Bipolar decision making

Making Decisions with Bipolar Disorder

Making Decisions with Bipolar Disorder
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By LaRae LaBouff on November 22, 2016

One of the critical thinking skills that can be affected by bipolar disorder is decision making. This goes along with other aspects of cognitive functioning such as memory, attention, some motor skills and social skills. People are affected in different ways and to different extents depending on the severity of the disorder. Decision making in people with bipolar disorder also depends on whether the person is manic, depressed or between episodes.

Decision making has a great deal to do with impulsive behavior. One of the criteria for a manic episode is that the person is that the person engages in risky behavior. This can be anything from gambling or money spendingto sexual behavior. Again, the extent of the behavior depends on the person and the severity of the disorder, but impulsivity is generally present in some form across all phases of bipolar disorder, including between episodes.

Making a decision is a fight between logic and emotion. Logic requires significant amounts of energy and thoughtfulness. It takes time. There are generally seven steps in making any decision.

  1. Identify exactly what the decision entails and the desired end goal.
  2. Gather relevant information.
  3. Examine the options available using both logic and emotion.
  4. Weigh each alternative option based on the best way to reach the end goal.
  5. Make a decision based on the best option.
  6. Turn the decision into action.
  7. Evaluate that decision and its consequences.

During mania, action is often the end goal.Another symptom of mania is racing thoughts. When the mind is moving quickly, stopping to think hard about a decision can be incredibly difficult. People may not consider the consequences of their actions, which can lead to poor decision making. There is a sense of urgency, a driving need to act immediately based on impulse, not on logic.

During depression, its about the lack of planning.Hopelessness is a large part of depression. Without hope, there can be a lack of a sense of the future. It feels like depression is all that has existed and all that will exist. Its tiring. Fatigue weighs on the mind and body. In this state, there is little energy left to think and plan ahead, so decisions are made in the now, without forethought. This combination of hopelessness and impulsivity increases the risk for suicide.

During euthymia, it doesnt go away.Euthymia is the state between episodes. Its a misconception that between manic or depressive states, people with bipolar disorder are symptom-free. Cognitive function can still be affected and patients may have mild symptoms. Again, it depends on the person how severe this is. People with more advanced bipolar disorder will have more problems between episodes, as will people who do not follow treatment plans. Poor decision-making can be a part of this problem.

For people with bipolar disorder, good decision making can be especially difficult. It is up to the patient to attempt to keep it in check, but a strong support system of doctors, friends and relatives should also be in place to help out in hard times.

You can follow me on Twitter @LaRaeRLaBouff or find me on Facebook.

Image credit:totemisottapa


By LaRae LaBouff on November 22, 2016

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How I Avoid Bad Decision-Making in Bipolar’s Gray Areas

Post Views: 19,710


Especially as a mom, I can’t let bipolar’s sporadic “judgment blackouts” get the best of me! Now I

always follow these 3 steps for making smart choices—regardless of mood.

Whether it has caused financial trouble, broken relationships, or just fifty shades of red on our faces, I think it’s safe to say that all of us with bipolar have had our periods of poor judgment. And although we certainly can’t blame every wrong move we’ve made on the disorder, with bipolar it’s easy to go beyond the occasional misdirected flight-of-fancy and jump right into “bipolar-bad-decision mode.”

Different Strokes for Different Folks

It’s natural to put tons of thought into our big decisions about jobs, health, and relationships. It’s also natural to make quick decisions about mundane, repetitive, and inconsequential moves. But somewhere between “Should I move across the country?” and “Should I wear the brown or the dark brown shoes today?” is the gray area where we do most of our living. And for those of us with bipolar disorder, I think we benefit by putting extra thought into the midlevel decisions that fall between the big ones and the small ones.

