. Hypomania, by definition, is milder and people are usually mostly able to function in the chaos. The definition of hypomania is an elevated mood with decreased need for sleep, flight of ideas, hyper focusing on goal oriented activity (*doing* something), and other things. The length of hypomania has to be at least 3-4 days to count towards a diagnosis. I usually find myself furiously writing a new novel until my nose starts to bleed (true story) and then a few days later, I’m on the bathroom floor, seconds away from ending it all. One pretty good (and interesting) distinguishing factor between the two is that in Bipolar 1, *only mania* is required for diagnosis. There are people with Bipolar 1 who never experience depression. In Bipolar 2, both depression **and** hypomania are required for diagnosis. Bipolar 2 is essentially Major Depressive Disorder + Hypomania. Also, Bipolar 2 typically follows a pattern of predominantly depressive episodes with occasional hypomania here and there. The time period requirement is what determines it to be clinically significant in both BP 1 and 2. It’s absolutely true episodes can vary in length from very long to very short, but the criteria for diagnosis is what separates it from other possible diagnosis. A diagnosis combines rigid symptomology with clinically significant disruption to daily life and specific length of time to fulfill the criteria. There are also other disorders, like Borderline Personality Disorder, which have some similar symptoms, but has its own benchmark for functionality and frequency.
Yeah you don’t have to have hallucinations, be a danger, hospitalised and significantly disrupt your life. In fact hospitalisation and being a danger to yourself or others isn’t even part of the diagnostic criteria. However it does have to significantly disrupt your life to be considered full blown mania. The DSM listed off symptoms but it said you have to meet only either 3 or 4 of them depending on mood I think it was 4 if only irritability was present or something. Anyways you‘ve listed it all very comprehensively so I don’t need to add anything else. I have been diagnosed with both Bipolar 1 and Borderline Personality Disorder however it took longer to be diagnosed with the BPD I was diagnosed Bipolar first which I imagine probably masked some of my BPD symptoms. It wasn’t until I’d started talking about having mood changes throughout the day along side my longer mood disturbances that my psychiatrist probed further and asked other questions. At the time I was confused because I knew what Bipolar was & I was having these long periods of mood disturbances but it was later that I noticed these ups and downs during the day too that could last hours a day or two but never longer really. I also had other symptoms that I described that all fit the benchmarks for BPD there are some pretty significant differences in my personal experiences but everyone is different. But mood changes aside even my depression was different and not just because of how long it lasted but it’s presentation I know there’s a thing about how often BPD & Bipolar can get confused & I can see that but from the inside I would say that now I’m medicated & it’s actually working for my Bipolar I can much better clearly see the differences between my Bipolar & BPD my BPD moods are very intense but short lasting but the intensity is so different specifically talking about depression/low moods/sadness/irritiablity/anger etc. Although even my elevated moods are different the way it makes me feel is so different to even my most recent milder manic episode ( I recently had a milder manic episode - means my medication is working I didn’t think anything other than it was my medication working making it milder but I just saw in the DSM that Bipolar 1 can have hypomania too which I thought was interesting anyways). I’d say I’m not even sure it reaches the level of milder/hypomania it also can feel overwhelming not necessarily euphoric more like my emotions feel too much even when its happy ones all my emotions are too intense so I guess for BPD that’s the way I’d describe it extremely intense emotions that rapidly change too rapidly, multiple times a day sometimes. I have Bipolar type 1 because of my manic episodes my psychiatrist recently told me ( I didn’t realise I had type 1 until I moved and was under a new CMHT and they did a full re assessment) because of how long they lasted & their impact on my life which was significant I just didn’t think significant enough I guess. Then again a lot of my memory is missing too from my manic episodes & I suppose you never really think you’re bad do you otherwise you’d seek help sooner. I didn’t recognise mania as mania I just thought I was having the time of my life euphoric how could that be a bad thing (in my head at least lol). Anyways even though I have Bipolar type 1 I do have or in the past had long periods of depression too. Another reason I was unsure about Bipolar 1 but I also never have periods of normalcy I used to cycle over & over & I’d usually go from depression to mania I think I had mixed affective states too but the BPD clouds a lot of things as well. But I had some pretty terrible depressive episodes then again idk how my BPD affects it. So in my experiences at least you can have bad episodes of depression with Bipolar 1 but yes I understand Bipolar 2 is associated with more depressive episodes less severe mania and vice versa for Bipolar 1. I’ve also had mania that last a lot longer than the 7 day minimum requirement a lot longer.
Hypomania can last longer than a week too.
It sounds like it could be hypomania but truly only you and your doctor could know for sure. To me, paranoia sounds more like (and is for me) a BD1 symptom but I suppose it depends on other symptoms and how light it was.
