What Is Bipolar Psychosis?

Thoughtful woman
Rafael Elias / Getty Images
Table of Contents
View All
Table of Contents

Bipolar psychosis is the loss of contact with reality in which the person cannot distinguish between real and 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 of 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 can even be an extreme feature of postpartum depression.

More than half of people living with bipolar disorder will experience at least one symptom of psychosis over the course of their lives.

This article discusses the symptoms, diagnosis, and causes of bipolar psychosis. It also explores the treatment options and coping strategies that can help.

Symptoms of Bipolar 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.


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. When it comes 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

Diagnosis of Bipolar Psychosis

To diagnose psychosis in bipolar disorder, a doctor will ask questions about the symptoms you have been experiencing. They will want to learn more about your medical history, recent stressors you might have experienced, and any medications or substances you are taking.

A doctor or mental health professional will utilize the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR) to help make a diagnosis. The DSM is a tool that categorizes different types of mental disorders and describes their diagnostic criteria. 

Because psychosis can also be a symptom of other conditions, your doctor will rule out other causes. To do this, they might perform a physical exam, order lab tests, and conduct psychological assessments.

Causes of Bipolar Psychosis

The causes of bipolar psychosis are not fully known, but it is believed that a few different factors can increase the risk. These include:

  • Genetics: Studies suggest that certain mental health disorders, including bipolar disorder and schizophrenia, have a shared genetic connection. Having bipolar disorder may mean that a person has a higher risk of developing schizophrenia. 
  • Hormones: Psychosis may also be influenced by hormonal shifts, such as during puberty or following childbirth.
  • Marijuana use: Some research suggests that people with bipolar disorder who use marijuana have a greater risk of experiencing psychotic symptoms.
  • Stress or trauma: One study indicated that people who experience traumatic stress have an increased risk of developing psychotic disorders and bipolar disorder.
  • Sleep deprivation: Problems with sleep can worsen symptoms of bipolar disorder and may play a part in triggering the onset of psychosis.

Types of Bipolar Psychosis

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.

Treatment for Bipolar Psychosis

Treatment for bipolar psychosis typically involves:

  • Medication: Bipolar disorder is often treated with mood stabilizers, antipsychotics, or antidepressants.
  • Psychotherapy: Individual, group, or family therapy can also help manage symptoms of the condition. 

While there is no cure for bipolar disorder, treatment can help people manage symptoms and improve their quality of life. Adhering to your treatment can significantly improve symptoms and reduce your risk of having future psychotic or severe mood episodes.

Coping With Bipolar Psychosis

If you have bipolar disorder, there are also strategies you can use to monitor and manage your symptoms. Lifestyle modifications that can help include:

  • Monitoring symptoms: Keep a journal or use a mood tracker to monitor your moods and other symptoms. Be sure to note any changes in your environment, habits, or stress levels that precede mood episodes or psychotic symptoms.
  • Find social support: Enlist the help of loved ones to monitor your moods and behaviors. Create a safety plan so friends or family know who to contact if you experience psychosis. 
  • Avoid triggers: Avoid alcohol, minimize caffeine intake, and make sure that you are managing your stress levels effectively. 
  • Care for yourself: Make sure that you are getting enough sleep, eating a balanced diet, and getting regular physical activity.
  • Stick to your treatment: Follow your doctor's instructions and take your medications as prescribed.

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.

10 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  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

  2. Burton CZ, Ryan KA, Kamali M, et al. Psychosis in bipolar disorder: Does it represent a more "severe" illnessBipolar Disord. 2018;20(1):18-26. doi:10.1111/bdi.12527

  3. Picardi A, Fonzi L, Pallagrosi M, Gigantesco A, Biondi M. Delusional themes across affective and non-affective psychosesFront Psychiatry. 2018;9:132. doi:10.3389/fpsyt.2018.00132

  4. Neves Mde C, Duarte DG, Albuquerque MR, et al. Neural correlates of hallucinations in bipolar disorderBraz J Psychiatry. 2016;38(1):1-5. doi:10.1590/1516-4446-2014-1640

  5. Chaudhury S. Hallucinations: Clinical aspects and managementInd Psychiatry J. 2010;19(1):5-12. doi:10.4103/0972-6748.77625

  6. Gandal MJ, Haney JR, Parikshak NN, et al. Shared molecular neuropathology across major psychiatric disorders parallels polygenic overlap. Science. 2018;359(6376):693-697. doi:10.1126/science.aad6469

  7. Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V. Risk of postpartum relapse in bipolar disorder and postpartum psychosis: A systematic review and meta-analysisAm J Psychiatry. 2016;173(2):117-127. doi:10.1176/appi.ajp.2015.15010124

  8. Miller NS, Ipeku R, Oberbarnscheidt T. A review of cases of marijuana and violenceInt J Environ Res Public Health. 2020;17(5):1578. doi:10.3390/ijerph17051578

  9. Okkels N, Trabjerg B, Arendt M, Pedersen CB. Traumatic stress disorders and risk of subsequent schizophrenia spectrum disorder or bipolar disorder: A nationwide cohort studySchizophr Bull. 2017;43(1):180-186. doi:10.1093/schbul/sbw082

  10. Waters F, Chiu V, Atkinson A, Blom JD. Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awakeFront Psychiatry. 2018;9:303. doi:10.3389/fpsyt.2018.00303

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.