Symptoms of Bipolar Psychosis

Condition Most Often Associated With Extreme Mania

Bipolar Psychosis
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Around two-thirds 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 during which time a person cannot tell the difference between the real world and the imagined. It is a condition defined by 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 persons 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 a feature seen with other types of mental illness including schizophrenia and schizoaffective disorder. Certain physical illnesses such as Parkinson's, Alzheimer's, brain tumors, and stroke can also trigger a psychotic episode. Even women may be subject to psychosis as an extreme feature of post-partum depression.

Features of Bipolar Psychosis

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," suggesting that the person "snapped," the reality is that a psychotic episode usually develops slowly over time.

In many cases, the person will start to have difficulty concentrating, communicating, and keeping up with work or hygiene.

Suspicions and anxiety will often begin to manifest, leading to an increasing loss of self-awareness and reality.

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

By comparison:

  • Mood-congruent symptoms are those in which the hallucinations and/or delusions match the person's mood. In cases like these, the hallucinations may be contextualized by a person's delusions. The underlying belief that you're being spied on, for example, can manifest with imagined sounds or voices from the next room.
  • Mood-incongruent symptoms are those in which a person's mood does not match the hallucination and/or delusion. In this instance, people will often believe that there are voices telling them what to do or that they are being influenced by some unseen force. Episodes like these are considered serious and will more often than not require hospitalization.

Understanding Hallucinations

Hallucinations are characterized by physical sensations that are not real. With regards to bipolar disorder, this may be caused by an extreme manic episode combined with extreme sleep deprivation (the latter of which can cause hallucinations even in non-bipolar individuals).

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

  • Visual hallucinations
  • 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

Understanding Delusions

Delusions are false beliefs that a person believes are true. Previously referred to as paranoid disorder, delusions are characterized by episodes that either bizarre (something beyond the realm of possibility) and 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, can often manifest with claims of being poisoned, followed, or loved from afar.

Unlike persons experiencing hallucinations, those with delusions can often seem perfectly normal in casual situations. Psychotic delusions are typically clustered around one or several of the following themes:

  • Jealousy, usually related to a loved one's infidelity
  • Grandiosity, characterized by an inflated sense of self-worth
  • Erotomania, the belief that someone important loves you
  • 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

A Word From Verywell

The word "psychosis" can be scary to 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.

With a holistic approach to treatment (including psychotherapy, medication, and social support), most people can fully recover and return to normal life without further incident.

While bipolar disorder cannot be "cured" in the traditional sense, with proper diagnosis and treatment, symptoms of the disease can be successfully controlled over the long term.

View Article Sources
  • Savitz, J. van de Merwe, L.; "Neuropsychological status of bipolar I disorder: impact of psychosis." Brit J Psych. 2009; 194(3)L243-51. DOI: 10.1192/bjp.bp.108.052001.