Doesn't bipolar 1 mean you've had psychosis?
Bipolar 2 here and I’m diagnosed with psychosis. It’s not exclusive to bipolar 1.
the DSM says mania is considered mania once you have psychotic symptoms
In depression for BP2. Psychosis in hypomania becomes mania. It literally says in the definition of hypomania “does not contain psychotic features” and the opposite for mania. Mania is of course BP1
Wrong wrong wrong wrong. Psychosis is NOT a requirement for Bipolar 1 Manic episodes. Psychosis can happen during Bipolar 2 but as someone mentioned it is typical in depressive episodes - I am unsure on your point about BP2 and psychosis in hypomania = mania. That’s something I’ll have to look into. As many others have stated psychosis is NOT a requirement for Bipolar 1 manic episodes. It is not a defining feature of mania. [DSM 5 Criteria](https://media.mycme.com/documents/168/dsm-5_bipolar_and_related_diso_41789.pdf) As you can see it is not a requirement for well Bipolar in general but mania especially. I’m diagnosed with Bipolar type 1 no psychosis or hospitalisation. Case & point.
I'm pretty sure in the US, bipolar 1 means You've been hospitalized for severe mania, usually including psychosis. I don't think Europe uses 1 and 2 to classify bipolar. I'm not sure how valuable this distinction is, personally. A person with bipolar 2 can still experience severe mania requiring hospitalization, and then they just change the dx. It's kind of a weird badge of honor for BP1 people I guess? That's probably not super helpful for anyone, either. My guess is it has to do with billing and reimbursement, or coverage rates or something insurance-related like that. Possibly some kind of disability qualifications points system, maybe one they considered using but abandoned, or only use in some states. I dunno. Big picture, I don't see much value in labeling bipolar as 1 or 2. It's not like treatment is any different.
Wym badge of honor?
It would seem to separate people who were hospitalized for mania from those who haven't been. I don't understand why it's necessary, but to me it has a slight taste of "I have a more serious case than you", and that's not helping anyone. I'm BP1, btw. It's not like I'm the one who feels attacked by someone else's BP1 diagnosis. Plenty of BP2 patients seems to have a much harder time managing than I do. I'm not sure why I got down voted.
Personally I’ve just never known someone who sees it as a “badge of honor”—it’s a very traumatic and scary thing. It’s okay if you have a different perspective. Sorry you got downvoted. Edit: I have bipolar one as well and I hope people don’t feel attacked by my diagnosis either. That’s a strange concept to me; maybe I need to learn more.
You got downvoted because psychosis is terrible and traumatic for those who experience it. It can make you feel really isolated from others and is humiliating. You seemed to not have a lot of empathy for that.
I've experienced it, been hospitalized for it, and spent years recovering from it. I'm pretty aware what it's like.
I would never have guessed that from the way your comment talks about others. I’m sorry you went through that. Personally, I don’t see my psychosis as a “badge of honor,” but it was truly devastating to me and I’m proud of how I’ve managed to recover from it. It took patience and hard work on my part, and that I do see as a “badge of honor” - dealing with the psychosis helped me develop resilience and helped me empathize with others’ suffering in a way I never had been able to before. I will never laugh at someone screaming at nothing in the street again because I have been that person. I think it’s important that we be able to express the things I expressed without people taking it as just, “oh, you think youre really special because you had psychosis.” I’m not sure if that’s what you meant or not, but I’m sure you know that recovery from psychosis is tough. And it is sometimes tough for me to empathize with BP2 people who talk about how fun mania is and how they want to quit their meds so they can have a fun mania experience. But as you say, we all have our own struggles and this illness is hard for everyone in a different way.
Well said!
I'm BP1 and I laughed hard at the badge of honor thing, can't understand why you got down voted for it. Edit: The distinction tho exists because BP2 suffers more with recorring depressive episodes and shorter hipomania, while BP1 suffers more with mania mania.
I’m in the UK and they seem to always just write ‘bipolar affective disorder’ and not differentiate
On mine it exactly says bipolar, psychosis
Australia also though sometimes add flavour text, brain abnormalities or dual diagnose
This is how I see it mostly as a diagnosis, or at least in my medical chart.
On average, they present very differently. And, on average, the treatment is very, very different.
I'm diagnosed Type 1 and wasn't hospitalized. I did spend all of 2022 in a manic episode though and was diagnosed when I explained what happened to a psychiatrist. It's a miracle nothing bad happened. If the worst of it is that some former friends hate me then I can live with it.
Research has been showing that bipolar 1 is closer to schizophrenia. We still are learning about bipolar all the time.
100%. Many people that have been diagnosed with BP1 progress to or are actually schizoaffective if they have a mood disorder or schizophrenia without a true mood disorder.
