Bipolar disorder causes unusual shifts in mood, ranging from periods of mania to periods of depression. It can also change a person’s energy levels, the way they think, behave, and even sleep.
Roughly 1 in 40 U.S. adults live with bipolar disorder, according to Mental Health America. It is the sixth most common cause of disability worldwide.
Some people may use the term “high functioning bipolar” to refer to someone with bipolar disorder whose symptoms appear to affect their daily life less than others with the condition.
A 2020 study found that almost 23% of their participants with bipolar disorder could be considered high functioning.
This article explains what high functioning bipolar disorder is, its symptoms, causes, treatment, outlook, and more.
High functioning bipolar disorder is not an official diagnosis. It is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) as a type of bipolar disorder.
“High functioning” refers to people who have bipolar disorder but who manage to function in many aspects of their life. This does not mean their struggles and symptoms are any less severe.
High functioning is a broad term that can be difficult to define, especially since there is no absolute right or wrong way to function.
Generally, when assessing how a person’s bipolar may be affecting their life, a mental health professional tends to consider how it impacts the following areas:
- their ability to control physical functions
- how they can perform domestic and self-care activities
- how they manage their work life, social life, and relationships
- their overall ability to manage their environment and influence important parts of their life.
A person with bipolar disorder experiences dramatic changes in mood. They will have at least one episode of “high” mood or mania and, usually, at least one episode of “low” mood or depression. They may also experience periods of neutral moods.
Symptoms of bipolar vary between individuals. Episodes usually last for at least
A person who appears to have high functioning bipolar disorder may have found ways to cope with masking their symptoms to make them seem less obvious. However, they will still experience the symptoms, and they can be just as difficult and stressful for that person to deal with.
| Symptoms of mania (manic episode) | Symptoms of depression (depressive episode) |
|---|---|
| increased energy | lack of energy |
| decreased need for sleep | sleeping too much |
| overly “high” or euphoric mood | withdrawal from activities |
| irritability | irritability |
| increased activity and restlessness | sleeping too much |
| racing thoughts | nervousness |
| faster speech | insomnia |
| becoming easily distracted | a change in dietary habits |
| risk-taking behavior, such as substance use, excess spending, or reckless driving | difficulty focusing |
| impaired judgment | memory problems |
| increased libido | chronic pain or other physical symptoms that do not respond to treatment |
| high levels of self-confidence or self-importance | thoughts of suicide |
| denial that anything is wrong | increase in risk-taking behavior |
A person may also experience a hypomanic episode. It includes symptoms of a manic episode, but the symptoms are less severe.
Some people with bipolar disorder also experience psychosis, which can involve symptoms such as hallucinations, delusions, and paranoia.
If a person experiences difficulties with their mood or suspects they could have bipolar disorder, they should consider contacting a doctor.
If a person has a bipolar disorder diagnosis but their ability to function has changed, they should contact their doctor to reassess their treatment plan.
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
- Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you’re not in the same household, stay on the phone with them until help arrives.
There are no diagnostic criteria for high functioning bipolar disorder. A mental health professional may diagnose a person with bipolar disorder but acknowledge that they are high functioning.
Before diagnosing bipolar disorder, a doctor may want to rule out any other potential causes of mood changes, such as thyroid conditions or medications.
With the use of the DSM-5-TR and a person’s history of symptoms, a doctor can assess what type of bipolar disorder a person may have from the following:
- Bipolar I disorder: A person has had one or more manic episodes lasting at least 7 days, or fewer than 7 days if the person required hospitalization. The person may also have experienced depressive episodes, but a diagnosis does not need this.
- Bipolar II disorder: A person experiences at least one depressive episode and at least one hypomanic episode, but not a “full” manic episode, in bipolar II disorder.
- Cyclothymic disorder: Also called cyclothymia, it is a chronically unstable mood state in which a person experiences hypomania and mild depression for at least 2 years.
- Bipolar disorder (other or unspecified): If a person has experienced periods of significant mood elevation but does not meet the criteria for the types above, a doctor may diagnose “other specified” or “other” bipolar disorder.
Bipolar disorder can be challenging to diagnose and may be even more difficult to detect if a person is high functioning.
Research shows that people who appeared high functioning may not be taken seriously when asking for help. For this reason, it may take them longer to receive a diagnosis and get the care they need.
Research suggests that bipolar disorder may occur because of a combination of the following factors:
- Chemical imbalance: An imbalance of the brain chemicals norepinephrine, serotonin, and dopamine may play a role in the development of bipolar disorder.
- Genetic factors: People who have a relative with bipolar disorder are more likely to have the condition themselves.
- Environmental factors: Significant events, such as the loss of a family member or leaving home for the first time, may trigger the onset of bipolar disorder.
Research has shown that people with a better understanding of their condition may be better equipped to notice early signs of episodes and, therefore, more able to manage their symptoms. This may result in them being more likely to seem high functioning.
Treatment aims to stabilize a person’s mood and manage their symptoms.
Treatments include:
- Medication: The most common medications used to treat symptoms are mood stabilizers, such as lithium, and second-generation antipsychotics (SGAs).
- Psychotherapy: Psychotherapy can help relieve a person’s symptoms and equip them with strategies to manage bipolar disorder.
- Electroconvulsive therapy (ECT): If medication and psychotherapy have not helped manage a person’s symptoms, a doctor may suggest ECT.
- Lifestyle changes: Some lifestyle changes may help a person maintain a stable mood. Such changes may include keeping a regular routine, having a regular sleep pattern, maintaining a nutritious, balanced diet, and getting regular exercise.
Effective treatment
While bipolar disorder is a chronic condition, treatment often improves symptoms and can drastically improve a person’s quality of life.
A person may still experience mood changes with treatment, but working closely with medical professionals can help manage the symptoms.
While bipolar disorder cannot be completely prevented, there are ways a person can prevent their condition from worsening or from significantly impacting their quality of life.
Research suggests that early intervention can help reduce the severity of the condition. A person can seek help at the first signs or symptoms of bipolar disorder.
High functioning bipolar is not a diagnosis. Instead, it is a term that refers to people who have bipolar disorder but who appear to have less-severe symptoms than others with the condition.
High functioning does not mean a person does not experience symptoms or that their symptoms do not cause them distress.
It is important that a person with bipolar disorder, even if they appear high functioning, talks with a medical professional and has access to support.