Yes, people with bipolar disorder think differently. But they can manage their thoughts and lead happy, healthy lives with effective treatment.

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Content warning: Self-harm, suicidal ideation

Unpredictable. Unstable. Untrustworthy. Unreliable. Unable to take care of themselves. Unable to manage their moods.

There are many misconceptions about how a person living with bipolar disorder thinks and acts. Although some folks may relate to this experience, these stereotypes are oftentimes both wrong and harmful.

“If more people knew how those with bipolar disorder think, it would help greatly with understanding and compassion for those with the illness,” confirms Claire Ishi Ayetoro, who lives with bipolar I. “It could also greatly help those who care for someone with bipolar disorder.”

So, how does a person with bipolar disorder really think?

“Bipolar disorder is a serious mental health condition which includes an experience of mood [episodes] from emotional highs, referred to as mania or hypomania that can last for days to a week, to lows, or a depressed mood which can last for weeks,” explains clinical psychologist Dr. Desreen Dudley, PsyD.

According to the Depression and Bipolar Support Alliance, 5.7 million American adults are currently diagnosed with bipolar disorder.

There are different types of bipolar disorder, including:

Your thoughts may differ depending on the type of bipolar disorder you live with. (Good news: They can all be managed with proper treatment.)

Does someone with bipolar disorder remember what they say? Yes.

Do people with bipolar disorder know what they’re doing? Also yes.

“Many people think that a person with bipolar disorder doesn’t have any control over themselves or that they’re unable to take care of themselves or function in society. This simply is not true,” says Ikaika King, who was diagnosed with bipolar II when he was 17.

“In many ways, we think exactly like everyone else most of the time. It’s when we have symptoms that things start to go haywire,” adds Gabe Howard, author of “Mental Illness Is an Asshole” and host of Psych Central’s Inside Mental Health podcast.

People with bipolar disorder may face unique challenges as a result of their condition, but they’re fully capable of leading happy, healthy, successful lives.

Sometimes. For example, Ayetoro had suspicions for years before officially being diagnosed in 2014.

“I experienced what I thought were abnormal swings in mood from very high energy to very low energy for a very long time before. My moods would get so low that I was spending unusual amounts of time in bed depressed,” she recalls. “It was strange that this depression would follow periods of extremely high spirits.”

She experienced two manic episodes before receiving her diagnosis. “It was somewhat of a relief to put a name to what was [going on] with me, but then began the hard road to stability.”

On the other hand, Howard was surprised to receive a diagnosis of bipolar I with psychosis at age 25. “As for what made me believe I may have had an illness… literally nothing. I was tricked into going to the hospital. Up until the moment I was admitted, I thought everything was ‘normal.’ It was quite the shock.”

“Who would I be without bipolar disorder? I’d love to find out,” he adds. “But harnessing my mind and using it to the best of my ability has been my life’s work.”

Cyclical thoughts

Ayetoro describes her thinking as “cyclical.” She explains that she’ll start off “high” at the beginning of a cycle with positive, rational thoughts and a productive work ethic. But when she’s in a “low mood,” she may fail to meet deadlines, be filled with anxiety, and experience self-deprecating thoughts.

“Thinking in cycles makes consistency in anything a major difficulty,” she says. She adds that there’s no set amount of time for these states of mind — some last a while and others are short-lived. The way she thinks is highly dependent on her mood as well.

King noticed his moods fluctuate drastically throughout most of his teenage years as well. “Some days, I was full of energy, extremely enthusiastic, and carried myself with confidence. On others, I felt exhausted, hopelessly overwhelmed, and deeply discouraged with my life.”

Depression

Depression influences more negative and hopeless thinking, says Dr. Dudley. “During a depressive episode, feelings of hopelessness, helplessness, and low self-worth can lead them to view things negatively.”

King notes his episodes of depression are usually lengthy. “When I’m feeling this way, my thoughts seem to move at a slower rate. My ideas feel cloudy and unfocused. It’s easy to feel overwhelmed and overworked, and I have a hard time taking things one step at a time. It feels like my brain is just stuck in the mud.”

“Depression in bipolar disorder type II can feel like it’s never going to end and like you have no control of your life and [makes] me feel like I should just give up on my goals,” he adds.

Mania

“A manic episode is a distinct period of abnormal elevated mood with increased energy, excessive engagement in activities, grandiosity, racing thoughts, and decreased need for sleep, lasting for several days to a week,” Dr. Dudley explains.

