Can Bipolar People's Eyes Give You A Clue As To When They're Experiencing Mania?
You may have heard that you can tell a lot by looking into someone's eyes, but scientists believe that the eyes of people with bipolar disorder may reveal something more than just emotion. Read on to learn about the relationship between the human eye and bipolar disorder.
The human eye and bipolar disorder
From a scientific standpoint, our eyes are organs that react to light and pressure and, like every other part of the body, they are connected to our brains to offer signals about our environment for our brain to process. That said, it makes perfect sense that our eyes and eye movement are connected in some way to our emotions. But can our eyes give us physical clues as to whether someone has bipolar disorder? Some scientists seem to think so. For example, there is thought to be a link between impairments in color vision processing—our ability to perceive and discern colors—and bipolar I disorder. Additionally, some people have observed changes in the appearance of eyes (e.g., sparkling eyes) in people experiencing mania.
Another study, published in Biological Psychiatry, involved scientists using electroretinography (ERG) to get an up-close look at the retina and how well it was working. The retina is located at the back of the eyeball and is part of the central nervous system. It contains cells that are sensitive to light, and it activates nerves to send signals through the optic nerve to the brain, which ultimately form an image for the brain.
The retina is made up of two types of photoreceptors that process light: rods and cones. The rods process black and white light so that we can see in low-light conditions. In addition to sending black and white information to our brains, rods give us our peripheral vision. On the other hand, the cones process color. ERG is a tool that measures the rods and cones in the retina.
In the reference study, scientists concluded that the retina of the eye plays a role in whether a child is at a high risk of developing a psychiatric disorder where mania is a symptom, including bipolar disorder and schizophrenia. That being said, while a specialized eye exam may help doctors identify mania symptoms, there are other ways to detect if someone is experiencing a manic episode. Often, it takes several sources of information for doctors and therapists to get a clear enough picture to make an accurate diagnosis.
Doctors may look for physical signs of a condition by tracking vergence eye movements, or how the eye tracks an object coming towards an individual. In addition, there is a link between saccadic or anti-saccadic eye movements to bipolar disorder and schizophrenia. By identifying irregular saccadic eye movements, doctors may help to paint a complete picture in identifying mental illness.
Retinal function and the risk of developing bipolar disorder
Your annual eye examination may be an early indicator of bipolar disorder if it includes an assessment of the retina. Researchers have known for some time that people who live with bipolar disorder and schizophrenia have abnormalities in their eyes’ retinas. Until recently, those findings were of little use because of the symptoms of the illnesses and the medications being used to treat them.
To gain a clearer picture of the role of the retina in mental and behavioral health, researchers enlisted the help of healthy young adults over the age of 20 who were at risk of developing bipolar disorder or schizophrenia. Specifically, they chose young adults with a family history mental illness having at least one parent living with bipolar disorder or schizophrenia. They then examined these young people’s retinas and compared the results with a control group of individuals whose families didn't have a history of the illnesses.
The results proved that the group that had the genetic risk for bipolar disorder and schizophrenia had a reduced ability to activate the rods in their eyes compared to the control group. Taking the study a step further, researchers repeated it using control groups for age, gender, and testing season and got the same results. In all studies, there was no difference in the responsiveness of the eyes’ cones.
What do these results mean for the eyes?
Researchers believe that the study results indicate that the rods in the retina may be an early warning sign for those who may experience symptoms of bipolar disorder or schizophrenia later in life. The study will likely be used as a basis of knowledge for other mental health studies in genetic testing and prevention research.
While researchers consider the study to be a success, they acknowledge that it's difficult to form an exact explanation as to why there is a higher risk in the offspring of people living with bipolar disorder and schizophrenia. Prior studies using animals suggest that the reason may be due to an abnormality of the brain chemicals serotonin and dopamine. They also believe the higher risk may be related to receptor sensitivity of serotonin and dopamine.
Researchers point out that it's possible that the brains of children who are born into a family that has a strong history of bipolar disorder or schizophrenia may have abnormal brain development.
