What Does the Term ‘High-Functioning’ Bipolar Disorder Mean?

Bipolar disorder is a mental health condition characterized by dramatic shifts in mood and energy levels. The mood episodes linked to bipolar disorder can make it difficult for the person to go about their day-to-day life.

However, some people with bipolar disorder are able to manage their symptoms and go about their day. Colloquially, this is referred to as ‘high-functioning’ bipolar disorder.

"People with ‘high-functioning’ bipolar disorder may not have mood episodes if they’ve found the right medication, or they may still have mood episodes and have learned the skills to manage them," says Dr. Daramus.

‘High-functioning’ bipolar disorder isn't an official clinical diagnosis; it’s just a way that people describe someone who has bipolar disorder and still lives their life with less interference from the symptoms than a lot of other people with the same diagnosis, explains Dr. Daramus.

This article discusses why this term can be stigmatizing and explores the symptoms, causes, and diagnosis of bipolar disorder, as well as some treatment options and coping strategies that may be helpful. Because the term 'high-functioning' is stigmatizing, this article will use the term "bipolar disorder with low support needs" moving forward (this excludes quotes from expert sources).

Why the Term Is Stigmatizing

The term ‘high-functioning’ has been gaining a lot of popularity; however, it has problematic implications.

While some people with bipolar disorder may genuinely have mild symptoms and be able to function on a daily basis without much interference from their symptoms, there are others who may have severe symptoms and experience severe functional impairment as a result.

People Who Have High-Support Needs May Feel Pressured to Hide Their Symptoms

According to the National Institute on Mental Health, while 17.1% of people with bipolar disorder have moderate symptoms, 82.9% have severe symptoms and experience severe functional impairment. These people may face pressure to hide their symptoms despite having severe symptoms of bipolar disorder.

People With Low-Support Needs May Not Be Taken Seriously

Additionally, the colloquial term can also make it seem like the symptoms of the condition are less severe than they actually are.

As a result, the person may be more likely to dismiss their symptoms instead of getting help and treatment. Others may also fail to take the person’s symptoms seriously, since the person may outwardly appear to be “fine” or “normal.”

This can be dangerous to the person and their loved ones. For instance, someone with bipolar disorder may be more likely to engage in risky behavior during a manic episode and may be at risk for suicide during a depressive episode.

Symptoms of Bipolar Disorder

People with bipolar disorder may experience different sets of symptoms depending on the type of episode they are experiencing. The different types of episodes include:

• Manic episodes: These episodes are characterized by extreme energy and a sense of elation.
• Hypomanic episodes: These episodes are milder versions of manic episodes.
• Depressive episodes: These episodes are characterized by feelings of sadness or emotional numbness.
• Mixed episodes: During these episodes, the person may have symptoms of mania and depression.
  

Manic Symptoms

These are some of the symptoms of mania:

• Feeling up, elated, or high
• Talking very fast about many different things
• Experiencing racing thoughts
• Wanting to do a lot of things at once
• Exercising poor judgment
• Engaging in risky behaviors
• Feeling touchy or irritable
• Believing they are exceptionally talented or powerful
• Having a reduced need for sleep
• Experiencing a loss of appetite

Depressive Symptoms

These are some of the symptoms of a depressive episode:

• Feeling sad, hopeless, or worthless
• Feeling empty or numb
• Feeling restless or worried
• Talking and moving slowly
• Feeling like there’s nothing to say
• Forgetting things often
• Having difficulty focusing or making decisions
• Feeling unable to do simple tasks
• Losing interest in everything
• Having difficulty sleeping or sleeping too much
• Experiencing changes in appetite and weight
• Thinking about death or suicide
  

Causes of Bipolar Disorder

While there isn’t a single, straightforward cause of bipolar disorder, there are many contributing risk factors that play a role, including:

• Genetics: Bipolar disorder is often, but not always, genetic, says Dr. Daramus. It runs in families, so a child may be more likely to develop it if their parents or siblings have it.
• Stress: Stressful or traumatic events such as the death of a loved one, an accident, a serious health condition, a divorce, or financial difficulties can trigger mood episodes. 
• Environmental factors: Living in a high-conflict home with volatile relationships can directly influence mood episodes, says Dr. Daramus.
• Brain structure: People with bipolar disorder have minor differences in the size, structure, and function of certain parts of their brains.
• Natural rhythms: Individual mood episodes can be influenced by circadian rhythms and factors such as sleep, seasons, and sunlight levels, says Dr. Daramus. 

Diagnosing Bipolar Disorder

The diagnostic process for bipolar disorder may involve:

• A detailed interview that covers the person’s medical history and symptoms
• A physical examination and lab tests can help rule out other health conditions that cause similar symptoms

The person’s healthcare provider will determine whether their symptoms meet the criteria listed for bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Based on their symptoms, Dr. Daramus explains that the person might be diagnosed with:

• Bipolar 1 Disorder, if they’ve experienced depressive episodes and one or more manic episodes
• Bipolar 2 Disorder, if they’ve experienced depressive episodes and one or more hypomanic episodes

Bipolar Disorder Treatment

Bipolar disorder can be managed with treatment. According to Dr. Daramus, treatment may involve:

• Medication: Most people take medications called mood stabilizers, to help prevent and manage mood episodes. Anticonvulsants (seizure medications) and antidepressants can also be helpful to people with bipolar disorder, but antidepressants need to be taken along with a mood stabilizer, as they can cause manic episodes if taken alone.
• Therapy: Therapy is a helpful way to learn coping skills, manage conflict, and build a support system. Therapy also provides professional support in recognizing and managing episodes. Some people with low-support needs bipolar disorder might be able to manage without medication; while they may still have mood episodes, using coping skills may be sufficient.

Coping With Bipolar Disorder

Dr. Daramus shares some tips that can help you cope with bipolar disorder and be more functional:

• Take your medication regularly: It’s important to take your medication regularly as prescribed by your healthcare provider. Let them know if you’re experiencing any side effects. Don’t stop taking the medicine without consulting your healthcare provider first, even if you feel fine.
• Maintain a regular sleep schedule: Aside from medication, maintaining a regular sleep pattern is one of the best ways to manage bipolar disorder.
• Avoid conflict: Being in a low-conflict environment with healthy, supportive relationships is critical for symptom management.
• Try using sunlight lamps: If you live in a place without much sunlight or where the sun sets early, try using a sunlight lamp. Some people with seasonal depression or bipolar disorder find them helpful.
• Channel your energy productively: During an episode of mania or hypomania, it’s helpful to have a healthy way to use up your energy. Channel your energy toward productive outlets such as exercise, work, or personal projects.
• Ask a loved one to help curb your impulses: In a manic episode, you’ll need someone who can help you channel all of that energy. A lot of people overspend and end up in debt, so you might need someone to manage the money or take away your credit cards.
• Find creative outlets: During depressive episodes, some people like having a creative outlet for their feelings. You can try different things such as art, crafts, and music, and see what you enjoy most. It can also be helpful to put together playlists with songs that can help you manage your moods.
• Make sure you eat: You may not have an appetite during a depressive episode; stock up on healthy snacks or protein bars that take little effort to eat.
• Have someone check on you: During a depressive episode, you definitely need people to check in on you and let you know you’re cared about.

Keep in Mind

Being able to manage bipolar disorder is commendable. However, hiding the condition or dismissing it in order to hide symptoms can be harmful. In addition to helping with the symptoms of the condition, treatment can help you explore the reasons why you're not comfortable acknowledging your condition.