Key Takeaways
- About half of people with bipolar disorder will experience psychosis in their lifetimes. Psychosis refers to a break in reality in which people sense something that’s not there (hallucinations) or believe something that’s not true (delusions).
- Psychosis is more likely to occur in people with bipolar I disorder during manic episodes. Delusions appear to be more common than hallucinations among people with bipolar I.
- Treating psychosis can help people with bipolar disorder engage with other forms of mental healthcare. Therapy, self-management strategies, and medication can help address psychosis and other bipolar disorder symptoms.
Generally speaking, psychosis represents a disconnect from reality. It occurs when a person experiences hallucinations (sensing things that aren’t there) or delusions (having false beliefs). While it’s frequently associated with psychotic disorders like schizophrenia, psychosis can also occur in people with bipolar disorder.
This disconnect from reality is sometimes referred to as bipolar disorder psychosis, and research suggests that it’s relatively common. One study found that about half of people with bipolar disorder experienced psychosis in their lifetimes.
How psychosis symptoms appear in bipolar disorder
Bipolar disorder is a mental health condition characterized by intense mood swings. People with this condition experience periods of low mood called depressive episodes and periods of elevated mood called manic episodes.
Psychosis can occur during either depressive or manic episodes. But it’s more common during manic episodes. In addition, delusions appear to be more common than hallucinations with bipolar I.
During a manic episode, a person with bipolar disorder may experience:
- Increased irritability and agitation
- Significantly reduced need for sleep
- Impulsive or risky behavior
- Elevated mood or a feeling of invincibility
- Excess energy and fast speech
- Trouble with focus
- Racing thoughts
During this manic state, they may experience delusions or false beliefs, such as:
- “The government has installed a tracking system in my brain to read my thoughts.”
- “I’m being constantly followed by someone who’s trying to harm me.”
- “My favorite celebrity and I have a secret romantic relationship.”
- “I’m receiving classified information through the TV that only I can understand.”
- “I have magic abilities I can use to protect myself and others.”
Receiving a diagnosis
To determine whether a person is experiencing bipolar psychosis, their provider will conduct a thorough evaluation of their symptoms. Research suggests that psychosis is more likely to occur in bipolar type I compared to bipolar type II and in mania or mixed episodes compared to depressive episodes.
But, to be diagnosed with bipolar disorder with psychosis, you must meet the diagnostic criteria for bipolar disorder and be demonstrating psychotic symptoms at the same time.
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Comparing psychosis in other conditions
While psychosis can accompany bipolar disorder, it can also be a symptom of other mental health conditions. Hallucinations and delusions can occur in people with:
- Schizophrenia
- Schizoaffective disorder
- Autism spectrum disorder (ASD)
- Postpartum psychosis
- Post-traumatic stress disorder (PTSD)
Please note that while some mental health conditions (like psychotic disorders) are known to cause psychosis, we can’t establish the same connection between psychosis and other conditions. For example, people with autism can experience psychosis. But autism isn’t considered a stand-alone cause of psychosis, and psychosis isn’t an official symptom of autism.
Potential causes of bipolar disorder with psychosis
Experts are yet to understand why so many people with bipolar disorder experience psychosis. But it appears that psychosis may be more prevalent in people with more severe symptoms of bipolar disorder. These symptoms include frequent agitation, increased anxiety, and heightened hostility. People experiencing these symptoms may not recognize or understand the unusual nature of their thoughts and behaviors,
There’s also evidence to suggest that this presentation of bipolar disorder may run in families. So if you have a first-degree relative (like a parent or sibling) with bipolar psychosis, you may be at greater risk.
Can you recover from bipolar disorder and psychosis?
If you’re living with bipolar disorder and experiencing psychosis, know that help is available and you can manage your symptoms with the right support. Bipolar disorder is considered a chronic condition that typically requires ongoing care. But, for treatment to be effective, your provider will likely prioritize addressing active psychosis before introducing other forms of support.
Once a person achieves stability, they can begin bipolar disorder treatments like:
- Cognitive behavioral therapy (CBT): CBT can help you recognize unhealthy thoughts and learn new coping strategies. For example, if you’re having a manic episode and think, “I feel invincible. I don’t need to sleep!” CBT can help you challenge that thought and remember that rest is important.
- Self-management strategies: While not a replacement for professional help, learning about bipolar disorder, identifying your triggers, and maintaining your physical health can help you manage your symptoms.
- Medication: Various medications can help alleviate symptoms of bipolar disorder. You can talk to your provider about whether medication is right for you.
Finding the right providers is an important step toward helping you manage symptoms of psychosis. Whether it involves therapy, medication, or a combination of both, you can develop a plan that works for your lifestyle and helps you feel empowered.
Find care with Rula
During psychosis, a person may have hallucinations and/or delusions that represent a break from reality. While this experience is typically associated with psychotic disorders like schizophrenia, research shows that it also affects about half of people with bipolar disorder. Managing symptoms of psychosis and bipolar disorder can be challenging. But with the right support, people with bipolar psychosis can achieve stability, balance their mood, and improve their quality of life.
At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best.
Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.
About the author
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
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