How a Person with Bipolar Disorder Thinks: Cognitive Patterns

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Bipolar disorder is a complex mental health condition characterized by significant mood swings including episodes of depression and mania.

These changing states can affect thinking, judgment, and social behavior, leading to challenges in personal and professional relationships.

Understanding the inner workings of a person with bipolar disorder’s mind is intricate because each individual will have unique experiences. Yet, common patterns in thought processes have been observed.

Understanding Bipolar Disorder

Bipolar disorder

Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly.

People with bipolar disorder experience intense emotional states that occur in distinct periods called “mood episodes.” Each episode represents a drastic change from a person’s usual mood and behavior.

It is estimated that 82.9% of individuals with bipolar disorder experience serious impairment, which represents the highest rate of serious impairment among mood disorders.

Diagnosis and Types

To diagnose bipolar disorder, a doctor may conduct a physical examination, interview the patient, and order lab tests.

Psychiatrists typically use criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose the specific type of bipolar disorder.

Types of Bipolar DisorderDescription
Bipolar ICharacterized by manic episodes that last at least seven days, or manic symptoms severe enough to require immediate hospital care.

Depressive episodes occur as well and typically last for at least two weeks.
Bipolar IIInvolves a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I.
Cyclothymic Disorder (Cyclothymia)A milder form of bipolar disorder involving numerous periods of hypomanic symptoms as well as depressive symptoms lasting for at least two years (one year in children and adolescents).

Mood Episodes

EpisodeDescription
Manic EpisodeA manic episode is characterized by a period of at least one week where an elevated, expansive, or unusually irritable mood is present.

During this time, individuals may have high energy levels, talkativeness, reduced need for sleep, and demonstrate behaviors that are unusual for them, which might lead to significant distress or impairment.
Hypomanic EpisodeHypomania is similar to mania but less severe. It’s identified by an elevated mood for at least four consecutive days.

It’s distinguishable from mania by its lower intensity and the absence of psychosis.
Depressive EpisodeA depressive episode is marked by feelings of sadness, hopelessness, and a lack of interest or pleasure in activities.

These feelings last most of the day nearly every day during the episode, which must persist for at least two weeks.

Individuals with bipolar disorder may also experience a mixed state, where features of both mania and depression are present simultaneously.

It is crucial to dispel stereotypes and stigma associated with the disorder by fostering awareness and promoting accurate information.

Thought Patterns During a Manic Episode

Thought patterns during a manic episode

During a manic episode, individuals with bipolar disorder often experience distinct changes in their thinking and reasoning.

This section explores the characteristic thought patterns observed during such episodes.

Racing Thoughts

Racing thoughts describe the rapid succession of thoughts that individuals often cannot control during a manic episode. They may have difficulty focusing on one idea before another one intrudes.

Delusional Thinking

Individuals may engage in delusional thinking, marked by beliefs that are not grounded in reality. For example, they might believe they have special talents or have made significant discoveries.

Flight of Ideas

Flight of ideas is characterized by a person’s swiftly changing ideas and topics, making conversations difficult to follow. Links between ideas may make sense to the individual but appear disjointed to others.

Tangential Thinking

Tangential thinking involves abruptly changing the topic of conversation to something that might have a loose connection, often without completing the initial train of thought.

Circumstantial Thinking

With circumstantial thinking, an individual may provide excessive detail and stray from the main point, but they eventually return to the original topic, unlike in tangential thinking.

Paranoia

Paranoia can manifest as irrational distrust or suspicion towards others. Those experiencing a manic episode may incorrectly believe others are plotting against them or harboring ill intentions.

Thought Patterns During a Depressive Episode

Thought patterns during a depressive episode

During a depressive episode, a person with bipolar disorder may experience distorted thinking patterns that can contribute to their emotional pain.

These cognitive distortions can significantly affect their daily functioning and overall quality of life.

Rumination

Rumination involves obsessively thinking about the causes, meanings, and consequences of one’s depressive symptoms.

Individuals with bipolar disorder often find themselves in a cycle of negative reflection, which may perpetuate their depressive state.

All-or-nothing Thinking

In all-or-nothing thinking, individuals see situations in black or white, with no middle ground.

For example, they might believe that they must be perfect or they’re a total failure, ignoring any in-between states of achievement.

Catastrophizing

Catastrophizing is the tendency to expect disaster and to excessively worry about every small mistake being a sign of a catastrophic outcome.

People with bipolar disorder may predict the worst-case scenario for many situations during a depressive episode.

