Mental health conditions are anything but straightforward. Not only are there more than 200 diagnosable mental health conditions as defined by the DSM-5, but many of them can be co-occurring or have features of one as a symptom for another. In this case, we’re talking about bipolar disorder with features of psychosis.

People with bipolar disorder don’t always experience psychosis. On the other side, psychosis can develop for a variety of reasons, from schizophrenia to substance use. However, if you have a primary diagnosis of bipolar disorder, you may not know what psychosis symptoms look or feel like, which can lead to a lack of proper treatment.

If psychotic symptoms occur exclusively during mood episodes, they may lead to a diagnosis of bipolar disorder with psychotic features. If psychosis appears outside of mood episodes, that may be more consistent with schizoaffective disorder.

Read on to learn about what it means to have bipolar disorder with features of psychosis. We’ll also discuss treatment that may help through Lightfully levels of care.

What it means to have bipolar disorder with features of psychosis

Bipolar disorder is a mood disorder characterized by unusual mood and energy changes. It can affect your productivity and relationships if left untreated. It involves experiencing changes in emotional, mental and behavioral patterns as you shift between manic and depressive episodes. Manic episodes cause heightened energy and irritability. Depressive episodes can cause overwhelming feelings of sadness and fatigue.

Bipolar disorder can look different for everyone. It can vary in levels of severity, triggers and duration of episodes. While not everyone experiences psychosis with bipolar disorder, a study showed that it was prevalent in more than half of the participants who had been diagnosed with the mood disorder. Psychosis is more common in bipolar 1 than bipolar 2, as bipolar 2 has less severe symptoms. Psychosis symptoms are also much more likely to develop in manic or mixed episodes, with 20% or fewer participants experiencing psychosis during depressive episodes. 

Psychosis refers to a set of symptoms that can make a person feel out of touch with reality and have false perceptions. While the emotions and behaviors may be recognizable by other people, a person experiencing psychosis is often unaware that anything is unusual.

Here’s what psychosis can look and feel like during a bipolar disorder episode:

• Delusions — Psychosis can cause you to develop false beliefs that go against reality, even with proof. Delusions often center around how you see yourself and how you believe others see you. For example, you may think that someone is infatuated with you due to an inflated sense of self-importance. It can also make you think that you have special powers. Other common types of delusions can make you believe that someone has set out to harm you or that a catastrophe is going to occur soon.
• Hallucinations — While delusions are about beliefs that aren’t real, hallucinations refer to sensing things that aren’t real. This means seeing, hearing, smelling, tasting or feeling things that don’t exist. There are examples for every sense, but auditory hallucinations are the most common. This can mean that you believe you hear someone talking to you or that you hear a suspicious sound that hasn’t actually been made. 
• Disordered thinking — When you’re experiencing psychosis during a bipolar disorder episode, it can interfere with your thought patterns. It can lead to irrational or unusual thoughts that aren’t based on logic or that you’re unable to communicate in a clear, comprehensible manner. You may have a difficult time concentrating or you may lose your train of thought as you speak, as disordered thinking often causes racing thoughts.
• Lack of self-care and hygiene — Psychosis during a bipolar disorder can interfere with your motivation to carry out self-care and hygiene routines. This can include not showering on a regular basis, not brushing your teeth or not wearing deodorant. It also means that you may be taking less pride in how you care for yourself, such as eating a balanced diet.

Severe psychosis symptoms during a bipolar episode can put yourself or others at risk, as hallucinations and delusions may lead to suicidal ideation or violence. If you need help, call or text the 988 Suicide & Crisis Lifeline by dialing 988.

Lightfully can help you manage bipolar disorder with features of psychosis

If you’ve been diagnosed with bipolar disorder, your health care provider will determine the best treatment options to help you reduce the severity and frequency of your episodes. If you’re experiencing psychosis during a majority of your episodes, they may adjust your treatment plan, such as adding an antipsychotic medication. Common medication classes used in bipolar with psychotic features include mood stabilizers, atypical antipsychotics and sometimes antidepressants.

If your bipolar disorder with psychosis symptoms needs further support, our Lightfully four levels of care can help you move along your mental health journey:

• Residential Treatment 
• Partial Hospitalization Program
• Intensive Outpatient Program
• Virtual Intensive Outpatient Program 

Change is possible. When you’re ready to take the first step, reach out to our Admissions Concierge Team. We’ll take the next steps together, toward the fullest, brightest version of you.