As a parent of young children, I feel a great responsibility to make good decisions at every turn. And as a person with bipolar, I anticipate sporadic judgment blackouts. If I want to do right by my family then I have to make myself make time to find the right moves. So, if I find myself getting excited about something, I wave a white flag and surrender to the swirl of ideas in my mind. I see this as a way of being mindful of my fluctuating brain chemistry. When I pause to give myself the extra time to think, I’m able to sift through the muck of (hypo)manic ideas and find the moves that actually suit me—and avoid outcomes that are too stressful, embarrassing, or destructive.

So, I’d like to share my standard operating procedure for measuring the authenticity of my ideas before I move forward with them. I run through these steps before I greenlight much of anything. I’m guessing that my SOP may seem overly analytical to some people, but what can I say? … I’m a mom.

3 Steps to Avoid Bipolar-Inspired Bad Decisions:

  1. Brainstorm the potential obstacles and outcomes involved with this decision. Then consider that there are probably some things you haven’t thought of yet. Try to think of what those may be.
  2. Fast-forward into the future and imagine how “future you” will feel after all is said and done with these outcomes.
  3. Ask yourself: Is the desired outcome worth the time and/or effort?

Stop and Smell the Roses

Some questions I may or may not have put through this process are: “Should I purchase this Georgia O’Keeffe original?” Or “Should I fly with three young kids out of the country for a weekend getaway?” Or “Should I go see this new horror movie that everyone is talking about?” (Spoiler alert: these are all NOs)

More often than not, I stop after considering step #1. Just knowing that I’ve chosen not to do several things because of this one extra step has helped me gain confidence in my process and judgment. It helps me find the moves that are most authentic to ME—and weed out the ones that may be simply bipolar-driven.

Painting by Numbers

Thinking through a step-by-step process seems simple enough, right? The problem is that bipolar (hypo)mania can make it very difficult to slow down thoughts long enough to practice mindfulness. That’s why I try to make this review process standard—even if it means I’m overthinking some things a bit.

Putting in this extra thought also helps during the times when I’m blue—because it can seem impossible to find motivation to do the things I should do. When I’m feeling that way, step #2 comes in especially handy; I know that “future me” will feel normal again. That makes it easier for me to remain semi-engaged, rather than full-on retreating into isolation and depression. I try to take care of “future me” as much as possible.

Let’s not allow bipolar-induced bad judgment to color our lives with broad strokes of regret, difficulty, and anxiety. In my journey with this disorder, I’ve learned that an ounce of mindfulness is worth a pound of damage control. It’s easy to get distracted from our goals; but if we pause more often to consider more moves in the grey area more carefully, we can stay on track and show our true colors!


I Can See Clearly Now by Jimmy Cliff
Doo-Wop by Lauryn Hill
Poison by BB
Slow Down by Bobby Valentino
True Colors by Cindi Lauper
*Ever get a song stuck in your head? Well, I often get bombarded with them when I’m writing—so, these are my musical muses for the post.

family, grandiose thinking, hypomania, wellness plan

About the author

Bipolar Disorder | Symptoms, complications, diagnosis and treatment

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Episodes of mood swings may occur infrequently or several times a year.

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When the mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, alertness, judgment, behavior, and the ability to think clearly.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medication and psychological counseling (psychotherapy).


There are several types of bipolar and related disorders. They may include mania, hypomania, and depression. The symptoms can lead to unpredictable changes in mood and behavior, leading to significant stress and difficulty in life.

  • Bipolar disorder I. You have had at least one manic episode, which may be preceded or accompanied by hypomanic or major depressive episodes. In some cases, mania can cause a break with reality (psychosis).
  • Bipolar disorder II. You have had at least one major depressive episode and at least one hypomanic episode, but never had a manic episode.
  • Cyclothymic disorder. You have had at least two years - or one year in children and adolescents - many periods of hypomanic symptoms and periods of depressive symptoms (though less severe than major depression).
  • Other types. These include, for example, bipolar and related disorders caused by certain drugs or alcohol, or due to health conditions such as Cushing's disease, multiple sclerosis, or stroke.

