If you have bipolar disorder, you may experience delusions that make it challenging to know what’s real. Treatment through meds and therapy can help.

Bipolar disorder is a mental health condition characterized by fluctuations in mood. Approximately half of all individuals with bipolar disorder experience symptoms of psychosis, according to a 2021 study out of India.

If you’ve been diagnosed with bipolar disorder and experience symptoms of psychosis, you may feel overwhelmed and have trouble distinguishing reality from a hallucination or delusion. Delusions are pervasive, and rigidly held false beliefs or ideas about reality despite having evidence to the contrary.

Delusions occur in many mental health conditions, including:

  • schizophrenia
  • schizoaffective disorder
  • bipolar disorder

Research indicates that psychosis occurs in up to 60% of individuals diagnosed with bipolar disorder.

The same research suggests that the most common types of delusions present in people experiencing mania are:

  • delusions of grandeur (a superlative and inflated self-concept e.g., you’re the most desirable and best at nearly everything)
  • delusions of reference (a belief that “all roads point to you”)
  • persecutory fallacies (believing one or more people or institutions are “out to get you”)
  • somatic delusion (a conviction something biologically, physically, or medically wrong with you) is less common
  • erotomanic delusions (a belief that a particular person is in love with you) is less common

Cotard delusion is also possible with bipolar disorder.

Examples of bipolar disorder delusions

  • Grandiose delusions: “I’m a famous actress.”
  • Referential delusions: “Did you know that band wrote that song for me?”
  • Persecutory delusions: “My neighbor is spying on me and going to attack me.”
  • Somatic delusions: “There are bugs laying eggs inside my skin.”
  • Erotomanic delusions: “My boss is in love with me.”
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How long do bipolar delusions last?

The duration of bipolar delusions may be dependent on the individual’s current mood episode. For example, delusions are common in manic episodes. According to 2021 research, manic episodes could continue from 4-13 months if not treated.

If you’re receiving treatment for bipolar disorder, mania can last anywhere from 4 days to 3 months. Delusions can also appear during depressive episodes. Depressive episodes in bipolar disorder generally last at least 2 weeks and can last up to several months.

Psychosis in bipolar disorder takes two forms:

  1. mood-congruent (delusions or hallucinations align with your present mood)
  2. mood-incongruent (delusions or hallucinations don’t match up with your present mood)

Research is conflicting about whether mood-congruent or mood-incongruent features are associated with the intensity of the type of bipolar disorder.

For example, a 2021 study that examined features of psychosis in 92 bipolar patients found that mood-congruent features of psychosis were associated with a more severe course of illness.

Older longitudinal research found that those with bipolar disorder I that had mood-incongruent symptoms often required treatment at a younger age and found it was associated with greater severity of the condition.

Psychosis may also look like:

  • anxiety
  • bizarre or odd statements
  • difficulty communicating
  • disorganized thinking
  • emotional responses that don’t match the environmental context (e.g., manic laughter)
  • problems at work or school
  • suicidal thoughts
  • trouble distinguishing reality

If you experience psychosis, others may notice it before you do since you believe that what you’re experiencing is real.

Bipolar delusions and delusional disorder are similar but different. With bipolar disorder psychosis, the person experiences delusions within the context of the mood episodes related to their type of bipolar disorder. Mood episodes can include:

With delusional disorder, the person has experiences that are likely to occur in real life but are not true. Delusional disorder is rare, with studies estimating that it’s experienced in 0.05% to 0.1% of the population.

In delusional disorder, the delusion must be present for at least one month and does not occur due to a medical condition or another type of mental health condition. Many people with delusional disorder do not experience a disruption in their life, (functioning) outside the delusional episode(s).

Treatment options for bipolar psychosis are typically a combination of medication and psychotherapy.

Medications used to treat symptoms of bipolar disorder psychosis are:

These types of medications are known as antipsychotics. Because of the long-term side effects of taking these medications, it’s important to talk with a healthcare professional about your history and ask questions before starting antipsychotic medication.

Psychotherapy may also help reduce symptoms associated with bipolar disorder. Some common types of psychotherapy used to treat bipolar disorder include:

Research from 2017 indicates that CBT was effective at improving symptoms of depression and reducing the intensity of manic symptoms.

Family-focused therapy works on improving personal relationships and increasing family support. Older research on FFT found that individuals who underwent family-focused therapy compared to individual treatment were less likely to be hospitalized over 2 years.

Psychoeducation focuses on several factors such as:

  • understanding bipolar disorder
  • recognizing the symptoms of bipolar disorder
  • medication management
  • strategies for coping with bipolar bipolar disorder symptoms

Research from 2019 indicates that psychoeducation is effective as a maintenance treatment for bipolar disorder.

Bipolar delusions are a part of psychosis, which involves losing contact with reality.

Bipolar disorder delusions occur in both manic and depressive mood episodes and are typical in individuals with bipolar disorder. While there are various types of delusions, grandiose delusions are the most common among bipolar delusions.

Seeking and sticking to treatment can drastically reduce symptoms associated with bipolar disorder psychosis. You may try antipsychotic medication and psychotherapy together to improve your overall well-being.

If you need help locating a mental health professional, you can use this Findcare tool. You may also consider joining a peer support group at NAMI.

If you or someone you know is considering suicide or self-harm, you can:

You aren’t alone, and treatment can help.