Those racing thoughts can negatively impact a person’s ability to focus or complete tasks. “Sometimes, I’ll have multiple thoughts at the same time and/or my thoughts will go so fast in my brain I can’t capture them accurately,” says Howard.

Dr. Dudley says manic episodes may inspire higher energy levels, creativity, and feelings of invincibility, too.

This is especially true for King. “When I’m feeling the manic part of my bipolar, my thoughts come at a fast rate. Information feels like it’s easier to digest and I can find a level of flow in work and relationships with less effort. This is when my mind feels like it can process things with the most efficiency,” he says.

Self-harm

Dr. Dudley notes that people with bipolar disorder are more vulnerable to feeling suicidal or experiencing thoughts of self-harm.

Jennifer Hicks was diagnosed with bipolar II at 33 years old. “During my late-20s early-30s, I had an exercise addiction,” she calls. “At the same time, I had anorexia and engaged in self-harm.”

Howard says his mind works differently than other minds, and some of those differences are life-threatening. “When my mind tells me that it would be okay to harm myself or even kill myself, that’s very serious. Everyone gets sad, but my emotional spectrum includes depression and suicidal depression.”

“I thought about suicide as far back as I can remember, but I didn’t know it was wrong. Because I was born this way, it was normal to me,” he recalls.

Psychosis

“When bipolar disorder mood symptoms are severe, a person may experience psychosis, or delusional and paranoid thinking which is out of touch with reality,” says Dr. Dudley.

Howard says that bipolar psychosis is frightening because what he thinks is happening isn’t actually happening. “I believed demons were under my bed and chasing me. I believed the demons were there because my brain told me they were there. Realizing my brain was giving me incorrect information was particularly devastating.”

If you relate to any of these thoughts or experiences, know that treatment is available. There are different ways to manage your thoughts and achieve stability with bipolar disorder.

Medication

Medication can be extremely effective for thought management. “Since bipolar disorder is a neurological brain disorder, certain medications work to improve brain functioning,” says Dr. Dudley.

According to the National Alliance on Mental Illness (NAMI), common prescriptions may include second-generation antipsychotics (SGAs), antidepressants, or anticonvulsants. It’s recommended to work with a mental health professional to determine the best medication plan for you.

Therapy

“Bipolar disorder requires diagnosis and treatment by a trained licensed professional,” reminds Dr. Dudley. If you think you may have bipolar disorder, consider scheduling an appointment with a therapist.

Therapy can help you learn ways to challenge negative thinking patterns and practice more adaptive behaviors, she adds.

Support and education

Dr. Dudley recommends becoming educated on bipolar disorder, including how to support a loved one with the condition and ways to maintain your own emotional well-being.

Hicks says she’s grateful for her husband’s support as she navigates living with bipolar disorder. “We went through some really dark times because of my mental health issues, and he has been incredibly supportive. I know that his support is part of what has helped with my (relative) stability.”

“After sharing my experience with trusted family members, I found the help I needed and opened the doors to finding treatment that works for me,” adds King.

Find what works for you

King finds relief through self-reflection, frequent exercise, multiple hobbies, and having creative outlets. For Ayetoro, journaling and deep breathing practices help to bring her peace. Most people we interviewed are thankful for taking medication.

But what works for one person may not work for the next.

Howard encourages folks to try different things and not be afraid to fail. “Every failed coping skill attempt gets you closer to what will work.”

Consider combining these approaches for a more holistic treatment plan. Speak with a mental health professional to figure out what might work best for you.

“I’m fond of the phrase, ‘If you meet someone with bipolar, you have met one person with bipolar.’ We’re all very different,” says Howard.

No two people with bipolar disorder share the same thoughts or experiences, but there are some common thought patterns among most folks who have it. This includes cyclical thinking, manic and/or depressive episodes, suicidal ideation, and psychosis.

Educating yourself can help to remove the stigma and support those living with the condition. This also means being mindful of the harmful myths and stereotypes that exist about people with bipolar disorder.

“I think the public sees the idea of an alternating state of mind as a sign of being unreliable, but in reality, people with bipolar can absolutely adapt to their condition and learn to live a healthy lifestyle with it,” says King.

With effective treatment, Dr. Dudley says that a person with bipolar disorder can experience extended periods of stable mood. Medication, therapy, a strong support network, and other mental health resources can help you better manage your thoughts and achieve long-term stability.