Bipolar Mania Symptoms

Grandiosity
What is grandiosity?
Grandiosity occurs when a person has an inflated self-esteem, believe they have special powers,
spiritual connections, or religious relationships.38
When grandiosity is severe, the person may be delusional about his or her capabilities.20
What does it feel like to be grandiose?
A grandiose individual feels unrealistically powerful, important, and invincible. These beliefs
are frequently accompanied by feelings of euphoria and intense pleasure. Nothing seems
impossible and every problem has a solution.
The person may feel an urgent need to initiate projects or activities.
How can I recognize this symptom?
To others, the person's behavior seems pompous, boastful, and exaggerated. Observers may
perceive the grandiose individual to be conceited and condescending.
The person's speedy pursuit of dreams, goals, and projects may seem impulsive.
Set goals and initiated plans may be unrealistic.29
How does grandiosity impact life?
Bipolar disorder symptoms affect all aspects of life. A grandiose person may appear to be rude
and boastful. Naturally, this makes it difficult to make new friends and current relationships are
strained.
When a person is grandiose at work, they may find it difficult to be productive. Grandiosity is
frequently accompanied by decreased judgment.
For example, a person may believe they have special insight that their employer does not have.
The person may feel obliged to share their break-through knowledge with their employer and
disagree with management decisions. The felt passion and urgency lead to inappropriate
arguments.
The fallout of grandiose behavior, especially when compounded with other symptoms of bipolar
disorder, can be devastating. The high risk behavior, inflated self-esteem, and delusions may
lead to job loss, expulsion from school, and terminated relationships.
 Sometimes, the pursuit of unrealistic ideas involves financial investment. The person may suffer
significant financial losses.8

Irritability
What is irritability?
Irritability occurs when a person responds excessively to physical or emotional stimuli.9
How does the irritable person feel?
Irritability is a very uncomfortable feeling. It is opposite to the feelings of euphoria and intense
pleasure that could also occur in bipolar mania. The person suffering from irritability feels very
stressed.
To the observer, irritable behavior may seem exaggerated. The person appears to be over-
reacting. The person's experience, however, is intense. The feelings are urgent and important.
How can I recognize this symptom?
The person may present as argumentative, demanding, intrusive, hostile, impatient, angry, or
over-sensitive.
The person takes most things personal. The person is easily and quickly offended at seemingly
neutral comments. The person may feel threatened when faced with normal, harmless stimuli,
and as a result, may respond aggressively.
The person may become angry quicker than usual.23 Intense feelings of anger may not be
controllable and possibly results in verbal or physical aggression.
How does irritability impact life?
A person who normally is respectful, careful and socially appropriate may find themselves
arguing with strangers over trivial matters. Their demanding and intrusive behavior may prevent
them from creating new relationships.
The person who suffers from irritability and other mania symptoms may initiate altercations that
result in verbal or physical disputes. The person may find themselves in trouble with the law.15
The person may not realize the consequences of their words, behavior, or arguments. To the
observer this seemingly selfish, unloving, and arrogant behavior may be unacceptable.
Like most symptoms of bipolar disorder, irritability can have disastrous effects on relationships
and quality of life. Continued irritable behavior may lead to job loss, terminated relationships,
and marital conflict.
Distractibility
What is distractibility?
Distractibility is an inability to maintain focus or attention. Minimal stimuli cause the mind's
attention to divert and wander.14
The person may be distracted internally (thoughts, feelings, ideas or emotions) and externally
(environmental events and physical stimuli).
What does distractibility feel like?
The person may feel frustrated by their inability to pay attention. The mind may feel out of
control.
How can I recognize distractibility?
The person's productivity decreases. He or she may seem 'lost'.
New projects are started prior to completion of current or old ones. The person is unable to
maintain attention on simple and short activities.
The person changes the subject of the conversation frequently.
He or she seems busy and occupied, while at the same time, not getting much done.
How does distractibility impact life?
Tasks of daily living such as work, studying, or leisure activities become difficult. For example,
a student may be unable to stay attentive in class and find it difficult to submit assignments on
respective deadlines.31
Distractibility, by itself, is a cognitive challenge. When present with other symptoms of bipolar
disorder, distractibility is debilitating. It makes the success of already unrealistic and manic
goals and activities even less likely.
Distractibility usually presents simultaneously with other bipolar mania symptoms. The
combined effect of these symptoms can leave the person unable to perform activities of daily
living.3

