Symptoms of Bipolar Psychosis

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More than half of people living with bipolar disorder will experience at least one symptom of psychosis over the course of their lives. Psychosis is defined as the loss of contact with reality in which the person cannot tell the difference between what is real and what is imagined. Symptoms include delusions (believing something that is not real) and/or hallucinations (seeing, hearing, touching, smelling, or tasting something that is not real).

Psychosis usually accompanies episodes of extreme mania in people with bipolar I disorder (the more severe form of the disease). While less common, it can also happen to people with bipolar II disorder.

Psychosis is also a feature seen with other types of mental illness, including schizophrenia and schizoaffective disorder. Certain physical illnesses such as Parkinson's disease, Alzheimer's disease, brain tumors, and stroke can also trigger a psychotic episode, and it can even be an extreme feature of postpartum depression.


Within the context of bipolar disorder, there is no clear understanding of what causes psychosis. While people will often refer to it as a "psychotic break," the reality is that a psychotic episode usually develops slowly over time.

Early Warning Signs of Psychosis

Some early warning signs of psychosis include:

  • Consistently worrying about grades or job performance
  • Experiencing strong, inappropriate feelings or no feelings at all
  • Failure to keep up with personal hygiene
  • Having unwarranted suspiciousness of others
  • Struggling to concentrate or think clearly
  • Withdrawing from friends and family

Getting help for psychosis sooner rather than later can make the recovery process faster and easier, so early indicators should not be ignored. That said, people close to the person experiencing psychosis are usually the ones to detect these symptoms.

Mood-Congruent vs. Mood-Incongruent

People experiencing psychosis will typically appear incoherent and completely unaware of how extreme their behavior has become. In terms of symptoms, they are typically classified as being either mood-congruent or mood-incongruent.

Mood-Congruent Symptoms
  • The hallucinations and/or delusions match the person's mood.

  • The hallucinations may be contextualized by a person's delusions.

  • The underlying belief that you're being spied on can manifest with imagined sounds or voices from the next room.

Mood-Incongruent Symptoms
  • A person's mood does not match the hallucination and/or delusion.

  • People will often believe that there are voices telling them what to do or that they are being influenced by some unseen force.

  • The episodes are considered serious and will more often than not require hospitalization.


Delusions are false beliefs that a person believes are true. Previously referred to as paranoid disorder, delusions are characterized by episodes that are either bizarre (something beyond the realm of possibility) or non-bizarre (things that are within the realm of possibility).

Examples of bizarre illusions include being abducted by aliens or having a CIA tracking device in your head. Non-bizarre delusions, by contrast, often manifest with claims of being poisoned, followed, or loved from afar. Unlike hallucinations, delusions can often seem perfectly normal in casual situations.

Psychotic delusions are typically clustered around one or several of the following themes:

  • Erotomania, the belief that someone important loves you
  • Grandiosity, characterized by an inflated sense of self-worth
  • Jealousy, usually related to a loved one's infidelity
  • Persecution, in which you believe others plan to do you harm
  • Somatic delusions, by which you believe you are ill or have a physical defect


Hallucinations are characterized by physical sensations that are not real. With regards to bipolar disorder, hallucinations may be caused by an extreme manic episode combined with extreme sleep deprivation (the latter of which can also cause hallucinations in people who don't have bipolar disorder).

Hallucinations don't just involve perceptions, but actual sensations involving one or more of the five senses. They can be classified as:

  • Auditory hallucinations, such as hearing voices that aren't there
  • Olfactory hallucinations, involving smells
  • Tactile hallucinations, such as feeling bugs crawling all over you
  • Taste hallucinations
  • Visual hallucinations

Safety Considerations

The word "psychosis" can be scary for some people, suggesting the affected person is likely to inflict self-harm or cause harm to others. While this is possible, particularly in cases of severe mood-incongruent psychosis, episodes are usually more troubling than dangerous, but they still require treatment.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

With a holistic approach to the treatment of bipolar psychosis—including psychotherapy, medication, and social support—most people can fully recover and return to their normal life without further incident. While bipolar disorder cannot be "cured" in the traditional sense, with proper diagnosis and treatment, symptoms of the disorder can be successfully controlled over the long term.

1 Source
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  1. Dunayevich E, Keck PE. Prevalence and description of psychotic features in bipolar mania. Curr Psychiatry Rep. 2000;2(4):286-290. doi:10.1007/s11920-000-0069-4

By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.