
This post was published on Tumblr on September 20, 2024
I was diagnosed with bipolar disorder at age 19 and had a psychotic episode at age 21, so I’d like to say I know a bit about what I’m talking about. And I’m a writer! So today, I’d like to provide some facts about bipolar as a jumping-off point for your research.
This is just my opinion as someone who has lived with bipolar for a long time. Everyone experiences bipolar a bit differently, so not everything I mention will apply to everyone, and my own story may not reflect every single bipolar person. With that disclaimer, let’s go.
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Types of Bipolar Disorder

Bipolar is typically separated into two types. What kind you have depends on your predisposition to either extreme: mania or depression.
Bipolar 1
People with Bipolar 1 tend to have more severe manic episodes and less severe depressive episodes. They are more predisposed to experience psychotic episodes, though psychosis can happen in Bipolar 2 as well. Bipolar 1 patients may only have very brief depressive episodes or they may only experience their “baseline” and mania. (As an aside, I have Bipolar 1.)
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Bipolar 2
People with Bipolar 2 lean more toward depressive episodes. They may experience hypomania, which is a less severe form of mania, but their primary symptom will be depression.
It’s important to note that while many say Bipolar 1 is more severe because of the manic episodes and risk of psychosis, this does not discount the extreme suffering that can result from Bipolar 2. Patients with Bipolar 2 have just as many struggles as Bipolar 1 patients.
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Phases of Bipolar

Depression
This works much the same as the typical depression that people with Major Depressive Disorder experience, but bipolar patients may be more agitated, self-destructive, and aggressive when depressed.
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Hypomania
This is the “less severe” version of mania. This is demonstrated by DIG-FAST: distractibility, impulsivity, grandiosity, flight of ideas, activity increases, sleeplessness, and talkativeness. These happen in full mania too, but to a greater extent.
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Mania
A more severe, destructive version of hypomania: everything is dialed up to 11. People may become hypersexual, spend money they don’t have, destroy relationships, make inappropriate comments at work, or even fly into destructive rages.
Mania can be terrifying, both for the sufferer and for those around them. You can be so extremely happy that it’s almost painful, or so angry that you feel like you’re going to tear your own skin off.
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Psychosis
This typically is the “end result” of mania which happens to about 50% of people experiencing a manic episode. It is typified by delusions and hallucinations. We’ll discuss these a bit more later.
Contrary to popular belief, psychotic hallucinations are typically auditory, not visual, though visual hallucinations can occur as well. Other strange and less common hallucinations include olfactory (smelling things that aren’t there), gustatory (tasting things that aren’t there), or sensory (feeling people touching you).
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Euthymia
This is the normal, calm state in between depressive and manic episodes, where one has a sense of well-being and stability. It is the goal of therapy and medication management.
However, experiencing euthymia doesn’t mean that the bipolar disorder is gone: it just means that it is in remission. Bipolar patients must always be on alert for warning signs of mania and be active participants in their own care.
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Warning Signs of Mania

Manic episodes often come with prodomes, symptoms that appear before full-blown mania.
Bipolar patients and their families should be on alert for these warning signs and, if they continue to occur for more than a week or so, schedule an appointment with the patient’s psychiatrist to see if they need a higher medication dosage.
Here are some common signs that happen before full-blown mania:
Feeling either really great or really terrible for no reason. Sometimes you can feel really great and really terrible at the same time. It’s a very weird feeling.
Functioning well on little sleep for days on end. Not just one sleepless night, but being able to go to work and function on like 4 hours of sleep night after night.
Increased or decreased appetite. Either you hate food or it’s the most important thing in your life. Can fluctuate day by day.
Increased productivity. You’re getting soooo much done and so quickly! (It probably sucks but we’ll put that aside for now.) You just want to work on your passion projects constantly.
Sudden interest in multiple new hobbies all at once, and throwing yourself into them with such passion that it’s scary.
Weird physical symptoms. You may find yourself locked into a position and not want to move, or your skin may feel odd, like it’s too tight or prickly.
Sudden bouts of tinnitus. It sounds really weird, but it’s been proven to be a sign of impending mania along with the skin symptoms I mentioned before.
Your eyes look different. Your pupils are always dilated.
Not everyone will get all of these, but most people will have at least one trigger that happens to them every time before a manic episode. For me, it was hypergraphia (because of course it was).
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Symptoms of Mania

