Someone with bipolar disorder thinks primarily the same way any other “typical” person does. The difference is in the moods that influence their thoughts and behaviors. People with mood disorders generally have difficulty keeping “how they feel” distinct from “how they think,” and emotions tend to blend into thought processes. Those with bipolar disorder experience grand shifts in mood ranging from depression to mania, with their thoughts sometimes reflecting very negative or overtly euphoric emotional states.
Online Bipolar Test
A few questions from Talkiatry can help you understand your symptoms and give you a recommendation for what to do next.
What is Bipolar Disorder?
Bipolar disorder is a mood disorder typically including intense shifts in mood from severe depression to severe mania that occur on a somewhat cyclical basis, sometimes becoming rapid cycling bipolar disorder. With these shifts in mood come changes in energy levels, thinking patterns, and behavior. Bipolar symptoms can vary from person to person but will generally affect one’s ability to complete daily tasks and interact with others.
There are different types of bipolar disorders (such as bipolar I vs. bipolar II), each with its own risk of symptoms ranging from mania to depression and the associated variations in thought patterns. Not everyone with a diagnosis of bipolar disorder will experience the same symptoms, and some will not ever experience the lowest lows of depression or highest highs of mania or cycle in and out of these states at the same rates as others.
There are five commonly diagnosed types of bipolar disorder:1
- Bipolar I: This is characterized by experiencing a manic episode lasting at least a week and may also involve experiencing abnormally elevated moods and a major depressive episode. The key attribute of the Bipolar I diagnosis is the presence of at least one manic episode.<a1
- Bipolar II: This is characterized by experiencing a hypomanic episode (low-severity mania not strong enough to impair social/occupational functioning or require hospitalization) and a major depressive episode.1
- Cyclothymic Disorder (or Cyclothymia): This is characterized by at least two years of shifts in mood that are similar to, but do not meet, criteria for hypomanic and major depressive episodes.1
- Substance-Induced/Medication-Induced Bipolar Disorder: This is characterized by the onset of bipolar I or II-like symptoms due to the use of or withdrawal from a substance, toxin, or medication that persists beyond the immediate effects of intoxication or withdrawal. 1
- Medical Condition-Induced Bipolar Disorder: This is characterized by the onset of bipolar I or II-like symptoms resulting from a medical condition. Common medical conditions that cause this are Cushing’s Disease, Multiple Sclerosis, Strokes, and Traumatic Brain Injuries, among others.1
Having a bipolar or related disorder diagnosis can lead to changes in behavior and functioning that are abnormal. People with bipolar are more likely to exhibit shifts in personality based on their moods, sometimes becoming more grandiose, unable to think clearly or focus, or more irritable based on their altered perspectives.
How Does Bipolar Disorder Alter Someone’s Thoughts?
To understand this, you must first know that a “mood” is a state of mind, not an emotional response. Because mood disorders like bipolar change the person’s state of mind, they affect thinking patterns of decision-making that are typically based on rational thought processes. Someone with a depressed mood thinks differently than someone who is simply sad. Similarly, someone in a manic mood thinks differently than someone who is merely excited or happy.2
The mood shifts involved with bipolar disorder affect how the brain functions and its ability to make sound decisions and process information. Because the mood states of depression, hypomania, and mania can be prolonged experiences, the person with bipolar can have long periods where their behavior and decision making is compromised. Dealing with prolonged altered states of behavior can make it very difficult to communicate effectively with others and interact with the world around them.1
What Does a Manic Episode Feel Like?
Mania in bipolar disorder consists of experiencing a persistently elevated mood leading to increased irritability, activity, and energy at an abnormal level.