The human eye and your brain
The retina is connected to the brain by the optic nerve, opening the door to the brain. Is it possible that the reduced response from the retina produces actual perceptual challenges in the eyes? Researchers aren't ruling out that possibility. They suspect that this could be why people living with bipolar disorder and schizophrenia have difficulty with how they perceive the world around them, which may be a contributing factor to functional impairment.
If we look at the larger picture, researchers have conducted other studies showing ERG anomalies in people living with other mental health illnesses like seasonal affective disorder, autism, major depression, and substance use disorders. This information supports the notion that the function of the retina may help properly diagnose certain mental health conditions.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
Are there other ways to know if someone is experiencing mania or bipolar disorder?
To better understand mania, it helps to know more about the different categories of bipolar disorder. Doctors have classified bipolar disorder into four categories according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
Bipolar I – The person has had a manic episode lasting a week or longer or needed to enter a behavioral health hospital for treatment. The person may have had a depressive episode before or after manic episodes, or they may not have had a depressive episode at all.
Bipolar II – The individual has moderate symptoms of mania (also referred to as hypomania) that last for at least four days and where symptoms are present for most of the day on most days. Similar to bipolar I, the individual may have a major depressive episode before or after having manic symptoms or may not have depressive symptoms at all.
Cyclothymic disorder – This category of bipolar disorder is characterized by periods of hypomania that alternate with periods of depression. Symptoms aren't usually severe enough to be classified as either hypomania or major depression.
Not Otherwise Specified (NOS) – There is a final category of bipolar disorder formerly called NOS. The term was seen as being too general and has instead been replaced by two different terms to help with diagnosis: "other specified" and "unspecified". Individuals who fall into this category may have symptoms of mania and depression that affect their daily lives; yet, their symptoms don't easily fall into any of the categories above.
Eye tests for distinguishing between unipolar and bipolar depression
Because depressive symptoms are present in both bipolar disorders and depressive disorders, knowing whether someone is exhibiting bipolar or unipolar depression can be important. Misdiagnosis can lead to ineffective treatment or the use of modalities that exacerbate symptoms. Recent research suggests that eye movement analyses may be used to determine whether someone is experiencing bipolar disorder or a form of unipolar depression. In one study, researchers found that reaction times and accuracy in certain visual tests can help distinguish between the two.
Inside bipolar depression and mania
Everyone experiences occasional periods of feeling extra excited or slightly down in the dumps. Barring situations where individuals can point to a specific event that's causing extreme mood changes, these moods usually pass in short order and aren't considered mania or depression. In some cases, an individual may only experience unipolar depression, meaning they never feel an elevated mood or mood swings like individuals with bipolar disorder do.
The difference between unipolar and bipolar depression is that bipolar disorder causes extreme changes in mood, though. Mania, for example, is characterized by an unusually high level of energy and activity. It can be challenging to recognize mania, other manic symptoms may include:
Racing thoughts
Sleeplessness or insomnia and still feeling great
Difficulty concentrating
Higher energy
Failing to finish tasks they started
Irritability
Feelings of exhilaration
Inflated self-esteem
Risk-taking behavior
Impulsivity
Talking loudly and quickly
High energy level
There are different types of mania, including euphoric mania and dysphoric mania. Euphoric mania or a euphoric manic episode involves individuals feeling like they are in an energized good mood, their eyes may widen and they may appear to have sparkling eyes. There is also anecdotal evidence of changes in eye color occurring in people experiencing hypomania or mania—typically blue eyes changing to brown.
How dysphoric mania differs is that it is a mixed mania bipolar episode and involves individuals experiencing both agitated depression and mania at the same time. This means a person may be in an energized bad mood. Each person’s own dysphoric mania presents a variety of symptoms, however, in some cases, dysphoric mania narrows the eyes for a long period of time and may include pupil dilation making the eyes appear black.
Reaching out for help: Bipolar disorder
For years, people with bipolar disorder, depression, or dysphoric mania turned to in-person therapy for treatment. However, while many people are interested in therapy, the idea of seeing a stranger can feel a bit intimidating. This is especially true for individuals who are experiencing symptoms of bipolar disorder like sudden and intense mood swings. There are other alternatives. For example, online therapy can be a more discreet way of connecting with a therapist or mental health provider.