Not all of these symptoms will happen to everyone, and every manic episode can be a little different. It all really depends on who you are. Now, I must say that anyone, bipolar or not, can have these symptoms. It is the intensity of them that defines mania.
Being physically incapable of sleeping.
It’s not insomnia like normal people experience, where you pop a melatonin or do some breathing exercises and manage to fall asleep. You cannot fall asleep.
Becoming extremely focused on random things, projects, and subjects.
For me, it was cleaning the house: I started throwing out old photos that I thought we didn’t need because I didn’t want any clutter. I would sweep the floor for hours at a time.
I also got really obsessed with Neolithic Scotland of all things. Now I can’t even remember half the shit I learned.
Hypersexuality, overspending, and kleptomania.
Unintentional pregnancies, STDs, and a whole lot of bad feelings can come from this.
Many people will go into extreme debt because of their mania, especially if they don’t have family support.
Other bipolar people feel an uncontrollable urge to steal things they didn’t even need to: they could afford it, they just wanted the thrill of stealing it.
Worsening of any addictions or developing new addictions.
Especially seen in gambling addictions because, well, you already want to spend a lot of money and it’s an extreme dopamine hit.
Sudden and intense aggression or emotional volatility.
Normally calm and relaxed people will go off the deep end about pretty much anything: screaming, throwing things, and then bursting into tears out of guilt.
Feeling invincible, or terrified of everything.
Manic people are convinced that nothing bad could ever happen to them and they can do whatever they want. Think of someone running into traffic, sure that no one will hit them.
On the other hand, others became terrified of random things or situations that never bothered them before. This can happen to the same person, sometimes simultaneously. You may believe everything is a threat, even when there is no clear and obvious threat.
Talking extremely fast and in an extremely disconnected way.
This is called flight of ideas; you start jumping from one discussion to another in ways that other people can’t follow. Your brain has made that leap but can’t articulate it for other people.
Shiny eyes.
You really can see mania in the eyes; it’s very unsettling. Manic eyes look dark, wide, and shimmery.
Mania can cause amnesia afterward, and the person may not remember large swathes of what happened, or it will feel “dream-like” and confusing. Of course, they’ve got some major damage control to do that can plummet them into depression.
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Symptoms of Psychosis