These are some things you may experience while in a manic episode:1
- Inflated self-esteem or sense of grandeur
- Decreased need for sleep
- Being more talkative than usual or feeling pressured to keep talking
- Racing thoughts and inability to focus on a single subject
- Becoming very easily distracted, even by unimportant things
- Increased impulsiveness and risk-taking behavior, and inability to think through decisions before they are made
- Increased goal-oriented activity sometimes mixed with increased non-goal-oriented activity
- Negative consequences at work, school, or in relationships
- Negative legal implications due to risk-taking behavior
- Adverse sexual or health outcomes due to increased risky behavior
What Does a Depressive Episode Feel Like?
Episodes of major depressive symptoms consist of experiencing persistently depressed mood or lack of pleasure along with decreased energy, focus, and motivation leading to significant distress or impairment in social, occupational, or other areas of functioning.
These are some things you may experience while in a major depressive episode:1
- Feeling sad, empty, or hopeless nearly every day
- A marked decrease in interest or pleasure in almost all activities nearly every day
- Significant changes in weight along with significant changes in appetite
- Insomnia or hypersomnia nearly every day
- Significant changes in activity observable by others, whether reflective of restlessness or lack of energy/motivation
- Fatigue nearly every day
- Feeling worthless or excessive guilt nearly every day
- Inability to think clearly or concentrate or make decisions almost every day
- Recurring thoughts of death, suicidal thoughts, or attempts at suicide
What Does a Period of Recovery/Stability Feel Like?
Recovery looks different from person to person with bipolar disorder. Most people with bipolar will stabilize with pharmaceutical and psychotherapy treatment, meaning a reduction in or diminishing of symptoms to a more manageable level.
These are some things that you may experience once you stabilize from bipolar disorder:1
- You may no longer immediately meet the diagnostic criteria for bipolar disorder due to the lowering severity of your symptoms, but you will retain the diagnosis
- Shifts in mood may persist but be manageable or not impactful enough to cause significant distress in work, school, or other relationships
- No episodes of severe major depressive symptoms or severe manic symptoms
- Prescribed medication adherence
- Following through with therapy as needed
- Increased control over decision-making and impulsivity
- Decreased risky behavior
Help for Bipolar Disorder
Online Psychiatry for Bipolar Disorder – Talkiatry can match you with a real psychiatrist who takes your insurance and is seeing new patients. They’re in-network with major insurers and offer medication management. Most psychiatry visits cost patients $30 or less* Free Assessment
DBT Skills Course for Bipolar – Jones Mindful Living Dialectical Behavior Therapy (DBT) is a popular treatment for bipolar. Learn DBT skills with live weekly classes and online video courses for only $19 per month. Free one-week trial
*Includes copayment, deductible, coinsurance, and $0 Visits. Excludes no shows.
12 Common Thought Patterns of Someone with Bipolar Disorder
Because bipolar disorder creates mood changes, changes in thoughts can come from impacts on the brain’s cognitive functioning during high-symptom episodes. Other thought processes may develop with the altered moods associated with bipolar disorder.
Thought Patterns During Manic Episodes
Here are several bipolar thought patterns and examples of what they could look like during manic episodes:
- Racing thoughts: Racing thoughts are a frantic generation of ideas in the conscious mind, racing from one thought to another. It may be experienced as fluid and pleasant experience initially, almost as in a flow state.1
- Flight of ideas: Flight of ideas is a rapid influx of racing thoughts that can accelerate to the point of you being unable to focus entirely on one thought before moving to the next. In conversation, you may be unable to speak coherently, which can be distressing. 1, 4
- Pressured speech: Pressured speech is when you talk continuously and without regard for others’ interest, sometimes out of context and intruding on any ongoing conversation. This speech pattern reflects the impulsiveness of mania.
- Tangentiality: In manic episodes, the rapid generation of thoughts can lead to distracted thinking triggered by outside stimuli, including conversations. Tangential thinking shifts focus onto other ideas or topics somewhat related to the one being discussed but never returns to the original thought.
- Loose associations: This is when thoughts and speech loosely relate to the topic or what has been said, sometimes in divergent ways and sometimes with auditory associations like rhymes (i.e., ”When I boarded the plane lane, jane sang.”). This can be very distressing and is most often seen in manic episodes and associated with racing thoughts.
