What Everyone Needs to Know About Bipolar Disorder

Nine years ago, Julie Kraft’s doctor uttered the words, “you have bipolar II disorder.” Immediately, images of unhinged film characters, sensationalist tabloid headlines and shocking news stories flooded her mind.

All these things are now associated with me, she thought.

Kraft felt embarrassed, ashamed, sad—and afraid. “I was fearful of being judged, backed away from, viewed as unsafe, unpredictable, unstable, an unreliable friend, an irresponsible mom, a moody wife, a woman of weak character, and the list goes on and on.”

It’s an understandable reaction because even though bipolar disorder is common—about 5.7 million American adults have it—myths and stereotypes still persist.

To cut through the caricatures and misconceptions, we asked several individuals who have bipolar disorder and a clinician who specializes in treating the illness to share what they think everyone needs to know. Here’s what they said:

Bipolar disorder is complex and varies from person to person.

For starters, there are three types of bipolar disorder: bipolar I, bipolar II and cyclothymia. The hallmark symptom of bipolar I disorder is mania; many people also experience depression (but it’s not required for the diagnosis). Mania features hyperactivity, euphoria, disorganization, decreased need for sleep, impulsivity, impaired judgment, irritability, racing thoughts and speech, said Deborah Serani, PsyD, a psychologist in private practice in New York, and professor at Adelphi University.

Mania also can include hypersexuality, grandiose beliefs, delusions and paranoia, she said. For instance, before getting treatment, Tosha Maaks, a mental health advocate, speaker and frequent contributor to Psych Central, had an overwhelming sense of being judged. All. The. Time. Whenever she’d walk into a room and see two people start laughing, Maaks was convinced they were laughing and talking about her.

Bipolar II disorder is believed to be less intense than bipolar I because it includes hypomania, instead of mania. And mania is known for sparking devastating, dramatic consequences, such as empty bank accounts and shattered relationships. However, bipolar II isn’t some softer version. It’s just different. Consequences of hypomania can be painful, too, and the depressive episodes can be very severe, even suicidal. (You can learn more about bipolar II disorder in this Psych Central piece.)

Individuals also might have mixed states, which means they experience mania or hypomania and depression at the same time, Serani said. Which means they may feel deeply sad or hopeless while feeling extremely energized, she said.

Some people with bipolar disorder experience rapid cycling: “episodes of mood elevation and depression followed by another cycle of mood elevation and depression four or more times per year.” For some, this cycling can happen weekly or even hourly, Serani said.

Cyclothymia features bouts of low-grade depression and hypomania, and the symptoms can be so subtle that people don’t even realize they’re struggling with a chronic illness. It also can batter relationships and, if left untreated, can progress into bipolar disorder.

In other words, bipolar disorder ranges widely in symptoms and severity—and it can vary widely within the same person. As Shaley Hoogendoorn told me for this piece, how her bipolar II feels really “depends on the day, month or season.” She noted it was really hard for her to get anyone to believe that she was struggling because she’s considered “high functioning.”

Bipolar disorder is highly treatable.

Bipolar disorder is a serious illness, but thankfully it’s one that can be successfully treated, and individuals can live fulfilling, meaningful, healthy lives.

“After accepting my diagnosis and creating a plan for personal healthy living, I have lived in recovery for more than 25 years,” said Charita Cole Brown, author of the book Defying the Verdict: My Bipolar Life. Her personal healthy living plan includes taking medication, eating nutrient-rich foods, exercising, seeking peace, resting in God, having accountability partners and paying close attention to her mood fluctuations.

Maaks also wants readers to know that a diagnosis of bipolar disorder isn’t a death sentence. “I live my life to the fullest doing everything I can to live up to my potential each day,” she said. Even though she can’t work in a “normal work environment,” she leads a wonderful life with her husband, and four well-rounded, happy kids.

The key with treatment is to know yourself. For example, Maaks has become especially mindful of her triggers, and how much stress she can handle. She knows her limits and honors them. “[I know] when to say no to the things I can’t handle and when I need to rest to prevent an episode from happening. I must be OK sometimes with just doing a little bit of something.”

The other key is to actually stick with treatment. Serani noted that research shows that about 50 percent of people with bipolar disorder abandon treatment, which exacerbates the illness. It’s not easy, but systems can help. Serani gave these examples: having your medication mailed every month; keeping medicine in a pill-box or pill key so if you forget a dose, you have a backup; using a smartphone alarm or pill-box with a timer for your medication; prepaying for therapy sessions; and asking supportive loved ones for help.

Everyone with bipolar disorder shouldn’t be lumped into the same category.

The stereotypes about people with bipolar disorder are endless: They can’t maintain healthy, long-term relationships. They’re selfish and have one-sided friendships where they just take, take and take. They shouldn’t have kids—and if they do, they’re probably subpar parents.

Yes, some people with bipolar disorder have trouble having healthy relationships. Yes, some people with bipolar disorder are self-centered, and some aren’t great parents. But these qualities and challenges are not universal. And they are not inherent to the illness. We assume they are because “the only stories, faces, cases that are headline-worthy and leave a lasting impression are the absolute extremes, the shocking ones,” said Kraft, an artist and author of The Other Side of Me: Memoir of a Bipolar Mind.

She underscored the importance of not lumping all people with bipolar disorder together. We understand this intellectually. Of course, every single person on this planet is different. Of course, we can’t make sweeping judgments about people who share the same illness. People with diabetes, arthritis and asthma are not the same. And yet when it comes to mental illness, that’s exactly what we do.

Like Maaks, Kraft is happily married (for 23 years) with kids. She believes that “it’s absolutely possible to have bipolar disorder and be an amazing mom or dad…If we’re willing to take responsibility for our mental health, commit to a treatment plan, and always try our best, then I think we’re definitely in the running for parent-of-the-year award.”

In fact, Kraft believes that having bipolar disorder has made her a better parent. “It has made me hyper-aware of my words, thoughts, actions, and state of well-being. I am constantly asking myself if, ‘Am I doing everything possible to stay well for my family?’ My children make me want to do better and be better—they deserve nothing less.” Plus, her illness has led her to teach her children invaluable lessons: “the importance of authenticity, vulnerability and perseverance in the face of adversity.”

Kraft also noted that her “fellow mental health warriors defy every myth and stereotype out there and their journeys prove it.” She suggested reading psychologist David Susman’s blog series “Stories of Hope,” which features stories from individuals with mental illness. In particular, Kraft has been inspired by advocates Hannah Blum, Suzy Favor Hamilton and Rudy Caseres.

Brown believes that we should view bipolar disorder like we view diabetes or cancer, because it is “a brain-based, physical disease.”

And we should offer individuals the same compassion, as Therese Borchard writes in her powerful piece. Borchard writes about depression, but this is true for bipolar disorder, too: “I believe the best thing you can do for a person who suffers from depression is to believe her.”

And the best thing we can do for people with any mental illness is to acknowledge that mental illness is hard and we can make it a whole lot easier if we don’t buy into the stereotypes, and we don’t perpetuate the stigma.

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