Let's Get the Record Straight on Bipolar: 5 Myths

When I think about memorable clients, many of the first to enter my mind are individuals living with bipolar disorder. The creativity, energy, and pain expressed by those with the condition are unmatched. I think not only of those with the diagnosis but also of families who have shared in their fight. I see faces of victory, people who have rebuilt after major mood episodes and carved out a recovery.

Yet, the reality of bipolar disorder hides behind mountains of misinformation. Tragically, this contributes to massive delays in diagnosis with an average of eight years between when someone begins to experience symptoms and when the challenge is correctly identified (Fritz et al., 2017).

To address common myths surrounding bipolar, I met with David Medina, a psychiatrist who has spent 25 years treating people with the condition. He is particularly interested in what he calls the spectrum of Bipolar Disorders across the lifespan. Whereas Bipolar I Disorder is marked by the highest of high moods, mania, Bipolar II Disorder is defined by “hypomania”, a shorter and less severe episode than full blown mania. A person with either Bipolar I or II may or may not suffer depressive episodes, which are often referred as “bipolar depression”

Source: Courtesy of Dr. David Medina

Myth 1: Bipolar Disorder Is Just Mood Swings

Stereotypically, bipolar disorder has been depicted as erratic personality traits and rapid mood swings. Someone might sigh, "They are so bipolar," when bothered by another person's indecisions or moodiness. This is not what bipolar is. Manias and depression that accompany bipolar disorder are, by definition, longer lasting than the media-friendly mood swing version.

Medina points out that, for example, in bipolar I mania, symptoms must last at least seven days. He describes the beginnings of mania as showing up with "changes in energy levels." Elaborating further, "The battery doesn't wear out. You can go without sleep and not feel it." Still, he carefully remarks, "Mania is not a good thing," as impulsivity and irritability accompany mania. He shares that it is not uncommon for someone to have terrible experiences in mania, finding themselves "in hospital, jail, or a car accident" when the condition goes unchecked.

Myth 2: Medication Is the Only Treatment for Bipolar Disorder

"For people with bipolar disorder, therapy is essential," Medina shares. While medication can treat mood symptoms of bipolar disorder, individuals often benefit from therapy to address relationship difficulties, anxiety, coping with symptoms, and accompanying trauma symptoms.

According to a recent study, of the 114 adults surveyed, as many as 78 percent reported at least one major traumatic experience in their lifetime (Rowe et al., 2023). For people with bipolar symptoms that do not respond to medication, alternative treatments are available. Among those under investigation for bipolar depression is a modality of neuromodulation vagus nerve stimulation (VNS). Medina describes the intervention as an "implant done by a surgeon, and programmed by a psychiatrist." This implant then sends signals to the vagus nerve, which may help create new pathways in the brain. Preliminary research has been positive, with individuals receiving VNS having an improved chance of recovery and decreased risk of suicide compared to participants in the treatment-as-usual group (McAllister-Williams et al., 2020).

Myth 3: You Can't Live a Good Life With Bipolar Disorder

The pain of bipolar depression and the damage done by mania are real. Yet, many living with bipolar live happy and productive lives. Medina shares, "A lot of successful people are bipolar." Indeed, several notable people are believed to have lived with bipolar disorder, including Vincent van Gogh, Winston Churchill, and Virginia Woolf (Fink and Kraynak, 2023). Some research has suggested an overlap between some genes believed to be linked with bipolar disorder and ones associated with creativity (Greenwood, 2020)

Myth 4: People With Bipolar Disorder Who Experience Psychosis Must Also Have Schizophrenia

Psychotic symptoms like delusions and hallucinations sometimes accompany the extreme mood states of bipolar disorder. Medina shares about "delusions of grandiosity," citing an example of believing that one can "solve all the world's problems." Grandiose delusions echo the sense of invincibility of bipolar mania. In depression, many with bipolar disorder experience psychotic symptoms that display instead a dark mood, such as delusions of ruin that give a sense of catastrophe or hearing negative voices.

Myth 5: Bipolar Disorder Looks the Same in Everyone

Bipolar disorder is perhaps one of the most diverse mental health conditions identified. With seven possible symptoms of mania listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision—three are required for diagnosis—there are a total of 35 possible combinations of symptoms for mania alone. Not to mention that this does not account for the many faces behind those symptoms. A person is more than a diagnosis. Each person living with bipolar disorder has a unique story, personality, and life. The person behind the eyes is more than the moods that bipolar casts.

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Closing

Bipolar disorder is a complex condition with a multitude of effective treatment options. Most often, treatment of bipolar disorder is multi-modal interventions to address its biological, psychological, and social aspects. In addition to psychopharmacology agents and psychosocial interventions , Neuromodulation technologies may relieve symptoms in those individuals who have not yet achieved stabilization of their mood states.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.