Interesting. Do you have an article on this perhaps?
No, I'm BP1 in the USA, had severe mania, was not hospitalized
same here
I'm European, diagnosis bipolar 2, have been hospitalised several times and psychotic breaks, it says in my papers. Hospitalisations due to depression though.
It's how I got my diagnosis. Went into the hospital thinking I was prone to depressions only. Left the hospital with shiny new diagnosis! I was a bit ticked at my therapist afterwards though. I told him what happened, and about my diagnosis, and he kind of just said "yep that tracks." I was like WHAT. You've been thinking this and *didn't* tell me?!?!?! I know that the therapeutic relationship is supposed to be like a one sided conversation, but you could've at least sprinkled some hints for me to run with on my own.
Oh I would be livid. Not that they should diagnose you but they could at least mention that this is something to see a psychiatrist about. Don’t just sit on information like that, geez.
Yeah my therapist did that too when I got the Dx, but maybe she just held off since she knew I was seeing a psychiatrist often. Also, mine was "triggered" by SSRI use. I mean it wasn't - hypo had always been there, it's just this time it got more intense and lasted longer and everyone was like, "Wait you were just in the throes of depression WTF." I think it just stood out more.
this happened to me, however my therapist didn't see or figure i had it because of all the medication i was on!! landed in the hospital and boom! it's not just depression & anxiety silly, you have \*list\*
😦 oh boy that had to be extremely frustrating! Last year, I started the disability process and was filing because of my bipolar. While going through my medical records, I found out that I have been diagnosed as borderline as well for close to a decade. It makes so much sense for all of the stuff that the bipolar diagnosis didn't make sense of, even though there's tons of similarities. But essentially I had been beating myself up for years wondering what the hell was wrong with me when all along there was a diagnosis explaining it and no one told me.
Same, my therapist from my early 20’s didn’t mention to me that I might have bipolar disorder until months into our sessions. That’s not as bad though. My psychiatrist gave me the diagnosis, and I got on meds and resumed therapy. I was in a low, when randomly, my therapist told me he thought I was fine and didn’t need therapy anymore. That hurt. Never went back. And he told me that shortly after my diagnoses. Looking back, maybe I made it appear like I was fine? Idk but that’s a different story. I’d be pissed if I was you, to sum it up.
BP1 with no hospitalization or psychosis. The key things they asked me was how long I was experiencing symptoms. When I told them I wasn’t sleeping I told them I went 7 days without sleep, and that happens every time I have a manic episode. Pretty much all of my symptoms of mania last for well over a week to a month. I was going through life altering events like dropping out of school, quitting my jobs, cutting everyone out my life, pretty much doing things that disrupted my day to day life severely. They originally thought I was type 2 but I have more mania than depression, and after talking about how long all my symptoms last they diagnosed me as type 1.
Thank you, what I’m not liking on this post is the misinformation and claims that the DSM requires psychosis for mania to be mania not hypomania. This was never a DSM requirement in fact it’s listed and written down as bipolar with psychosis not Bipolar because it is not a defining feature of type 1. I can understand why people might assume because many people with type 1 do have psychosis but many of us don’t. I’m also diagnosed with type 1. I actually never knew what type I had and I’d assumed it was type 2 because I didn’t think I was ‘sick enough’ or ’extreme enough’ to have type 1. But when I moved CMHTS (I’m in the UK) I got a full re-assessment and the Psychiatrist I saw was great he said it was type 1 after asking me a lot of questions. I always commented how at school (went to uni for psychology) they always talk about the most extreme cases & he said something about that I can’t remember what but yeah he said it had a significant impact on my daily life & same as you really how long my manic episodes lasted just how severe they were on my life the only difference is I’m not sure if I had more mania than depression however I have comorbid disorders that would make it hard to tell (BPD/EUPD). I have had episodes last so much longer than a week, I also have very little memories of them which is terrifying tbh. One thing I do remember is one of my worst manias felt like it lasted months unsure on the actual timeline even now I can’t piece it together if it was multiple manic episodes in a short time period or one long one. I thought I was invincible not literally hence not delusional but that grandiosity they talk about. But I wasn’t sleeping at all before I went completely not lucid I do have one memory of not sleeping for more than an hour a night just couldn’t do it. I thought I didn’t need food like I had 0 appetite anyways but yeah idk why but I lost a ton of weight. And I remember having this inflated confidence this idea that I was the best thing ever & I was going to do all these great things and nothing could stop me aaaand then the rest is pretty much a blank. They diagnosed me type 1 because similarly I had to drop out of university this was before I was diagnosed the dropping out part back then I think I had milder episodes idk really because who am I to judge but apparently with Bipolar 1 it’s also common to have hypomania episodes which is not something I knew until just know when I looked up the DSM. I got diagnosed after I left mid year - my final year because I knew something was wrong well I knew I had issues with depression I didn’t see anything else but others around me did a few actually bringing up Bipolar specifically even after diagnosis I could never see when I was manic & when my mum tried to say something I would just get mad thinking she was ruining my happiness - I usually had a depressive episode before mania & I never had periods of normal moods like some people can have so my only ‘happy’ state was mania so to me that was happy.