Bipolar II is not a milder form of Bipolar I but is a separate diagnosis. Although bipolar I manic episodes can be severe and dangerous, people with bipolar II can be depressed for longer periods of time, which can cause significant impairment.

Although bipolar disorder can occur at any age, it is usually diagnosed in adolescence or early twenties. Symptoms can vary from person to person, and symptoms can change over time.

Mania and hypomania

Mania and hypomania are two different types of episodes, but they share the same symptoms. Mania is more pronounced than hypomania and causes more noticeable problems at work, school, and social activities, as well as relationship difficulties. Mania can also cause a break with reality (psychosis) and require hospitalization.

Both a manic episode and a hypomanic episode include three or more of these symptoms:

  • Abnormally optimistic or nervous
  • Increased activity, energy or excitement
  • Exaggerated sense of well-being and self-confidence (euphoria)
  • Reduced need for sleep
  • Unusual talkativeness
  • Distractibility
  • Poor decision-making - for example, in speculation, in sexual encounters or in irrational investments

Major depressive episode

Major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in daily activities such as work, school, social activities, or relationships. Episode includes five or more of these symptoms:

  • Depressed mood, such as feeling sad, empty, hopeless, or tearful (in children and adolescents, depressed mood may manifest as irritability)
  • Marked loss of interest or feeling of displeasure in all (or nearly all) activities
  • Significant weight loss with no diet, weight gain, or decreased or increased appetite (in children, failure to gain weight as expected may be a sign of depression)
  • Either insomnia or sleeping too much
  • Either anxiety or slow behavior
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Decreased ability to think or concentrate, or indecisiveness
  • Thinking, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorder may include other signs such as anxiety disorder, melancholia, psychosis, or others. The timing of symptoms may include diagnostic markers such as mixed or fast cycling. In addition, bipolar symptoms may occur during pregnancy or with the change of seasons.

When to see a doctor

Despite extreme moods, people with bipolar disorder often do not realize how much their emotional instability disrupts their lives and the lives of their loved ones and do not receive the necessary treatment.

And if you are like people with bipolar disorder, you can enjoy feelings of euphoria and be more productive. However, this euphoria is always accompanied by an emotional disaster that can leave you depressed and possibly in financial, legal, or other bad relationships.

If you have symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder does not improve on its own. Getting mental health treatment with a history of bipolar disorder can help control your symptoms.

Bipolar affective disorder (BAD), its signs, types and methods of treatment

Manifestations of various emotions, a change in a person's mood, manifestations of both sadness and joy are normal and depend on many factors - from temperament and character to ongoing events that influence from the outside. However, when these changes are excessive, often unexpected and for no apparent reason, emotions get out of control, or a person remains in a radically positive or negative mood for a long time, it is very likely that bipolar disorder can be diagnosed. This disease was first described at the end of 19century, the famous German psychiatrist Emil Kripelin, calling it manic-depressive psychosis. Many world famous personalities such as Vincent van Gogh, Isaac Newton, Ludwig van Beethoven, Abraham Lincoln suffered from this disease. The pronounced form of this disease, which in the international classification of diseases is called bipolar affective disorder (BAD), is detected in 3% of the world's population.


  • 1. Bipolar Personality Disorder - Overview
  • 2. Symptoms and signs
  • 3. Types of Bipolar Disorder
  • 4. Phases of Bipolar Disorder
  • 5. Bipolar disorder in women
  • 6. Treatment of Bipolar Personality Disorder

It is not uncommon for women to be treated with a combination of drug therapy and cognitive behavioral or interpersonal therapy with a psychotherapist.

Bipolar personality disorder - general information

According to statistics, bipolar disorder affects people between the ages of 14 and 44. Unlike adults, children and adolescents experience more frequent mood swings from mania to depression, sometimes several times a day. 90% of young people make their debut precisely from the phase of depression or melancholy. Another feature of bipolar disorder is that, due to the low level of diagnosis, the patient can live with this disease for 5-10 years without knowing the cause of the painful symptoms.

