Bipolar Disorder: Symptoms

Switch between manic or hypomanic episodes and episodes with depression

The essential feature of Bipolar Disorders is the switch between manic or hypomanic episodes and episodes with depression. This chapter describes the primary symptoms of manic and hypomanic episodes. For a description of the symptoms of the depressive episodes, see the chapter “Depressive Disorders”. The duration of the manic episodes is in most cases only about 10-20% of the total duration of the disease. Nevertheless, the manic episodes and the concurring changes in mood and behavior of those affected are often a special burden on the family and friends.

Euphoric or irritable mood

In manic episodes those affected live mostly in a very euphoric mood, that can sometimes skip to an irritable mood. The mood can be lifted permanently, but most people experience rather a mood lability.

Flight of ideas and pressured speech

Almost all patients experience in the manic phase a pronounced flight of ideas. They find it very difficult to follow a certain line of thought, instead they suffer under incoherent and unrelated thoughts which result in a pressured speech.

Loss of impulse control

Many patients experience in manic episodes a loss of impulse control. This can lead to certain impulses, such as the urge to buy or possess certain things, which can lead to rash actions, such as an increased spending.


The sleep is usually affected, about 90% of the patients have a shortened sleep duration under which they suffer more or less.

No boundaries

In manic episode the patients often experience problems in realizing their own boundaries and the boundaries of others. Many patients experience in the manic episode a “sense of omnipotence”, which can quickly lead to conflicts with the social environment.

Sensitivity to criticism and rebukes

Many patients react in the manic phase more sensitive to criticism or rebuke which may lead to conflicts with significant others.

Depressed mood and suicidality

Within the manic phase may occur sudden and unpredictable, over minutes or hours-lasting depressive episodes, during which the patients can quickly develop suicidal thoughts. In combination with the increased energy levels and the feelings of omnipotence can arise a significant suicide risk.

Alcohol and drug use

In the manic phase may exist a tendency to an increased use of alcohol or substance abuse with the risk of dependency.

Increased libido

Approximately one in three affected experience during manic episodes an increased libido. In some cases this may be associated with promiscuous behavior.

Delusions and hallucinations

A relatively high proportion of patients (50%) develops in certain phases of the disease psychotic symptoms like delusions. This can become a major burden for patients and their families. Some of the patients also experience auditory hallucinations.

Dr. Sandra Elze & Dr. Michael Elze