If your bipolar symptoms don’t notably interfere with your daily life, your healthcare professional might say you’re “high functioning.”
Bipolar disorder is a chronic mental health condition marked by significant shifts in energy and mood as well as altered thinking. Symptoms vary widely from person to person and may change over time.
When someone’s symptoms aren’t having a major impact on activities in their day-to-day life, they may be referred to as having “high functioning” bipolar disorder.
It’s important to note that “high functioning” is not a clinical diagnosis and doesn’t necessarily reflect your symptom level nor the impact the disorder has had on your inner life. Your level of functioning can also change over time due to a range of factors, including life stressors and changes to your treatment plan.
The term “high functioning” doesn’t have a clear medical definition. Some clinicians use it to refer to people who require a lower level of assistance for daily activities. But terms like “high functioning” and “low functioning” don’t account for people’s unique life circumstances, abilities, and strengths. It’s best to avoid using this kind of language outside of a conversation with your healthcare professional.
If you have bipolar disorder and appear to function well in daily life despite your symptoms, your healthcare professional might refer to you as high functioning. This might mean you have a job, are able to maintain strong personal relationships, and live independently.
A healthcare professional might refer to someone with high functioning bipolar disorder as having:
- milder symptoms, such as reduced severity or frequency of mania or depression
- symptoms that don’t impact your ability to work
- symptoms that don’t negatively impact social relationships
One study of 145 people with bipolar disorder found that 22.8% of participants (33 people) had high levels of psychosocial functioning. Psychosocial functioning refers to someone’s ability to navigate everyday tasks and maintain relationships.
In this study, predictors of higher psychosocial functioning included:
- having bipolar disorder type II
- higher educational level
- better performance in verbal memory, attention, and executive functions
In addition, while this study found that participants with bipolar II had better functioning, this isn’t always the case (more on this later).
Bipolar disorder is sometimes described as a spectrum disorder because symptoms can vary greatly from person to person. They can also change over time.
Whether a person is considered high or low functioning, bipolar disorder always involves some level of mania or hypomania, and in most cases, depression.
Mania can involve:
- extreme feelings of excitement or elation
- unusually high energy levels
- having grand ideas and plans
- feeling self-important
- not feeling like eating or sleeping
- talking very loudly or quickly
- illogical reasoning or delusions
- making high risk or unusual decisions one wouldn’t typically make
Hypomania involves similar symptoms, but they’re typically less severe and don’t last as long.
During a depressive episode, you might have the following symptoms:
- extreme sadness or feeling low
- loss of interest in previously enjoyed activities
- feelings of hopelessness or worthlessness
- very low energy levels
- memory and concentration difficulties
- feelings of guilt
- low appetite
- suicidal ideation
Manic and depressive episodes usually don’t occur together at the same time. Instead, you’ll likely experience rapid fluctuation in your symptoms. When depressive symptoms do occur at the same time as manic symptoms, it’s called bipolar disorder with “mixed features.”
Certain criteria must be met to receive a diagnosis of bipolar disorder, regardless of function level.
Again, high functioning bipolar disorder isn’t a recognized diagnosis. Instead, your healthcare professional might make a diagnosis of bipolar disorder, but note that you’re considered high functioning if symptoms don’t currently have a major impact on your daily life.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a diagnosis of bipolar I or II requires that three (or more) of the following symptoms be present (four if the mood is only irritable):
- inflated self-esteem or feelings of grandiosity
- racing thoughts or wild ideas
- decreased need for sleep (may feel rested after only a few hours of sleep)
- excessive focus on goal-oriented activities (either socially, at school/work, or sexually) or psychomotor agitation
- excessive talking or pressure to continue talking
- engagement in high risk activities
- trouble concentrating
In bipolar I, the episode must last at least 1 week and be present most of the day, nearly every day (or any amount of time if hospitalization is necessary).
In bipolar II, hypomania needs to last at least 4 consecutive days and be present most of the day, nearly every day.
Some people may believe that bipolar II is a less severe form of bipolar, but this isn’t true. While mania symptoms tend to be less severe in bipolar II,
Other types of bipolar disorder include:
- rapid-cycling bipolar disorder (four or more episodes of mania, hypomania, or depression within a year)
- cyclothymic disorder (multiple episodes of hypomania and depression occurring at least 50% of the time over a 2-year period ).
Bipolar disorder is a chronic condition that responds best to a long-term treatment plan.
Medications for bipolar disorder can help stabilize your moods and reduce the impact of your symptoms on daily life.
Bipolar medications may include:
- Lithium: This medication is the first-line treatment for bipolar disorder. Lithium helps prevent both mania and depression (depression to a lesser extent). It may also help with aggressive or self-harming behavior.
- Anticonvulsants: These medications may be prescribed to treat mania either alone or with another medication. They are often prescribed for people with rapid cycling bipolar.
- Antipsychotics: Antipsychotic medications may help with acute mania and depression.
- Antidepressants: These may be prescribed with mood stabilizers, like lithium, to help treat depression in bipolar disorder. Their use in bipolar disorder is
controversial, however, because many experts say they can trigger mania, worsen rapid cycling, or show no benefit at all.
Cognitive behavioral therapy (CBT), in combination with medication, may also be helpful for people with bipolar disorder. CBT is a type of psychotherapy that helps you identify and change untrue or unhelpful thinking patterns.
- improve depressive symptoms
- reduce mania severity
- improve psychosocial functioning
- recognize or anticipate the onset of a manic or depressive episode, making it easier to seek support
The best treatment option for you will depend on a range of factors, including your symptoms and any other health conditions you might live with. Your healthcare professional will work with you to develop a treatment plan that’s tailored to your needs.
Bipolar disorder can have an impact on many aspects of daily life, from work to personal relationships. If a healthcare professional refers to you as having high functioning bipolar disorder, it means your symptoms don’t have a significant impact on your daily life.
It’s important to note that your level of function may change over time, often due to factors beyond your control. For example, maybe you find a job that makes proper accommodations to meet your needs, allowing you to function better at work and home.
In addition, being high functioning doesn’t mean you don’t experience symptoms. Even if you feel your symptoms don’t significantly impact your daily life, working with a mental health professional to develop an effective treatment plan can help to improve your quality of life.