Managing depression or mania sounds like a challenge, however, you do not have to manage alone, and online therapy can help. Studies support the idea that online therapy can improve mental health by alleviating certain symptoms of mental health conditions and illnesses. One such study evaluated the use of a specific treatment for bipolar disorder. Results showed that this treatment was indeed effective when delivered remotely.
Takeaway
It's not likely that we're at a point in scientific discovery where it makes sense to test the retinas of every person who may be living with bipolar disorder. Still, the more that researchers learn about the brain and how it works together with our other organs, the closer they will become to identifying effective treatments for bipolar disorder, schizophrenia, and other mental health disorders.
At BetterHelp, you can get the personal attention you need to address bipolar disorder symptoms in a safe environment. BetterHelp provides licensed, experienced, and accredited psychologists, marriage and family therapists, social workers, and board-licensed professional counselors who specialize in a wide range of mental health areas. Below are some reviews of BetterHelp counselors working with people like you.
What are bipolar eyes?
The term “bipolar eyes” refers to a reported physical characteristic of bipolar disorders that may cause a person's eyes to change appearance depending on periods of mania and depression. Those who have reported seeing bipolar eyes claim that a person's pupils can become dilated or change colors. For example, a person may claim that a person’s blue eyes turned brown during an episode, or that they witnessed someone’s normally blue eyes turn black.
While studies may not support these claims, there have been certain conclusions made about the eyes of those with bipolar disorder, specifically that those experiencing these conditions may have changes in their ability to focus on certain objects. One study concluded that those with experience smooth pursuit eye movement deficits, including a higher number of catch-up saccades.
In other cases, those experiencing mania have been said to exhibit “manic eyes,” which are reportedly watery or shiny. In addition, anecdotal reports have said that a person's gaze may change depending on which mood they are experiencing. But mania, just like depression, isn’t always physically apparent. Typically, the only way to know if someone has bipolar disorder is through a professional diagnosis.
Can you see bipolar in someone's eyes?
Whether or not you can see if someone is bipolar just by looking in their eyes is a highly debated topic, with individuals and professionals making arguments for both sides. While there is little evidence to support the claims that bipolar disorder can change the shape or color of the eyes, research suggests that it may affect pupil response and light sensitivity. One study investigating the post-illumination pupil response of those with bipolar disorders found that those experiencing hypomania had a higher sensitivity to light.
Despite the findings of this research, there still may not be a conclusive way to determine someone is experiencing bipolar disorder simply by looking into their eyes. In almost every case, determining whether you or someone you know has bipolar disorder will need to be done via a professional diagnosis.
What are bipolar facial features?
Bipolar disorders can have an effect on the facial features of those living with them. One study using 3D laser surface imaging and geometric morphometrics captured the facial surface of participants in order to determine whether the facial features of those with certain mental disorders, including bipolar disorder, varied from that of a control group. The study found that male participants tended to have the following facial features.
- A lengthened, narrow, turned-down nose.
- A posteriorly set and narrow mouth.
- Wide mandibles
- Forward set chin
- Inwardly displaced cheeks
- Narrow eyes
- A face that is wider at their tragion (a part of the ear)
Female participants, on the other hand, had the following facial features.
- Vertically short and laterally broad face
- Anteriorly set mouth
- A shorter, turned-up nose that is wider at the base, with a recessed nasal bridge
- Forward set and wider mouth
- Thinner lips
- Higher set and forward chin
- Upwardly displaced mandible
- Outwardly displaced cheeks
- Narrow eyes
- A face that is wider at their tragion (a part of the ear)
Can you see if someone is bipolar?
While it may not be possible to tell with 100% certainty whether someone is experiencing the symptoms of bipolar disorder by looking at them, there are signs that you can look for. If a person is experiencing a manic episode, they will likely act in a different way than you are accustomed to. High energy, excitement, quick agitation, and impulsiveness are all traits that one may display while experiencing mania.
During a depressive episode, a person may act in the opposite fashion. An individual who is severely depressed may tell you that they feel worthless or unable to accomplish anything in addition to having low energy and sleeping excessively. If you see these signs in yourself or a loved one, it may be beneficial to reach out for support.