Again, just like with mania, not everyone will experience all of these. If a person has multiple psychotic episodes, each one may be a bit different every time.
I’m going to separate this into several sections: common delusions, common hallucinations, and Other symptoms (which are often not discussed as much).
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Common Delusions
Delusions can shift throughout the course of a psychotic episode, seamlessly morphing from one to another without clear cause.
With psychoanalysis, one can often find that there are “seeds” of a delusion in the person’s everyday life, and they may be connected to current events. For example, someone may think they’re the reincarnation of a previous president during a presidential election.
Grandiosity
- Being god or a reincarnation of a famous person
- A belief that they have found the “key” to the universe and that everything is connected by some vast conspiracy
- Having some special role to play or a special status
- Being a member of a special community
- Having special knowledge or insight into issues, like world affairs
- Being ageless, immortal, or invincible
- Having a special connection with a celebrity, famous person, fictional character, people you know, or even strangers
Paranoia
- Being surveilled by a government entity, sometimes with the belief that they have had tracking devices installed without their consent
- Being stalked, harassed, or tormented by unknown entities or by strangers (gang-stalking)
- Being persecuted for a certain identity
- Being ill with another disease, like cancer or dementia
- A sense that loved ones have been replaced with clones or copies
- Believing that there is a secret “play” going on and other people are playing along with a secret “script”
- Believing other people can hear your thoughts, or that you can hear theirs
- A sense that a person’s face is not their “real” face and they are wearing a mask
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Common Hallucinations
Auditory
- Repeating noises, words, or phrases in distinct voices
- Spectral, unhearable music
- Nonexistent environmental noises, like train whistles or construction sounds
- “Ear worms” that loop for days or weeks
- Humming, whirring, or ringing
Visual
- Mutated or blurry faces, even of people you know well
- Haloes, auras, sparkles, flashes, and black spots
- Colorful lights, ribbons, or strings
- Seeing people you know who could not feasibly be there, like old coworkers, old partners, or deceased relatives
- Vague blurry shapes, or distinct monster-like entities
- Strangely shaped or mutated animals or people
- “String people,” “stick people,” or “void people”
- Shadows and skittering bugs, rodents, or snakes, often black or blurry
Tactile
- Bugs or small creatures crawling on the skin
- Itchiness or grittiness on the skin
- Light feathery touches along the skin, especially on the back or hands
- Goosebumps with no clear cause that don’t go away
- Sense that the mouth is full when nothing is there
- Prickly tongue
Gustatory
- Bad smells, like feces, garbage, body odor, or burning plastic
- Good smells, often those from childhood
- Losing sense of smell or taste
- Metallic taste (may be a medication side effect)
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Other Symptoms
- Muscle stiffness
- Catatonia
- Slurred or fast speech
- Lack of appetite
- Weight loss
- Migraines
- Parkinsonian symptoms (tremors)
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How Bipolar Is Treated

Bipolar is treated in a few ways, with the most important and prominent being medication.
Medication
Bipolar is typically treated with mood stabilizers, which is a vague class that includes anticonvulsants, SSRIs, SNRIs, and other groups of medications. (The medication I use, Lamictal, is an anticonvulsant.)
Psychiatrists must be very careful when prescribing antidepressants for Bipolar I patients because too much can bring on mania. Bipolar 1 patients will often have an antipsychotic added to their regimen as well. There are new classes of drugs that combine antidepressants with antipsychotics for a one-and-done deal.
Bipolar patients may also have antianxiety medications added to their regimen.
Psychosis is a medical emergency and must be treated as soon as possible. Fast-acting antipsychotics can be injected in the emergency room to stablize a psychotic patient. They may also use tranquilizers to calm a paranoid or combative patient.
Like with schizophrenia, patients who are not medication-compliant may opt for a long-lasting antipsychotic injection that only needs to be done once a month or once every three months.
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Therapy

A history of trauma is one of the things that predisposes a person to bipolar disorder, so working on this can help reduce symptoms. EMDR therapy can be a safe and effective way to process trauma for bipolar patients.
However, Cognitive Behavioral Therapy (CBT) doesn’t work very well for bipolar patients because, well, their cognitive distortions are brought about by chemical changes in the brain, not just seeing the world “wrong.”
Dialectical Behavioral Therapy is a better choice for bipolar patients because it helps them become more aware of their thoughts and, therefore, better able to manage their emotions.
Other options include equine-assisted therapy (my favorite!), art therapy, and family therapy to help build a stronger support system.
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Lifestyle Changes
All the stuff that helps “normal” people can help bipolar patients, too. For example, having a set routine, eating well, setting and keeping a bedtime, getting exercise, and eating well are all crucial for managing bipolar, in addition to medication and therapy.
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Common Myths About Bipolar