Insomnia
What is insomnia?
Insomnia refers to an inability to fall or stay asleep at night.7
What does insomnia feel like when caused by mania?
 The person may feel energetic and believe they have an unlimited supply of energy. The
person's experience may be that they do not need to sleep. They may believe they don't require
the same amount of sleep as other persons.
The person may sleep less in order to pursue grandiose projects. It is not uncommon that a
person may pursue grandiose ideas into all hours of the night during a bout of mania.21
How can I recognize insomnia?
To others, it is evident that the person has difficulty sleeping. They may stay up late at night and
sleep in. The individual may look tired and worn throughout the day.
It is possible the person sleeps in or naps during the day in order to compensate for lost sleep
during the night. This may further disrupt the circadian rhythm (regular sleep cycle).5
They may say, "I'm not tired", or "I don't need that much sleep, I'm very busy with my projects."
Other signs and symptoms of bipolar disorder are evident. Increased energy, racing thoughts,
and flight of ideas are common during insomnia. As a result, the person who may not be
sleeping at night may also be unusually active.
Exercising in the middle of the night in order to cope with bipolar symptoms such as increased
energy is not unusual.
How does insomnia impact life?
In bipolar disorder, sleep deprivation can trigger a manic episode, or increase the severity of
already present mania symptoms.22
Work and school performance may decrease. Students may falls asleep in class or workers may
need extended periods of rest in order to make it through the day.

Pressure of Speech
What is pressure of speech?
Pressure of speech is an unusual increase in the rate or speed of conversation. The person with
pressure of speech talks much faster than what is considered normal or ordinary.
Pressure of speech may be severe enough that the person may not be understood.
What is it like to have pressure of speech?
The person experiences an urgent need to raise a point, discuss an idea, or to talk.
The person may feel frustrated or irritated by other people's request to talk slower, repeat
sentences or to calm down.
How can I recognize this symptom?
 It is frequently difficult to interrupt an individual who experiences pressure of speech. When it
is a symptom of mania, the person may appear to be anxious, enthusiastic, and speak with
urgency.
When the person also has flight of ideas and racing thoughts, their conversation reflects an
abundance of ideas, which may not all be related to the subject of the conversation.
The person also may rhyme words or use words that sound similar. The person may play with
words and use puns.34
How does pressure of speech impact life?
The person with pressure of speech may find what he or she talks about to be of great
importance. The person may talk even when not appropriate.32
For example, a student may interrupt the teacher in class to share ideas. The teacher finds it
difficult to guide the conversation so that it benefits the rest of the class. She struggles to take
control and to continue teaching.
At work, a person suffering from pressure of speech may talk incessantly in meetings or with
co-workers. The experienced need for urgency results in disrupted meeting schedules, and
decreased productivity in the workplace.
The person who has pressure of speech and other bipolar symptoms at work may experience
reprimand or job loss.39

Racing Thoughts & Flight of Ideas

What are racing thoughts & flight of ideas?
Racing thoughts literally mean that thoughts race, or go very fast. Racing thoughts usually
present with flight of ideas.41
In flight of ideas, the subject of thought changes very quickly. A person suffering from this
bipolar symptom will change the topic of conversation frequently.14
What does it feel like to have racing thoughts & flight of ideas?
Racing thoughts and flight of ideas leave the person feeling exhausted and overwhelmed.
Although the person may feel worn and tired, the inability to fall asleep can result in feelings of
frustration.
How do I know if someone suffers from racing thoughts and flight of ideas?
The person may be highly distracted and change the subject of the conversation constantly.
 Pressured speech is common. The words may sound rushed and sentences are scrambled. He or
she is unable to talk fast enough to keep up with their thoughts and ideas.
The person may share with you that their thoughts are going very fast, feeling uncomfortable
and annoyed by their incessant thinking.
How does this bipolar disorder symptom impact life?
Racing thoughts may trigger insomnia or interfere with a person's ability to work, study, or to
enjoy leisure activities. It is difficult to fully interact with the external environment when the
mind is active and draws attention inward.
The person may be busy, but unable to accomplish a great deal. Their attention shifts
consistently and the person begins to work on other things without finishing tasks in progress.
Bipolar mania sufferers often report they have no control over their thoughts and are unable to
slow them down. This may prevent them from falling asleep at night.16