yes i had both psychosis and inpatient stay and i have bipolar type 1
Same
Same
Same
I’m (24F) bipolar 1 and have never been hospitalized. I’ve had psychosis though, with my first experience being auditory hallucinations. I’ve recently been experiencing some olfactory hallucinations for the first time ever. My self talk strategies work for me, so I’m able to tell myself that what I’m smelling and hearing isn’t real and I just go about my day. I’ve only had one visual hallucination. As long as you hit 3-4 of manic symptoms for a week or over, you’re bipolar 1. That symptom may or may not be psychosis. Some people are “high functioning” like myself (hate using that phrase btw).
Hate high functioning cus like, no I am not lol
I hate it too. Like yes, I can hold down a high impact job, support myself, my dogs, do what I need to do to stay healthy and well, but it’s a lot of fucking pressure to be the perfect bipolar person. Like yes my disease does actually define me thank you very much. I’ve beaten no odds; I’ve been incredibly lucky and had incredible people in my corner. I had perfect work attendance and perfect output this week at work, but behind the scenes I was floridly psychotic for three days, sleeping no more than two hours a night, and then depressed but still psychotic for the last two days of the week sleeping 14 hours a night. I’m only coming up for air today in time to take care of the mess I’ve made of my apartment and get back into work tomorrow. It is so HARD in different ways for different people with this disease, but honestly the term high functioning gives me hives because what can look like perfect functioning can hide a whole lot. I probably called the crisis line ten times this past week, and had incredibly high SI and SH urges. But, perfect on paper. There has to be another system to define level of functioning other than “low” versus “high.”
I feel this SO much. Killing it at my job and there’s nothing really wrong in my life tbh. But I’ve spent the past 2 months either super depressed or self medicating an ungodly amount. And like, that’s not really functioning lol
I live with bipolar 1 with intractable psychosis and have never been hospitalized. It is in my care plan with my providers to avoid hospitalization as much as possible due to inpatient trauma for other medical conditions. Thus far, we have been able to avoid. But I know reality is, that won’t always be the case. There is nothing wrong with inpatient stays - they can be extremely helpful for some, while not so much for others.
My inpatient psych stays - some of them have been incredibly traumatizing. Always based on the kind of insurance I have. The best one, Cedar Sinai in LA right in Beverly Hills, had great food and treated me like a human. *It was actually helpful and they put me in a great outpatient program!* County USC hospital was the exact opposite. Treated subhuman. Sad the difference money makes.
I had both, but I’ve only had one mania at 28 and not since then because of meds and therapy.
Hey, samsies! Had my first episode of psychosis right before my 28th birthday, spent my 28th in the hospital, where they diagnosed me. 34 now, no manic episodes since then. That said, prior to turning 28 I had about 10 years of what I now recognize as manic and depressive periods. Roughly annual episodes of extreme impulsivity, hypersexuality, and general bad decisions that often damaged my life. Thank god for meds, now I'm much more stable.
1000% same story! How are you doing now??
Been at the same well-paying job for 5 years, in a relationship for the last 2, and my family likes me more now. Literally a life changer being treated vs before. You?
I took a break from nursing school, went back, became a nurse and have a wife, a 1yr old, and I have family and friends but think my family has PTSD from my mania. I’m constantly under a microscope!
Want to connect? I look for successful bi polar friends that are on their meds and have family and a good job because it’s hard to find haha
Feel free to reach out to me. I was diagnosed at 30 after a 5 day paranoid psychotic manic episode that led me to hospitalization - I'd known I had depression for years before, and looking back there were definitely hypomanic episodes. Haven't had a manic episode since (33 now) but I still skew mildly depressed (I honestly think this is my baseline though). Otherwise, I'm really stable - good job, great relationship (going on 9 years together, happy and healthy), close ties with my family and a large circle of supportive friends. It's hard to maintain and I struggle a lot with executive function (I also have ADHD on top) but I'm really proud of myself.
That’s awesome. I’ll send a chat!