- Circumstantial thinking: Associated with manic episodes, the brain cannot filter out important information from unimportant information. This can come across as including many unnecessary details or loosely associated news in your conversation.
- Delusions of Grandeur: R. Belmaker says, “Delusions of grandeur, of importance, or of being the Messiah, or of being an important businessman are frequent in mania and can also be accompanied by mood-congruent hallucinations, such as the applause of crowds.”5 It is possible that bipolar’s effect on the brain can lead to delusional thinking (i.e., delusions or persecutory delusions) and possibly even hallucinations in the extreme.
- Psychosis: Psychosis can manifest in both manic and depressive episodes, most commonly presenting as delusions of grandeur, paranoia, and/or hallucinations.
Thought Patterns During Bipolar Depression
Thought patterns of a depressive episode differ. Here are some examples of thought patterns during a bipolar depressive episode:
- Thought blocking: This is a symptom seen in both manic and depressive episodes and is where someone is talking but cuts off mid-thought, often falling silent. For example, “I was talking with Steve the other night, and he told me how his golf game has…(silence)”.
- Negative self-talk: Thoughts of guilt or self-reproach are common with depressive episodes, and can lead to thoughts of suicide and death. If left with these without intervention, it could lead to action taken to plan out or execute a suicide attempt.
- Poverty of speech: Primarily associated with depressive episodes, thoughts can become so crowded that you are left unable to speak. This pattern can look like being unable to engage in conversation, answer questions, formulate a coherent thought, or respond in anything more than simple single to few-word answers.
- Rumination: Rumination, or cyclical thinking, occurs when someone focuses on their perceived source of distress and cannot immediately bring attention away from it or keeps coming back to it. Rumination is typically seen in depressive episodes and can lead to the worsening of negative symptoms like guilt and feelings of hopelessness.
Online Psychiatry Covered by Insurance
Talkiatry can match you with a real psychiatrist who takes your insurance and is seeing new patients. They’re in-network with major insurers and offer medication management. Get started with a short online assessment
Link to Neuroticism as a Bipolar Personality Trait
Neuroticism is part of the “big 5” personality types (Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism). It refers to the tendency of someone to experience negative emotions such as fear, sadness, guilt, and shame in response to stressors. People with bipolar disorder can be more prone to experiencing the negative emotions suggested in neuroticism due to the effects that their shifts in mood have on their overall thinking patterns.
Certain emotions experienced with Neurotic personality types include:
- Anger
- Anxiety
- Fear
- Guilt and Shame
- Self-consciousness
- Irritability
- Emotional instability
- Sadness
Neuroticism is just a trait and is not inherently maladaptive, but it can lead to increased sensitivity to and experience negative emotions. Pair this with poor stress management; the two can create paranoia over non-threatening situations or other additional difficulties.
Treatments to Cope with Bipolar Disorder Thought Patterns
If any of the symptoms and thought patterns mentioned above are something you experience, some treatments for bipolar disorder could work for you.
Medication
Medication treatment is a heavily researched and ever-changing area of medicine since bipolar disorders are diagnosed in about 2.8% of the US population. You can meet with a psychiatrist near you or use an online psychiatrist service to receive a consultation and possibly be diagnosed with bipolar disorder if you haven’t been yet.
Common bipolar medications include:
- Anti-psychotics
- Mood stabilizers
If diagnosed with bipolar disorder, you could reasonably expect to be prescribed medication and have dosage monitored and adjusted over your lifetime. However, pharmaceutical treatment is something to discuss with your doctor as you will need to work together to choose the appropriate one.6, 7
Psychiatry for Bipolar Disorder
Talkiatry offers online, in-network care with psychiatrists who specialize in bipolar disorder. Get started with a 15-minute online assessment.
