Psychosis is loss of contact with reality. Psychosis in bipolar disorder is more common than many people might think.

Psychosis is a symptom, not an illness, and it’s more common than most people might think.

The National Institute of Mental Health (NIMH) reports that, in the United States, as many as 3 in 100 people will have an episode of psychosis at some point in their lives, and around 100,000 young people experience psychosis each year.

And, according to a 2000 study, more than half of people with bipolar disorder will experience psychosis at some point.

It’s surprising, then, that psychosis is often left out of the conversation when we’re talking about bipolar disorder.

Episodes of psychosis can be scary, but treatment is available. Knowing is a battle — the sooner you accept your psychosis, the sooner you can try to get treatment.

Bipolar disorder is characterized by extreme shifts in mood and energy levels. This often means experiencing highs, or episodes of mania, and lows, or episodes of depression.

But bipolar disorder affects us all differently. For example, some people experience mania or depression, but not both. And many people have bipolar disorder with additional specifiers, or different features that occur with bipolar disorder, such as anxiety or psychosis.

Psychosis is when your thoughts or experiences make it difficult to tell what is real and what isn’t. This often involves hallucinations or false beliefs, known as delusions.

Some people with bipolar disorder will have hallucinations or delusions during an extreme manic or depressive episode.

While mania can involve psychosis, hypomania — a milder form of mania — doesn’t involve psychosis.

Psychosis is when you find it difficult to tell the difference between what is real and what isn’t. It’s a complex state that involves your thoughts and your physical experiences of the world.

Psychosis presents itself differently from person to person. Every person’s experience is different, but most people find it frightening and confusing.

Symptoms of psychosis usually mirror your mood at the time, which is known as mood-congruent psychosis. When the symptoms don’t match the mood, this is mood-incongruent psychosis.

Psychosis may involve some of the following:


Many people have auditory hallucinations, such as hearing voices. Some people also see or smell things that aren’t there. You might also see objects change shape or move in an unusual way.

Hearing voices, which could be helpful or nasty, is common in psychosis.


Delusions are beliefs that feel completely real but that nobody else believes are true, or beliefs that your other perceptions show cannot be true.

For example, delusions of grandeur involve the feeling of being very important. Paranoid delusions involve feeling like someone is trying to control or harm you.

Disorganized thoughts or speech

This might feel like your thoughts are racing. You may move very quickly between ideas and speak quickly. Other people may not be able to keep up or understand your train of thought. This is also a symptom of mania.

Treatments are available that can make psychosis easier to live with. You may have to wait for medications to get in your system.

Types of medication that can help include:

As time goes on, your episodes can be few and far between, and you can start to see patterns. For examples, some people may start to notice that the features of psychosis get worse when they don’t get enough sleep.

When the symptoms get too hard to manage, you can call your psychiatric healthcare team to adjust your meds or schedule emergency counseling sessions.

Cognitive behavioral therapy (CBT), a form of talk therapy, helps a lot of people with psychiatric conditions. Many people — mental illness or not — can benefit from therapy.

The National Alliance on Mental Illness has chapters across the country where you can find resources and support.

Want to learn more? You can take a deep dive into bipolar disorder treatments here.

Most people equate schizophrenia or schizoaffective disorder with psychosis.

In schizophrenia, people may live without stability when they first receive their diagnosis. It can take a little time to get into the rhythm of treatment.

Schizophrenia is a mental health condition that involves psychosis, which can include hallucinations, delusions, and disordered thinking. Treatments can greatly improve its symptoms and reduce the likelihood of recurrences.

According to the American Psychiatric Association, schizophrenia affects less than 1% of the population.

Schizoaffective disorder involves a major mood episode — which could include depression or bipolar disorder — at the same time as schizophrenia.

Schizoaffective disorder is less common than schizophrenia, affecting around 0.3% of people in their lifetimes.

Other factors that can cause psychosis include:

If you have psychosis without a known cause, it’s highly advisable to talk with a doctor about your experiences. Finding out the cause is the first step toward finding a treatment that works for you.

Finding a community of people with similar experiences can help you feel more at ease and accept your psychosis. The sooner you accept your psychosis, the sooner you can try to get treatment and start to feel better.

The Depression and Bipolar Support Alliance (DBSA) group offers peer-to-peer support. Sometimes group therapy is helpful because you don’t feel so alone.

You might also find it useful to follow blogs devoted to bipolar disorder, and add some self-help strategies into your comprehensive treatment plan.