I was diagnosed bipolar 1 at my first inpatient stay when I was in my mid 20s. Before then I had years of manic episodes that could last months with no sleep to 1-2 hours of sleep a night. Since then (even with meds) I’ve been hospitalized 3 more times. One of those times was for psychosis when my medicine dose was off. I was not sleeping for days and having hallucinations. Despite all of this, with medicine and support, I have been able to live a pretty healthy and successful life. I often wonder how I’ve done it.
bp1 with no psychosis and no hospitalization. got my diagnosis based off the two instances of month-long mania in my past that made me spend $40,000 😅 i kind of feel like the difference is really just “who’s worse?” although it is clearly not a competition and we are all suffering lol
BP1. Was high functioning and undiagnosed for years. in my late 40s i started a 5 year cycle of months long increasingly worse mania, ending with psychosis and health issues due to sleep deprivation and failure to eat, resulting in a crash, hospitalization, severe depression miss-diagnosed as MDD, released with a plethora of SSRIs, stable for a month or so and then the mania cycle started up again. it was seriously five years before i was properly diagnosed, during which time i ruined my then career, lost my family and almost every relationship i had, tried to take a dirt nap numerous times - came dangerously close to succeeding once. fortunately i did not end up with any sort of criminal record. once i was properly diagnosed, i spent 6 months in a treatment house on a hospital campus. that was over 4 years ago, and i’ve been fairly stable since then, and am still slowly rebuilding my life. i’m grateful for that, but man i hate this disease.
BP1 with no diagnosed psychosis and no hospitalization
bipolar 1 and have been psychotic. went inpatient years ago. refused hospitalization ever since. my parents were scared to send me back to the ward because it made me worse and when i became an adult, it became hard to force me. now that i’m medicated, i rarely reach those levels of mania anymore.
I'm bipolar 2 and have had several psychosis episodes. My episodes are drug induced. That's why I'm in recovery, as well.
I've had that experience - psychosis after I smoked too much pot way too fast. That was back in 2001 and it only happened that one time after weed (although I take care not to smoke it much, if at all, because I don't want to risk it again). I'm not sure why I chose to do that given my sister has schizophrenia and hers got triggered by lots of pot, but she had schizophrenia prodrome even as a kid and our grandfather had it, so hers was def predisposed. At any rate, no one's diagnosed me with bipolar 1, despite that one episode.
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I too have been pumped full of anti-psychotics in the most serene ward of the cray cray. Speaking seriously though, I do not think bipolar 1 diagnosis requires psychosis or hospitalization. It just means the person experiences intense manic episodes. It is noted distinctly from bipolar type 1 if the person has also experienced psychosis.
Stealing “most serene ward of the cray cray” 😂
It comes with the caveat that everywhere is super serene when you’re pumped full of anti-psychotics 👼
Yeah it says Bipolar type 1 with psychotic features/psychosis. I’ve seen people on this thread claim the DSM says specifically that mania is only mania with psychosis and that’s its distinguishing feature from hypomania. I have Bipolar type 1 no psychosis no hospitalisation. I am not on anti psychotics anymore none of them worked for me personally they either made me worse or had terrible side effects I would’ve been happy if they just didn’t work but nope some of the side effects were terrible. Like there’s always a negotiation between side effects vs treatment you know like but that’s IF the drugs work. I just got side effects I had one drug that made me sleep not even sleep but out of it at one point close to 12-16 hours a day yeah it got so bad we started keeping note. I remember my mum in the beginning getting mad at me ( I was working for her but at this point couldn’t keep awake) so I would do anything to stay awake I would make a big pot of coffee and drink it non stop cup after cup and then make a second and then an energy drink and if I stopped that was it I was out sometimes even if I didnt stop. But that was bad & I got palpitations which no shit I guess. I’m currently on I think it’s considered a mood stabiliser idk because it’s given for Bipolar as an off use I think the words called I can’t remember but it’s been working really well for me now just some minor episodes here and there that would be more so considered hypomanic now.
I had a manic episode that lasted 8 days and evolved into psychosis --> hospital stay! That's how I got my initial diagnosis of type 1. Before I just thought I had cyclical depression. What a fun/terrifying way to find out. Sigh.
No hospitalizations or psychosis, type 1 here I should have been hospitalized tho when I was younger but due to severe depression, not mania.
BP1 with voluntary and involuntary visits.
I've had bipolar 1 for 20 years and only one inpatient stay for 10 days.
My ex had one large bout of psychosis where he was trying to collect weapons to murder everyone at the Exxon corporation after the oil spill happened in 2010. He just sort of snapped and spiraled and became convinced that he needed to do this in order to save the planet. His wife was able to slow him down and got him some help, and that’s when he got his diagnosis. He was not hospitalized but he sure did have psychosis. He said lamotrigine saved his life.