Therapy
Cognitive-Behavioral Therapy for Bipolar Disorder (CBT-B) is the most common approach to addressing the thinking and behavior patterns associated with bipolar disorder. It is one of the most heavily researched approaches and has shown to be effective in helping treat bipolar disorder in conjunction with pharmaceutical treatments. Mindfulness-Based Cognitive Behavioral Therapy (MCBT) may also be effective. 8, 9
If therapy is something, you or a loved one has yet to consider, finding a therapist with experience in bipolar disorder and cbt will be the best option. You can use an online therapist directory to find mental health services covered by your insurance and in your area.
Self-Help Tools
If therapy and medications might not be readily available to you, self-help tools might help address distorted thought patterns. They can even improve the efficacy of other treatment methods! For example, thought-stopping mindfulness techniques pair an identified trigger with a practice of refocusing meditation or mindfulness strategies to interrupt maladaptive thinking patterns.
Here are some practical tools that can help reduce negative thought patterns:
- Process Journaling: A daily practice of journaling about situations that stand out to you throughout the day. Write down what happened, what you felt, what you thought, and how you responded, and then process if the reaction was based on evidence or assumptions. Process journaling can help reframe how you view the world around you.10
- Thought Stopping: One approach to doing this is to pair a verbal and physical trigger, like saying, “stop thinking about this for now,” snapping a rubber band on your wrist and then quickly going into a meditation practice to refocus on the present moment.
- Cognitive Reframing: Similar to cognitive restructuring, this is a technique where you take note of your thoughts and evaluate if they are serving you or hurting you. If the ideas are harmful, consider another way to look at your situation or a different perspective. Reframing is helpful when you get stuck ruminating over the same thing or concern from the same negative perspective.
- Improve Physical Health: Your physical health and perception can impact your mood.11 When you are not feeling well, unhealthy feelings can worsen the overall symptoms of bipolar. This can be done by either using exercise to improve mental health or practicing emotional self-care to enhance well-being.
- Build a Support System: Positive support systems, consisting of family, friends, and resources like community centers or groups, show positive effects on mood. They can serve as markers to tell you when you may need to seek help or make a change.
How To Best Support a Loved One with Bipolar Disorder
If you are part of a support system for someone with bipolar disorder, it is essential to know that their self-esteem may be hinged on their beliefs about how they can function in society. Bipolar disorder can be debilitating and lead to negative symptoms like delusional thinking and suicide. When you start seeing early signs that their thinking may be off, point this out and ask if they are taking medication as needed or still seeing a therapist if they have one.
If in an emergency, such as someone talking seriously about suicide or actively exhibiting dangerous behavior, it may be necessary to get outside help. The national 9-8-8 hotline can help with these situations.
Final Thoughts
Bipolar Disorder can bring about many negative thought patterns that may lead to interacting with the world differently. Inside you are still dealing with the same struggles as anyone else but aren’t able to process it the same way when symptoms are bad. But there are ways to manage this and still live a fulfilled life.
Additional Resources
Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.
Online Psychiatry for Bipolar Disorder
Talkiatry – Our psychiatrists can diagnose your condition, prescribe medication, and monitor your progress. Most psychiatry visits cost patients $30 or less* Free Assessment
Therapy for Bipolar & Medication Management
Brightside Health – develops personalized plans that are unique to you and offers 1 on 1 support from start to finish. Brightside Health accepts United Healthcare, Anthem, Cigna, and Aetna. Appointments in as little as 24 hours. Start Free Assessment
DBT Skills Course
Jones Mindful Living Dialectical Behavior Therapy (DBT) is a popular treatment for BPD. Learn DBT skills with live weekly classes and online video courses for only $19 per month. Free one-week trial
Starting Therapy Newsletter
A free newsletter for those interested in learning about therapy and how to get the most benefits out of therapy. Get helpful tips and the latest information. Sign Up
Choosing Therapy Directory
You can search for therapists by specialty, experience, insurance, or price, and location. Find a therapist today.
*Includes all types of patient cost: copayment, deductible, and coinsurance. Excludes no shows and includes $0 Visits