Bipolar people are dangerous and never get better.
Not necessarily true, though common media depictions show this as if all bipolar people are roving murderers.
In fact, bipolar people are more likely to kill themselves than anyone else: it has the highest suicide rate of any psychiatric illness, about 20 to 30 times more than the general population.
Bipolar comes with other issues, like executive dysfunction, that cannot always be managed or treated. BUT bipolar people very much can become stable and mostly asymptomatic with the right treatment.
A caveat, though. Even if you are in remission, you still have bipolar disorder and can relapse at any time. It is a brain dysfunction that causes measurable structural differences in the brain which do not go away.
Medication is a crutch and bipolar people can get better by themselves.
Wrong. Just like someone doesn’t magically get better from Type I Diabetes without treatment, bipolar people need medication.
Again, just like someone with Type I diabetes, you can’t just will the bipolar away. It is a chronic illness with genetic, epigenetic, and lifestyle factors. You need treatment.
Medication turns bipolar people into emotionless zombies.
Incorrect, with a caveat. The wrong dosage or type of medication very much can make someone into a zombie; I’ve certainly felt that way before. However, the correct treatment allows bipolar people to thrive and stay stable for years to come.
Once you snap out of psychosis/mania, you’re right back to normal.
Wrong. You don’t just wake up and are not psychotic anymore. It takes time for your brain to equalize and come back to baseline. I remember it as feeling like I was rising out of a long, long sleep.
Mania or depression causes brain changes that can last years after the episode. On average, the brain damage from mania exists for up to seven years after the last episode, and it worsens with each subsequent episode.
Any fluctuation in mood is a symptom of bipolar.
This is so, so, so annoying. Bipolar people are allowed to have bad days just like anyone else. If I’m having a shitty day but I’m not throwing phones at people, then I’m probably just having a bad day. If I’m really happy, it doesn’t mean I’m manic.
Bipolar people can’t help it and shouldn’t be punished for their actions.
What I like to say is that my bipolar doesn’t excuse my behavior, but it does explain it. Never use it as an excuse to be an asshole.
Everything about bipolar is terrible.
Wrong! Bipolar can have benefits like creativity, empathy, good problem-solving, and a unique perspective on life. A stable bipolar person can be a delight to be around. But these don’t discount the downsides and should not be a reason to refuse treatment.
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How to Create an Authentic Bipolar Character

Do your research.
Read a mixture of medical journals, stories from bipolar people, and good depictions of bipolar disorder in the media. Go beyond what I have discussed here and seek out good, peer-reviewed research.
Create the character first, then add the bipolar.
Don’t add bipolar just for the shock value. This is annoying.
Every bipolar person is different, just like every person is different. Get a feel for your character and then determine how they might act when manic or depressed.
Use an array of symptoms.
Don’t just go for “ooooh scary monster in the corner of my eye” because that’s boring and overdone. Look through the list I provided and consider how you can fit a few of them in there.
Remember that it takes time to recover from an episode.
You should not just have your character wake up one day and be cured. They will feel “off” for a while after an episode, like a very very long hangover.
Consider medication symptoms.
Decide what medication they will use and then look up the symptoms. Demonstrate how this makes them feel and whether it makes them want to continue treatment.
Think about how a character feels about their bipolar.
Some people don’t think it’s a problem because they like the energy, and others are terrified of relapsing. Some see it as a challenge to be overcome, and others find it to be a burden that they want to be rid of. And many will feel all of these at different times.
Show the impact on other characters.
Remember that your other characters are seeing and reacting to this. They may be terrified, frustrated, hurt, dismissive, or not want to deal with it.
Demonstrate times of stability, too.
Too many people use bipolar as an “ooooh soo sad” (especially psychosis) and don’t show the character just being a normal human being.
Show the ableism bipolar people face.
Yes, we do face ableism. People calling us crazy, denying us medical care, passing us up for jobs, or my very least favorite, “have you taken your meds today?”
Remember that many people are not medication compliant.
Medication compliance is one of the number one indicators of whether a person will stay stable long term. If your character refuses to take their medication, then they are more likely to relapse.
People have many reasons for not accepting treatment: they don’t like the way it feels, they’re embarrassed, they don’t see it as a problem, or they can’t afford it (some of these meds can be hundreds of dollars a month even with insurance). So make sure to explain why they are medication non-compliant.
And that’s about it. I hope you learned something that will help you create more realistic (and compassionate) fiction.



































