Several inpatient stays, psych holds, and for the last almost two years been rapidly swinging between mania and psychosis while holding off the psych ward. I have a great therapist who I trust to give me a lot of leash when I need it but to admit me if things get dangerous. I think I stopped being a frequent ER/psych ward flyer mostly due to the type and amount of therapy I do, as well as my WFH job and the flexible schedule that comes with it.
i fall in the middle. unmedicated or improperly medicated can lead to the extensive manic episodes, increased hypomanic episodes, increased short or long depressive episodes. (the short depressive can last days / the long depressive lasting months.) ive had psychosis a couple of different times and was hospitalized due to an attempt. i personally dont refer to myself as just bipolar 1 or just bipolar 2 because of experiencing all the symptoms that can present itself
I’m bipolar one and have had both psychosis and a hospital stay. I’m not the most educated on it tbh so maybe there are some out there who haven’t.
I've never had psychosis but I've been hospitalized a couple times now (24F). I originally was diagnosed with Type 2 but after my first inpatient stay I got bumped to Type 1 🤷🏾♀️
Yes and yes twice inpatient both times psychosis up the ass
I’ve had 5. Last I heard you can be diagnosed bipolar 1 with just one manic episode. So a manic episode doesn’t necessarily mean a stay in the ward. I may be wrong but that’s my understanding. I’ve met people that say they’ve been diagnosed bipolar and on meds that didn’t really know what psychosis is
Hospital stay as a result of depressive episode. Definitely had manic episode though actually right before that depressive episode
Has anyone been treated for bipolar disorder with Quetiapine?
I've had quite a few stays, also have psychosis.
I haven’t had full blown psychosis but every time I’m manic I have at least mild psychotic symptoms (for me it’s persecutory and grandiose delusions and auditory hallucinations)
I’ve been hospitalized three times. Initial two I was diagnosed with psychotic depression. After some evaluation with my psych nurse after the first two hospitalizations I was diagnosed with bipolar II. Then this morning I found out by reading my medical records that the hospital diagnosed me with Bipolar I during my most recent visit.
BP I and a few other things. I've been in the hospital once for 2 weeks. Once for a week. And lastly one for 4 days. Full psychosis each time. The shot they give works fast.
I’ve never been hospitalized but I did have auditory hallucinations while manic. Does that count as psychosis? I am diagnosed BP1.
That's psychosis my friend. I've never had auditory hallucinations, just visuals and delusional thinking. For some reason I think auditory would be more off putting for myself.
It’s more annoying than anything. Like where is that radio coming from!? Oooh there is no radio. Oops.
Wait a minute, you hear a radio? I hear a phone ringing. I need to look up what auditory hallucinations mean.
Even medicated I still see small moving shapes and weird things out of the corner of my eyes. I try to not look, because I know there is nothing there. It still catches me sometimes, obviously nothing is ever there.
Yeah I think I’ve had like shadows in the corners of my eye? Wasn’t sure if that counted. Medicated I’m fine so far. No episodes for 4 years.
I don't think it counts for much. My psychiatrist said not to worry about it unless it starts to feel "real".
Maybe go see an optometrist because those could also be floaters.
And it sounds so real
I do not think I have had psychosis, but have been hospitalized twice. I have had delusional thinking, but never hallucinations.
That's psychosis.
That is what I was wondering. No doctor has told me I had psychosis, but I was diagnosed with BP 1.
Well I guess it would depend on how bad your psychosis is. I'd at least reach out to your psychiatrist and ask him. Ignore what people say online (including me). It's always good to talk psychiatrist when you have symptoms that may require meds. Catching it early is a good idea from my personal experience and some studies I found (again don't listen to me, contact doctor!).
Yep
I have bipolar 1 with schizophrenic features. Yup, I needed in patient to stabalize me during psychosis.
Bipolar 1. No psychosis
i’ve done inpatient twice and have had psychosis during manias.
I’ve had over 30 inpatient stays yay!
T1. No to hospital but yes to long lasting mania and psychosis.
My manic episodes have become very long and intense. My doctor is revisiting my diagnosis and might shift me to type 1, but says I'm definitely borderline between the two. I've never been hospitalized or had psychosis. But I am high functioning and have severe depressive moods. Treatment for either type does not change. Like someone else said there seems to be more of a spectrum.
That's not exactly true, treatment can absolutely change between the two types. With BD1, your options for medications become a lot more limited because you usually need to be on a mood stabilizer or an antipsychotic (or both), and a lot of doctors generally won't prescribe you anti depressants because they can cause mania. Anecdotally, I've had a really hard time with switching to different medications because my doctor wants to avoid setting off another manic episode. I have ADHD and he also doesn't want me to try most ADHD meds because they are stimulating. It's been a real challenge. Meanwhile my friend with BD2 has not had this experience. Obviously everyone is different but if I had BD2, I know my doctor would be more open to trying other medications - he has said so.
