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Bipolar disorder: a guide to understanding the symptoms

what symptoms of bipolar disorder
  • Published: 4 Apr 2025

Bipolar disorder is defined as a set of symptoms and clinical conditions that can vary in severity, affecting more than 1% of the population1. Bipolar disorder can lead to cognitive impairment and affect a person’s daily functioning1. It is one of the leading causes of disability and is also linked to increased mortality, mainly due to the increased risk of suicide and cardiovascular disease1. As is the case with other mental health disorders, many people with bipolar disorder experience social stigma2.

 

What is bipolar disorder?

What is bipolar disorder and what are the symptoms? Bipolar disorder is a mood disorder3 characterised by extreme mood swings, which can fluctuate from very high (mania or hypomania) to very low (depression)4. The disorder can be chronic (persistent and recurring constantly), or episodic, meaning that it occurs occasionally and at regular intervals5. Regardless of how often it occurs, this condition does not resolve by itself and generally requires constant treatment throughout a person’s lifetime5.

The fifth edition of the  defines several forms of bipolar disorder6:

 

  • Bipolar I disorder
    In this form there are manic episodes, defined as episodes lasting at least seven days, with symptoms present for most of the day, nearly every day, or episodes so severe that they require hospitalisation5. Depressive episodes can also be present , sometimes in rapid succession, usually lasting at least two weeks5.
  • Bipolar II disorder
    Again, episodes of depression and hypomania occur, but the hypomanic symptoms are less severe than manic episodes in bipolar I disorder.5
  • Cyclothymic disorder (Cyclothymia)
    Cyclothymic disorder is a form of bipolar disorder involving milder or shorter depressive and hypomanic symptoms for a period of at least two-years (1 year in children and adolescents),  and therefore do not meet the criteria for classification as depressive and hypomanic episodes . As it is a milder form, it often gets overlooked, goes undiagnosed or is not properly treated7.
  • Other types
    Other forms of bipolar disorder can be caused by use of certain substances or medication, or by other medical conditions, such as multiple sclerosis3.

 

What are the symptoms of bipolar disorder?

The symptoms of bipolar disorder include manic episodes and can include depressive episodes .

At least three of the following symptoms are present during manic episodes 3:

  • increase in daily activities;
  • grandiosity;
  • diminished need for sleep;
  • racing thoughts, distractibility;
  • talkativeness and rapid speech;
  • increased risk-taking.

Major depressive episodes are so defined when at least five of the following nine symptoms are involved over a period of at least two weeks 3:

  • sad mood;
  • Insomnia;
  • feelings of guilt;
  • low energy;
  • poor concentration;
  • decreased appetite;
  • decreased interest in pleasurable activities (anhedonia) or psychomotor activity;
  • recurrent thoughts of suicide, or suicide attempts or acts of self-harm.

Recognising hypomania

Hypomania is a milder form of mania, which leads to less functional impairment, but should not be underestimated3. It is defined as at least four consecutive days of elevated mood with at least three of the symptoms mentioned, or irritable mood with at least four symptoms3.

 

Importance of early diagnosis and treatment

Early diagnosis and treatment of people at risk or with early symptoms can improve the course of the illness and prevent long-term negative consequences9. Diagnosis is based entirely on the interview with the patient, therefore it is important that it is as accurate as possible1. The right treatment can improve quality of life for people, enabling them to lead meaningful lives.2

Bipolar disorders can be hard to recognise, especially in the milder forms, which is why people should not hesitate to seek help at the first signs of symptoms.

 

  1. Vieta E., Berk M., Schulze T. et al., “Bipolar disorders”. Nature Reviews Disease Primers4, 18008 (2018). https://doi.org/10.1038/nrdp.2018.8
  2. World Health Organization (WHO), “Bipolar disorder”, 8 July 2024
  3. Sekhon S., Gupta V., “Mood Disorder”. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558911/https://www.ncbi.nlm.nih.gov/books/NBK558911/
  4. National Health Service (NHS, Uk), “Bipolar disorder”, 28 October 2024
  5. National Institute of Mental Health (NIMH-NIH, Usa), “Bipolar disorder”, 2025
  6. Diagnostic and Statistical Manual of Mental Disorder, Fifth Editrion, Text Revision (DSM-5-TR) (© Raffaello Cortina Editore su Licenza di American Psychiatric Association)
  7. NHS, “Cyclothymia”, 9 October 2023
  8. Yang S., Wichser L. “Manic episode in patient with bipolar disorder and recent multiple sclerosis diagnosis: A case report”. Medicine 99(42):p e22823, October 16, 2020. | DOI: 10.1097/MD.0000000000022823, https://pmc.ncbi.nlm.nih.gov/articles/PMC7571873/
  9. Martini J., Leopold K., Pfeiffer S., Berndt C., Boehme A., Roessner V., Fusar-Poli P., Young A.H., Correll C.U., Bauer M., Pfennig A., “Early detection of bipolar disorders and treatment recommendations for help-seeking adolescents and young adults: Findings of the Early Detection and Intervention Center Dresden”. Int J Bipolar Disord. 2021 Jul 2;9(1):23. doi: 10.1186/s40345-021-00227-3. PMID: 34215910; PMCID: PMC8253866. https://pmc.ncbi.nlm.nih.gov/articles/PMC8253866/
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