Behavior and Psychomotor Agitation

How does bipolar disorder affect a person's behavior?
There is an increase in goal oriented activities.44 In addition, the person seeks out activities that
give pleasure.
Unusual aspirations are common as well as increased motivation to pursue dreams and initiate
projects.
What is Psychomotor Agitation?
Psychomotor agitation refers to purposeless and restless activity. The person may need to pace
around the room, even if he or she wants to rest or sit down.14
What does it feel like to experience this change in behavior?
The person may feel energetic, enthusiastic, motivated, and creative.
What does it feel like to have psychomotor agitation?
The person may feel restless and nervous.27 Increased physical energy and feelings of urgency
may feel uncomfortable.
How can I recognize a change in behavior?
The person is more active in work, school, or social life. Eager to please, the employee goes the
extra mile. The student meets and exceeds assignment criteria. Socially, the person may be in
touch with new, present, and old friends, arranging dinner plans and social meetings.
 This flurry of activity does not always result in increased productivity. In mania, distractibility
is common and the person may find it difficult to 'keep things together'.
How can I recognize psychomotor agitation?
The person suffering from psychomotor agitation may pace back and forth, seem hyperactive,
or move purposelessly. Wringing of the hands or pulling one's own hair is common.27
How does the change in behavior impact life?
The person is increasingly outgoing, unreserved and sociable. The bipolar mania sufferer may
participate in high risk activities.1
As with all bipolar symptoms, the changed behavior affects work, school, social and personal
life. Depending on the severity of mania, this change can be beneficial or hindering.

Thoughtlessness
What is thoughtlessness?
Thoughtlessness refers to behavior that is rash, foolhardy, and reckless. The person may act
impulsively and does not consider the consequences of their actions. Impaired judgment is
common and the person may have limited or no insight into their high risk or unsafe behavior.
What is it like to experience thoughtlessness?
The consequences of thoughtlessness may result in feelings of shame, guilt, and embarrassment.
If the mood switches to depression, the mistakes of mania may contribute to intense feelings of
guilt and regret.24
The person may feel surprised by their actions and feel they are unable to trust themselves. Not
knowing how a person will act during mania may feel unsettling.
How can I recognize this symptom?
Thoughtlessness is spotted by rash and reckless behavior.
Some examples of thoughtlessness are dangerous driving, using financial credit with no means
to pay back, impulsively ending or starting intimate relationships, starting a new business
without a business plan, and giving away highly valued personal belongings.
How does thoughtlessness impact life?
Thoughtlessness and other bipolar mania symptoms are associated with spending sprees, foolish
investments,1 and increased criminal acitivity.15
Some examples of the chaos that may result from thoughtlessness are as follows:
Personal life:
 Giving a $100 tip when ordering coffee. Not enough money is left over to buy groceries.
Social life:
Engaging in unsafe sex or promiscuity, risking unplanned pregnancy and exposure to sexually
transmitted diseases.
Work Life:
Foolish investments. Purchasing expensive property for a new business and starting
construction while not possessing a marketable product or a business license.

Psychosis
What is psychosis?
In psychosis, the person loses contact with reality. Possibly, he or she experiences hallucinations
(false perceptions) and delusions (false beliefs). Psychosis can happen when mania is severe.30
What does psychosis feel like?
A person may suffer from false beliefs and perceptions that are mild in nature. The perception is
distracting and interferes with normal functioning.
Psychosis may also include seeing scary images, hearing disturbing sounds, and believing
terrifying things.
The perceptions may be false, but it is important to remember that they seem real to the person.
The emotions and thoughts that result from false perceptions possibly are vivid and intense.
What types of delusions are there?11

Erotomania: A false belief that someone loves the person. Normally, this person believes
the lover is of a high social status.
Grandiosity: A false belief that the person is more powerful, worthy than they really are.
He or she may feel they have special abilities and unique knowledge, that they are gifted.
Jealousy: A false belief that he or she is being cheated on by a significant other.
Persecutory: A false belief that the person is persecuted. Commonly, the person believes
they are followed and watched.
Somatic: A false belief that something is physically wrong. The person may believe they
have a terminal illness, a tumour, or other disease.
What types of hallucinations are there?40

Auditory: hearing a sound that does not exist.

Gustatory: tasting a flavor that is not present in the mouth.
 Olfactory: smelling odors that do not exist.
Tactile or somatic: a false perception of touch or a false perception of physical stimulation
in the body.
Visual: seeing things that do not exist. Could include shadows, lights, objects, or people.
How can I recognize psychosis?
The person may display bizarre behavior. The behavior usually reflects the person's false
perception or belief.
A person hearing voices may respond and talk back to the voices. A person who falsely believes
they have powers that they do not, may try use these 'powers'.
The person, who falsely believes that the government is reading their mind, would actually take
preventative action. He or she may wear a metal helmet to protect them from the government's
advanced equipment.
How does this symptom of bipolar disorder impact life?
Psychosis is very serious. The person suffering from psychosis may be unable to work, study, or
take care of themselves. Hospitalization may be necessary.
Psychosis is associated with low self esteem and high risk for suicide.19 Observing psychotic
behavior can be frightening for friends and family.

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