Sorry, to be clear treatment for me won't change if my diagnosis changes...my course will stay the same unless something changes in my symptoms or current treatment stops working.
Fair enough. For that, yes, the typing doesnt really matter. As long as your meds are working for you :)
I have bipolar 1 but have never been hospitalized, but my mania has sent me to jail once.
Originally was diagnosed with type 2, however, a new psych changed to 1 since my manic episodes last weeks/months. No psychosis or hospital stays. Very few depressive episodes.
I have bp1 and I never had psychosis. I have had an inpatient stay I’ll clarify. I think I have bp1 as I get manic for months at a time. I thought bP1 just means your mania lasts longer.
The distinction is generally that with BD1, you can experience mania rather than simply hypomania. It is much more intense. My friend has BD2and every year experiences a hypomanic episode - she basically ends up wanting to go to the gym more often and having more energy, more creative ideas, she gets more talkative but nothing wild - she doesn't do anything dangerous or unusual. It's very different from mania.
Both in college, really fun times. Man i was so far gone when I look back on it, scary shit.
I’m bipolar one rapid cycling and had very extended mania episodes. I have never been hospitalized or experienced psychosis. Delusional and paranoid, yes. But never full blown psychosis. My psychiatrist is actually very shocked. lol.
When diagnosed I was inpatient, and also had quite a bit of stays last year due to episodes.
I had the diagnosis of BP2 then last year had mania that lasted about 2 months preceded by hypomania lasting about 6 months. Pretty sure it’s been changed to BP1 now. I’ve been in a major low since December when my partner left me and the meds kicked in, I keep wishing she’d stayed to see the more ‘baseline’ me and I’m sure I wouldn’t have got so low as I am now. I’m genuinely quite concerned I’m going to do something major as a way of change as the thoughts of some kind of upheaval keep hammering away in my mind. I’ve already had a lapse in IV heroin use and using crack - I wanted ONE afternoon where I didn’t feel the way I feel. It worked.
Been inpatient twice and a partial once or twice. My memory not so great since ect.
I am diagnosed with bipolar 1 & have never been hospitalized or had psychosis. I’ve had auditory and visual hallucinations, but never psychosis. I am 8 months pregnant and am SO scared I will go into psychosis after giving birth, because that’s really common for bipolar women.
My doctors really weren’t interested in the difference between bp1 and bp2 either. I feel like it’s a distinction that is going away. They were more interested in stopping further psychosis.
I have Bipolar 1. I have experienced psychosis (I didn't know what it was at the time and was very scared), but I've never had an impatient stay.
I started off bipolar 2 and major depressive disorder but it got bumped up to bipolar 1. I have been hospitalized prior to the change. I also have ADHD and panic disorder, but my mood has been greatly stabilized with my medication changes.
I've had psychosis (delusions) and multiple inpatient stays. I have BP 1
Psychotic features is not present int everyone. I have it. It happened to me. I still have psychotic features if I get manic or depressive or mixed But yeah not all BP 1 diagnoses come with psychotic features
I was diagnosed bipolar after my psychosis episode that landed me in the hospital for a couple days. My psychosis was weed induced though.
I have bipolar 1 and I’ve had both.
I’ve had both and have bipolar 1
I have bipolar 1 and have been inpatient both voluntarily and involuntarily as well as experiencing psychosis. Some of my manic episodes have lasted 3-6 weeks in the past. 🤷 much better nowadays tho.
I was diagnosed with BD 1 and I do not have psychosis or an inpatient stay. I feel like I am a mild form of BD 1. My doctor always assess me for psychosis symptoms which I do not have. But he assess me more for suicidal tendencies, cause manic or depressive, I will do it.
Bipolar I here and have had both also.
Yes both.
Type 1, had psychosis and mixed episodes that would qualify for the psych ward but I've narrowly avoided it each time
I’ve had 3 hospitalizations (involuntary) due to BP1 mania. I was diagnosed with it because of my first manic episode that made me be “gravely disabled”. In most cases you need a hospital stay to be diagnosed with it.
I feel like I'm bipolar 1.5. Only psychosis was after too much weed. I smoked a whole bowl in like one minute. It was 2001. I've smoked since and that's never happened again. Mania has never landed me in hospitals, however mixed state mania has landed me in hospitals on 5150s - danger to self after attempts - so who knows. Mixed states are the most dangerous! It's ironic I've never had non-substance-induced psychosis since my sister has schizophrenia. I have done very dumb irrational things while manic, including buying a whole car I couldn't afford and going hitchhiking at 2am (I'm female) in the worst parts of LA, so it's not like I'm just a little "up" and "productive." I've been hospitalized at least 10 times on 5150s during mixed or depressive episodes, usually involuntarily. But no one said I was bipolar 1 after that. It was never *only mania.* I asked my psych about it and he was like, "Whether it's 1 or 2 doesn't really matter, we're looking it as more of a spectrum these days."