Can eyes tell about mental illness?
Certain mental illnesses may have an effect on the eyes, potentially causing retinal, eye movement, and vision changes. For example, one multistudy analysis showed that those with schizophrenia can experience changes in eye movement and visual cognition. Other mental illnesses like bipolar disorder may also cause changes to the eye that can be detected by tests like electroretinography. While those with bipolar disorders may have a high genetic risk of experiencing these changes, they can be difficult to observe with an unassisted eye. Overall, it may not be possible for an untrained individual to spot mental illness just by making eye contact with someone.
Do people with bipolar look normal?
Yes, neurodivergent individuals, like those experiencing bipolar disorder, will generally look just like neurotypical individuals. One of the most common stigmas around bipolar disorder and many mental illnesses is that someone will have different facial expressions or appear noticeably different. This misconception is largely created by the way bipolar disorder is presented in popular culture, which often uses negative or threatening images to depict these conditions.
While a person experiencing a manic or depressive episode may exhibit some external behaviors related to their symptoms, they are unlikely to appear like the characters we see in TV and movies. Eliminating these stigmas may necessitate more positive images of bipolar disorder represented in media, as well as a change in the way we view those experiencing bipolar disorder in our lives.
What do people with bipolar think?
Outside of manic and depressive episodes, those experiencing bipolar disorder will often think in the same way as someone without a bipolar condition. During episodes, people living with bipolar disorder may have significant changes in their thought patterns. Some of the largest shifts in thinking can come as a result of a severe bipolar disorder symptom, psychosis.
Psychosis is a condition that can alter someone’s perception of reality, making it difficult to understand what is real and what is a product of one’s own mind. Psychosis can come with a variety of symptoms, including paranoia, slower reaction time, social withdrawal, difficulty speaking, and hallucinations, all of which may make it difficult to function without support.
Who to see if you're bipolar?
In order to get diagnosed with bipolar disorder, a person needs to be evaluated by a medical team. This typically includes meeting with your primary care physician in order to rule out other causes for your symptoms or medical conditions that may complicate a diagnosis, such as thyroid disease and multiple sclerosis. After that, a person will need to be assessed by a psychiatrist. They may use multiple diagnostic tools, like self-assessments or psychiatric interviews, in order to determine whether you have a bipolar disorder. Diagnosis may also take some time, as a psychiatrist may want to observe how you transition between mood episodes before determining you have a bipolar disorder or another condition.
How do I know if I am manic?
If you believe you are entering a manic episode, there are a few warning signs and mood symptoms you can look out for. Identifying an episode early may give you time to get the support you need and avoid going into full-blown mania.
- Impulsive Behavior: People experiencing mania may engage in impulsive behavior, including risky sexual encounters, reckless spending, or the neglect of responsibilities.
- Insomnia: Due to the racing thoughts, euphoria, and high energy often associated with manic episodes, a person may have trouble getting to sleep and staying asleep.
- Hypersensitivity: Manic episodes also have the potential to increase the effect of stimuli. Sights, sounds, and smells that were once comforting or common could become overwhelming during a period of mania.
- Euphoria or Dysphoria: Depending on what type of manic episode you are experiencing, you may feel the high-energy elation of euphoria or the depressive negativity of dysphoria. A dysphoric manic episode can be complicated because its symptoms have some similarities with a depressive episode. Because of this, experiencing dysphoric mania makes determining whether one is entering a manic episode potentially more difficult.
Who to see if you think you have bipolar?
The first person you will likely see if you believe you have bipolar disorder is your primary care physician. Once they have ensured you don’t have any medical conditions that may complicate a diagnosis, the best person to see to get diagnosed with bipolar disorder is a psychiatrist. Depending on which psychiatrist you go with, there may be a different diagnostic procedure. Some mental health professionals will want to observe a mood episode or your overall behavior during the course of a few weeks or months. There is also the possibility of being misdiagnosed with other psychiatric disorders; this means it may take years until you are accurately diagnosed with bipolar disorder.
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