Bipolar Paranoia Treatment Challenges

Bipolar disorder is a mental illness characterized by extreme mood episodes. People with this condition may have periods where they experience manic or depressive episodes, depending on the subtype of the condition they are living with. Everyone with bipolar disorder experiences the conditions differently. For some, manic episodes can include severe psychotic features, including paranoia. Paranoia can make trusting one’s doctors and therapists difficult, as one may see them as perceived threats and struggle to comply with the treatment plan. 

What is bipolar disorder?

Types of bipolar disorder

There are three types of bipolar disorder. Each of these mental health conditions has symptoms that differ from others. Bipolar II disorder does not include mania, so psychosis is not a symptom of this subtype unless the person has a co-occurring psychotic disorder. 

Bipolar I disorder

People with bipolar I disorder have manic episodes that last nearly every day for most of the day for at least a week or manic symptoms so severe that the person requires immediate medical attention. People with bipolar I disorder generally have depressive episodes lasting two weeks or longer. Bipolar I disorder can cause psychosis and paranoia during manic episodes. 

Bipolar II disorder

Bipolar II disorder involves a pattern of depressive episodes and hypomania. Hypomanic symptoms are less severe than manic episodes and do not involve paranoia or psychosis. They do not lead to severe mania that can cause hospitalization. 

Cyclothymic disorder

Cyclothymic disorder or cyclothymia is a type of bipolar disorder where the person experiences depressive and hypomanic symptoms that are not intense enough or do not last long enough to qualify as hypomania or depression. This subtype does not include psychosis as a symptom. 

Symptoms of manic and depressive episodes and mood swings

Symptoms of manic episodes in bipolar I disorder and depressive episodes in every subtype can include the following. 

Manic episodes

Manic episodes cause an intense high and energy change, including symptoms like the following: 

• Being elated, high, or extremely touchy or irritable
• Being more active, jumpy, or wired than usual
• Having less sleep and not feeling tired 
• Talking quickly about many subjects
• Having racing thoughts
• Having an excessive desire for sex, drinking, food, or other pleasurable activities
• Believing one can partake in many activities at once without getting tired
• Believing one is unusually important, influential, or talented
• Experiencing psychosis or paranoia (in some people) 

Depressive episodes

Depressive episodes are present in bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Below are potential symptoms of depression to look out for: 

• Feeling down, sad, or anxious
• Becoming restless
• A sense of being slowed down
• Experiencing poor sleep
• Talking slowly
• Forgetting information 
• Having trouble concentrating or making decisions
• Believing one is unable to complete daily chores or self-care 
• Believing one is hopeless or worthless
• Having a lack of interest in activities

Psychotic symptoms

Research shows that people with bipolar disorder can experience psychosis, typically in the presence of hallucinations, delusions, or both. Over half of people with bipolar I disorder develop psychotic symptoms in their lifetimes, and they are more frequent during the manic phase than the depressive phase. Some types of psychotic and paranoid symptoms can occur in bipolar mental disorders, with persecutory, grandiose, and referential delusions, visual hallucinations, and auditory verbal hallucinations being the most common.

Paranoia in bipolar disorder

Paranoia can appear during periods of mania, typically as a form of delusions. For example, while in a state of mania, people with bipolar I disorder may believe that people are targeting, stalking, or surveilling them. These symptoms occur in those with bipolar I disorder mania, not hypomania, as seen in bipolar II disorder. 

What causes manic and depressive phases in bipolar disorder?

Various situations and stimuli may incite mania and depressive episodes in bipolar disorder, including the following. 

Major life changes

Challenging and stressful life events can incite mood swings in people with bipolar disorder. These changes can include losing a close family member, experiencing the end of a relationship, going through a natural disaster, or losing a job. These changes might also cause mood swings when positive. For example, a wedding or a new child might cause mania, hypomania, or depression. 

Disrupted sleep

Bipolar disorder and sleep are directly related. Bipolar disorder can disrupt sleep, and disrupted sleep can exacerbate or cause symptoms of bipolar disorder. Research has found that a lack of sleep can lead to more frequent episodes of mania.

Recreational drug or alcohol use

Recreational drug or alcohol use can lead to increased mood instability in people with bipolar disorder. For example, one study found that alcohol use was associated with mood instability and poor work functioning in bipolar disorder.

Treatment for bipolar disorder

Bipolar disorder is a lifelong illness, and manic and depressive episodes can reoccur over time, but treatment may help, even for those with severe symptoms caused by the disorder. Treatment plans often involve a combination of medication and psychotherapy.  

Medication

Healthcare providers may prescribe antipsychotic medications or mood stabilizers for people with bipolar disorder. Still, everyone responds to medications differently, so a provider may try several types to find one that works. Antianxiety or sleep medication may also manage some symptoms for some people. 

The BetterHelp platform is not intended to provide information regarding which drugs, medications, or medical treatments may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.

Psychotherapy

Talk therapy can be an effective part of treatment for bipolar disorder. Psychotherapy can help people learn to identify and change troubling emotions, behaviors, and thoughts. Multiple types of psychotherapy may be used to treat bipolar disorder, including cognitive-behavioral therapy (CBT) and interpersonal and social rhythm therapy (IPSRT).

Barriers to treatment

People with bipolar disorder may be more likely to seek treatment during depressive episodes. Hypomanic episodes may go unnoticed, and those experiencing a manic episode may struggle to know they need help. Manic episodes may also make it difficult for someone with bipolar disorder to trust their therapist or doctors. For example, someone who is experiencing paranoia during a manic episode may have a difficult time trusting their therapist enough to open up about what they are experiencing, or they may skip their medications as they don’t trust the doctor who prescribed them or believe someone is out to get them.

Get support for your mental health

Talk therapy can be a helpful tool for someone with bipolar disorder. Working with a therapist can help those with this condition develop coping skills, learn about their diagnosis, and identify factors contributing to mood swings. However, those facing therapy barriers might not reach out due to finances, time, or accessibility challenges. 

Individuals might consider online treatment for convenient care. When you sign up for an online therapy platform like BetterHelp, you can work with a licensed mental health professional from home. On these sites, people are often matched with a therapist within 48 hours, and clients can change therapists at any time for no fee until they find a fit. 

Research has found that online therapy can be as effective as in-person treatment. One study found that online mindfulness-based psychotherapy was effective for treating people with late-stage bipolar disorder, with study participants reporting increased quality of life. Researchers concluded that “mindfulness-based psychological therapy for late-stage BD appears feasible and effective.”