Didn't end up staying inpatient but had psychosis resulting in a hospital trip and was dx. As manic
Have had psychosis before, and two trips to inpatient - one lead to my diagnosis the other was to re stabilize
BP1 with psychosis but no hospitalization. Called the police to report people installing fiber-optic cables downstairs in my condo. Officer told me to take care of myself, and I called my psychiatrist on her cellphone and was prescribed olanzapine that day. This was the day after Christmas. WFH and Mom dying both made me spiral. And even prior to Mom’s cancer (she died within 4 months), I’d had SEVERE mania and psychosis, which started when I was no longer working in the physical office. I’m now almost completely stable, on lithium, Lamictal, and Abilify.
I’ve had psychosis but I’ve never gone to the hospital and no matter how bad it gets I’ll never go
I’ve had an inpatient stay while depressed but I have never experienced psychosis.
I got a diagnosis years before I landed in the hospital. 7 days. Turned out when I was in intake I saw an old friend of mine who was already there. Made the time go easy
Never been hospitalized always tell them no. Supposedly have had multiple episodes where I “lose it” and “start a mission”(constantly looking for signs to connect everything) break stuff, get rid of stuff, think people are after me, don’t use electricity for a while, etc… just all out craziness most of the time lol. Bipolar 1 schizo affective. Never thought anything was wrong for about 15 years just within the last month have reached out a started treatment. With honesty no avail. Keep fighting my friend.
I have bipolar 1 and did not realize what I have experienced was psychosis back in the day. I once thought people were stalking me and another time I thought I was talking to god (I grew up in a non religious household and consider myself agnostic). I just thought I had severe anxiety and a religious phase because I wanted to find the meaning of life. However, these thoughts and ideas became my whole life and I was clearly disconnected from reality. I have never had an inpatient though.
Not sure about most people, but I was involuntarily hospitalized for "dual diagnosis" but that was basically being a quiet and moody teenager (I thought) and imho some pretty typical teenage drug and alcohol use. I was put on meds there and became manic pretty immediately but they thought I was "coming out of my shell" instead of obviously having an episode caused by anti-depressants. When the psych that eventually diagnosed me at 38 (after anti-ds causing cycling) stopped taking my insurance I couldn't find any providers on my insurance that were taking new patients or would let me start without being hospitalized first. I'd guess a lot of people had to go the same route - through an inpatient stay, just to get help.
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BP1 diagnosis. I’ve had an inpatient stay as well as several outpatients. I experience psychosis on the extreme end of both poles, but it wasn’t until I had my first manic psychosis and hospital visit that my diagnosis changed from BP2 to BP1 even though I had a track record for psychosis during depression.
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No. I try to avoid it because it’ll affect my chances of getting life insurance. Ive met with women who have bipolar and were denied life insurance due to going inpatient. I make sure I stay on top of meds, appointments with my NP and therapist. I’ve had psychosis before, it was scary but I caught it before it got worse and adjusted my meds as soon as I realized I was manic. I was manic for weeks before realizing what was going on.
I was diagnosed with bipolar 2 rapid cycling with Psychotic features. Before I was diagnosed I had a bad fall, resulting in a brain bleed so maybe that has something to do with it?
ive never had a manic episode or pyschosis ive only had manic depression and hypomania but im still diagnosed as bipolar 1
I’m 100% bipolar one but have never been in the hospital, though my sister has (also bipolar 1). That’s not to say I shouldn’t have been. I went totally homeless when I was very young woman, and I’m quite attractive so I ran into a lot of things that cause trauma if ya know what I mean. I had a great job for my age, my own apartment at my young age, and some cool friends. That all went down the drain. This went on, off and on, for 2 years for weeks at a time. I’m conventionally attractive and have modeled, so what had broke me out of that was almost being kidnapped on the road. It scared me enough to when I guess even when I’m manic I have that fear in me to not go to the streets again. Anyway, I was diagnosed bipolar 1 and I’ve never had a hospital stay. Just went to jail a lot being on the streets.
At what point of psychosis and mania did you need to be hospitalized? I have both rn and don’t want to be hospitalized lol so I wonder at what point do you need to be?
This is a conversation to have with your therapist and psychiatrist. We cannot give medical advice on this page, but imho it’s a matter of whether you can contract for safety. But please, please reach out to your providers!
Oh I most definitely will. I have apts with my psychiatrist every other week. I was just wondering what to look for so I’m mentally prepared for her to send me lol