Most often, bipolar disorder is diagnosed in people whose immediate family members have had a similar problem. The causes of this disease are unknown, but stress, overstrain, and various diseases can provoke the manifestation of its symptoms. However, having fenced off a person from the influence of these factors, it is impossible to get rid of the problem, you need to seek help from a psychotherapist.

Bipolar disorder is a disease that cannot be completely cured. But with properly selected medication and psychotherapy, the quality of life is significantly improved and the periods between phases are lengthened. The person remains socialized and able to work.

Symptoms and signs

From the name it is clear that we are talking about two different poles of affective manifestations, that is, mood manifestations. One of these conditions is depression. Depression in bipolar disorder is pronounced, with vivid symptoms. It can last up to a year and is manifested not only by low mood, lack of ability to enjoy and interest in ongoing events, but also by psychosis, when ideas of self-accusation arise, the patient feels inferior, unnecessary, poisoning the life of others. There are also nihilistic thoughts about suffering from some kind of severe illness, despite medical evidence to the contrary. There may be delusional thoughts, as well as suicidal thoughts and even attempts.

The other pole of bipolar disorder is a hypomanic state or hypomania, the characteristic features of which are an increased euphoric emotional background, the patient is constantly on the move, hyperactive, and is distinguished by very fast, associative speech. The patient is constantly cheerful, often hypersexual, almost always awake or sleeping 2-3 hours a day.

Hypomania is often followed by a manic bipolar state with psychotic manifestations. The patient develops convictions in his own greatness, he believes that he is capable of anything, feels that he has a special calling in this world or that he is a descendant of great people. In extended manic episodes of mania with psychotic manifestations, anger, irritability, and direct aggression often occur. This condition leads the patient into extremely unpleasant and sometimes dangerous situations.

In addition to the typical symptoms of the disease, there are a large number of comorbid mental disorders. Comorbid mental disorders are those that accompany the underlying disease. The most common disorder of this kind is anxiety, which is manifested, among other things, by nonspecific autonomic symptoms, including sweating, palpitations, tremors of the limbs, various disorders of the gastrointestinal tract, dizziness, headaches, suffocation, and many others. In the case when these symptoms occur suddenly, mainly in public places, they are called panic attacks.

Types of bipolar disorder

Bipolar disorder can be of Ι and ΙΙ types.

Bipolar I disorder is a condition in which the patient has persistent manias, i.e. overexcitation, enthusiastic inappropriate behavior, manic psychosis, as well as severe depressions. Symptoms of this type are more severe, so hospitalization is indicated in most cases.

Bipolar I disorder is characterized by short periods of hypomania followed by periods of deep depression. Hypomania is a pre-manic state with less active manifestations. Hypomania lasts a very short period of time - from several days to several hours, so sometimes patients do not even notice them and do not inform the doctor about it. Only careful, painstaking work with the patient makes it possible to identify hypomania, make the correct diagnosis and prescribe treatment.

Phases of bipolar disorder

There are several phases of bipolar personality disorder:

  1. Depressive (unipolar depression). People experience a depressed mood, despair and despondency, complain of a lack of energy and mental concentration, they can either eat too much or too little and sleep.

Depersonalization and derealization may occur at the peak of bipolar depressive disorder. The boundaries of their own "I" and the world around them become blurred, patients experience difficulties in perceiving what is happening. Familiar places seem new, the colors of the surrounding world change, the patient constantly experiences a feeling of "déjà vu". Sounds become muffled, even if someone is talking very close, it seems to the patient that the voice is coming from afar.

  1. Manic (hypomanic). In this state, patients are full of energy, overly happy or optimistic, euphoric, and have extremely high self-esteem. At first glance, these are positive signs, but when a person experiences large-scale manic episodes, these symptoms and such an emotional state can reach dangerous extremes. A patient in this phase may indiscriminately spend huge amounts of money or behave carelessly, not realizing the full danger. In conversation, people may choke on words, speak at a high speed, or jump from one thought to another. These episodes may also be accompanied by delusions of grandeur or the adoption of serious decisions without thinking about the further consequences.