Disqualifying the Positives

Accomplishments or positive experiences are often dismissed with the disqualifying the positives distortion.

They might believe that their successes have no true value or that others could’ve done it better, thus maintaining a negative self-view.

Emotional Reasoning

Emotional reasoning

With emotional reasoning, individuals believe that if they feel something, it must be true.

If they feel worthless during a depressive episode, they might accept that feeling as a fact, rather than a symptom of their mood state.

Mind Reading

Mind reading is assuming that one knows what others are thinking, often negatively. They might believe that others see them as uninteresting or incompetent without any evidence to support these beliefs.

Overgeneralization

Through overgeneralization, a single negative event is viewed as a never-ending pattern of defeat. One failure or mistake might lead them to conclude that they will always fail.

Personalization

Personalization involves taking responsibility for external events that one has no control over.

People may blame themselves for negative events and believe they are directly responsible for the happiness of others.

Thoughts About Death and Suicide

Thoughts about death and suicide are significantly serious symptoms that can occur during depressive episodes.

These thoughts can range from a preoccupation with death to forming specific suicide plans, requiring immediate intervention.

Treatment Options

Therapy

Treatment options for bipolar disorder typically involve a combination approach that includes both medication and therapy. Each individual responds differently to these treatments, so a tailored plan is essential.

Medication

Medications such as lithium or valproate are fundamental in managing mood swings associated with bipolar disorder. They are often prescribed to reduce the highs and lows of the condition.

In some cases, when symptoms are severe, antipsychotics may be recommended to control episodes of mania or depression.

Therapy

In addition to medication, it is important to incorporate therapy into the treatment of bipolar disorder. Some therapeutic approaches used include:

  • Cognitive Behavioral Therapy: This form of therapy helps individuals recognize and change harmful patterns of thinking and behavior. A study highlights its effectiveness in treating bipolar disorder.
  • Psychoeducation: Teaching a person with bipolar disorder about their condition can empower them to manage their symptoms more effectively. It may involve learning about treatment strategies and how to recognize early signs of episodes.

How to Find a Therapist

When seeking a therapist for bipolar disorder, one should prioritize finding a specialist with experience in mood disorders.

Steps to Consider:

  1. Identify the Needs: A study shows individuals with bipolar disorder should consider therapists specialized in CBT due to the effectiveness of this approach.
  2. Research Qualified Therapists: Utilize therapist directories, such as Find-a-therapist.com, or online therapy platforms like BetterHelp for adults or Teen Counseling for teenagers.
  3. Verify Credentials: Ensure the therapist is licensed and has a track record with mood disorders.

Through this detailed approach, individuals can increase their chances of finding a competent therapist to support managing bipolar disorder effectively.

Conclusion

Thinking

Bipolar disorder impacts a person’s perception and experience of the world. Individuals diagnosed with bipolar disorder may have distinct cognitive patterns that influence their behavior and emotions.

The experiences of those with bipolar disorder can greatly influence their daily functioning and relationships with others, affecting not just the individual but also their family and friends.

Attention to cognitive patterns might lead to improved quality of life for those living with bipolar disorder and a deeper understanding of their loved ones.

References

Joyce, E., Tai, S., Gebbia, P., & Mansell, W. (2017). What are people’s experiences of a novel cognitive behavioural therapy for bipolar disorders? A qualitative investigation with participants on the TEAMS trial. Clinical Psychology & Psychotherapy24(3), 712-726. Link.

Mansell, W., & Jones, S. H. (2006). The Brief-HAPPI: A questionnaire to assess cognitions that distinguish between individuals with a diagnosis of bipolar disorder and non-clinical controls. Journal of Affective Disorders93(1-3), 29-34. Link.

Özdel, K., Ayşegül, K. A. R. T., & Türkçapar, M. H. (2021). Cognitive behavioral therapy in treatment of bipolar disorder. Archives of Neuropsychiatry58(Suppl 1), S66. Link.

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About the author

Eliana Galindo
Eliana is a dedicated psychologist from Colombia who has gained extensive experience and made significant contributions in child development, clinical psychology, and rehabilitation psychology. Her work as a rehabilitation psychologist with disabled children has been transformative and compassionate. In the child development field, she creates nurturing environments through assessments, interventions, and collaboration with families. In clinical psychology, she supports individuals overcoming mental health challenges with empathy and evidence-based approaches. Inspired by her experiences, Eliana is motivated to write about mental health, aiming to raise awareness and advocate for a compassionate and inclusive approach to well-being.

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