In the development of the manic phase, the following stages of development can be distinguished:

  • Hypomania - increased excitement, emotional upsurge.
  • Mania - all signs are more pronounced, aggression, irritability, irascibility and rage are possible.
  • Phase peak. The patient constantly experiences nervous excitement, he cannot relax. All his emotions are "heated" to the limit, coordination of movements is disturbed, thoughts are illogical and abrupt, in speech he constantly jumps from one sentence to another.
  • Relief of symptoms. The patient gradually calms down. Movement disorders are on the decline. The speed of thinking and increased emotional mood remain unchanged.
  • Return to normal.
  1. Mixed. Sometimes people have complaints that are characteristic of both depression and mania at the same time. They may also experience frequent phasing—4 or more episodes in one year.

In the intervals between depressive and manic phases in bipolar disorder, there is a light period during which the general background of mood becomes relatively stable, the person continues to respond adequately to certain events, the emotional sphere is under his control. This is the main criterion for remission of bipolar disease.

Bipolar disorder in women

According to statistics, bipolar Ι disorder occurs with the same frequency in men and women, and type ΙΙ disease is more often diagnosed in women. It is also known that the female course of the disease is characterized by rapid cycles and mixed episodes. Comorbidities often include eating disorders, borderline personality disorder, alcohol or drug addiction, and psychotropic drug abuse. Women are more susceptible to such somatic diseases as migraine (intense headaches), thyroid pathologies, diabetes, and obesity.

For women, a special technique is being developed to alleviate this disorder, since from adolescence to menopause there are specific changes in hormonal levels that must be taken into account. In addition, psychotropic substances, which are supposed to stabilize the condition, can adversely affect the intrauterine development of the fetus if the woman is in position. It is noted that in the first trimester of pregnancy this disorder is milder, but after childbirth they often have to deal with postpartum depression. Thus, at each stage of the development of the female body, a competent doctor must review and adjust the treatment regimen. Often in the treatment of women, a complex method is used that combines drug therapy and cognitive-behavioral or interpersonal therapy with a psychotherapist. This approach gives the fastest results.

Treatment for bipolar disorder

Attempts to get rid of bipolar disorder on your own do not bring the desired result and, ultimately, lead to an aggravation of the situation, including the development of drug or alcohol dependence. In the diagnosis of the disease, keeping a mood diary can help, where the patient records all his thoughts, emotions, feelings, changes in mood. Such records will help the doctor to assess the mental state in detail and make the correct diagnosis. If you suspect bipolar disorder, you should consult a doctor, and the sooner a person realizes that he has a disease and comes to the clinic for help, the sooner professional help will be provided to him and painful symptoms will be replaced by a stable condition. It is impossible to get rid of the disease on your own, since a person cannot fully adequately assess not only his actions, but also the alternation of the phases of the disease.

Bipolar disorder is one of the few mental disorders in which medication is indicated in 100% of cases, and psychotherapy is an auxiliary tool. This disease is incurable, but its diagnosis and treatment is extremely important. Treatment can reduce the number of episodes, their severity and intensity, as well as prevent negative life events, help prevent relationship breakups, job loss, and even suicidal attempts. Thus, the quality of life of a patient with bipolar disorder who is undergoing treatment will be several times higher than that of a person who neglects treatment. If the patient loses touch with reality and harms himself and others, he is subject to hospitalization, outpatient treatment in this case is not permissible.

If you have a disease, it is recommended to exclude coffee, strong tea, alcoholic and energy drinks from your diet in order not to provoke an overexcited state. If possible, you should stop smoking and in no case should you take even soft drugs. It is also very important to establish a sleep pattern, sleep at least 8 hours a day and try to go to bed at about the same time. You should learn to recognize mood swings and notice the early manifestations of new episodes.

Learn more