Reviewed by Tanya Harrell, PhD, LPC, NCC
The term “high functioning” is dependent on the diagnosis, and the term means different things depending on the disability or severity of the disability. As bipolar disorder is a broad spectrum, high functioning can mean many different ways of life. This article will help to break down the signs and symptoms of high functioning bipolar disorder.
Key Symptoms of Bipolar Disorder
The signs and symptoms of high functioning bipolar disorder are almost identical to “regular” bipolar disorder, but the high functioning person simply manages the symptoms better. Furthermore, the severity of bipolar disorder changes with the different types and with each person.
Bipolar disorder is defined by the National Institute of Mental Health as, “a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.”
The severity of these symptoms varies on the bipolar spectrum. The first task of this article is to break down that spectrum to show you where you might fall as someone with high functioning bipolar disorder. As you will soon understand, someone high functioning with severe Bipolar 1 will look much different than someone high functioning with a mild case of cyclothymia.
Bipolar Diagnosis Difficulties
According to a pair of surveys completed by the National Depressive and Manic-Depressive Association, bipolar disorder is frequently undiagnosed and misdiagnosed. The studies explain that 69 percent of patients with bipolar disorder receive a misdiagnosis initially, and over 33% of patients remain misdiagnosed for over 10 years. The mean time for a diagnosis reaches between 5.7 to 7.5 years.
Many of the people with high functioning bipolar disorder do not even know they have bipolar. Because they do such a good job of managing the symptoms on their own, people with high functioning bipolar disorder can go years without a diagnosis. Underdiagnosing and misdiagnosing are important aspects of high functioning bipolar disorder.
The Main Types of Bipolar Disorder
You may have heard before that someone is “on the bipolar spectrum.” It’s important to note that on this spectrum, there are a wide variety of symptoms that people with bipolar disorder have. The disease is most certainly not a one-size-fits-all diagnosis.
The most well-known form of bipolar disorder is Bipolar 1. To be diagnosed with Bipolar 1, people need to experience at least a single manic episode along with a history of depressive episodes. Unchecked and untreated, full manic episodes are often quite severe. People experiencing manic episodes can spend months in an elevated mood filled with reckless, excessive, and/or psychotic behaviors and thoughts. Since the presence of clinical mania can be so strong, people experiencing manic episodes are often identified as individuals with mental illness.
However, individuals are still often misdiagnosed with a variety of other severe illnesses like schizophrenia, schizoaffective disorder, or depression. Furthermore, between periods of mania, individuals with Bipolar 1 can show mostly symptoms of depression and other comorbid disorders, which can further mask the presence of bipolar disorder and confuse the proper treatment of the illness.
It is very possible to receive a clear diagnosis for Bipolar 1, and close work with a professional is highly recommended. You could start by taking a bipolar diagnostic test at https://www.mind-diagnostics.org/bipolar_disorder-test.
High functioning Bipolar 1 is the appropriate handling of the same symptoms that someone who struggles with Bipolar 1 deals with. A person with high functioning Bipolar 1 puts effort into self-care, maintenance, and works with doctors to try to manage their mood swings.
Depending on the severity of the case, the results for a high functioning person may vary. They may still be considered high functioning but struggle with work, relationships, and daily activities. Like bipolar disorder itself, high functioning bipolar disorder is a spectrum.
Bipolar 2 can sometimes be even harder to diagnose than Bipolar 1 because people with Bipolar 2 have hypomania instead of mania. Bipolar 2 revolves around recurring episodes of hypomania and depression.
Though potentially very serious, hypomania is a less severe version of mania. Since it is often less severe, hypomania may lurk hidden without a patient or doctor being able to notice them. Treatment for hypomania is crucial because hypomania can lead to debt, substance abuse, workplace difficulties, and relationship troubles, all of which can cause extreme stress. Though hypomania is classified as a less severe form of mania, it must be taken seriously by all those involved.
For someone who is high functioning bipolar, hypomania may be able to disguise itself. Spending habits, relationship decisions, or workplace happenings may seem somewhat rational when they are a product of an elevated mood.
While hypomania may be able to hide under the wire, patients with Bipolar 2 often get misdiagnosed with chronic depression. You may have a depression test, have high anxiety, have to get sober, and be treated for depression, anxiety, and attend AA meetings, and all the while you are going through Bipolar 2. This confusion can be extremely dangerous because people with Bipolar 2 often require different medications and treatment than someone with chronic depression, anxiety, or substance abuse alone.
It is very possible to be high functioning with Bipolar 2 and have no idea you have it. An open dialogue with qualified medical professionals will most likely lead to a correct diagnosis eventually, but there may be some twists and turns along your journey. However, it’s important to note the strides being made in both treatment options and the professional understanding of the bipolar spectrum.
The meaning of high functioning Bipolar 2 varies from case to case. Some people with high functioning Bipolar 2 can lead companies, while others take victories in their friendships and garden.
Cyclothymia can be difficult to diagnose because the symptoms are mild and can be continual. Thus, it can be hard for a person and their team to differentiate the normal life of the person from the illness. This “milder” form of bipolar disorder can truly hinder relationships, personal goals, and work, and it should be taken seriously.
Though they do not have the same severe highs or lows of Bipolar 1 and 2, people with cyclothymia benefit from treatment, and the disease should be taken seriously. It is quite possible for someone to have cyclothymia, thrive in their lives, and have no idea that they have unusual deviations in their mood.
People with cyclothymia are often more classically successful than people with Bipolar 1 and 2 because their symptoms are less severe. People experiencing high functioning cyclothymia can be at the top of their professions.
“Not Otherwise Classified”
This last term is a “catch-all.” Remember, the classifications of the mentally ill, as defined by the Diagnostic and Statistical Manual of Mental Disorders, is an ongoing work in progress. Doctors and counselors will often encounter someone who meets several qualifications of bipolar disorder, but they do not quite fit the mold of an official diagnosis. These people are told that they are on the bipolar spectrum because they experience unusual highs and lows without meeting the criteria of the DSM-5.
The important aspect of high functioning for these people on the bipolar spectrum is to do their best with where they are at on the spectrum.
Bipolar disorder is sometimes called the “CEO’s Disease” because some people can consistently thrive with the disease to the betterment of their work productivity. It often refers to people who are not classified or diagnosed, which has included people such as Winston Churchill or Elon Musk, though this is only speculative.
According to Business Insider, there is some serious math to back up this speculation of a CEO’s disease. The site states that people with bipolar disorder make 43% less than others on average. However, the top functioning individuals are 8% more likely to be in the 90th percentile of wages.
Sometimes bipolar disorder can manifest itself as an advantage in the business world. Every so often, high functioning bipolar disorder can refer to high stakes business. It would be misleading to focus on these uncommon occurrences, and it is important to touch upon the spectrum of the meaning of high functioning bipolar.
Surviving and Thriving with Bipolar Disorder
Surviving bipolar disorder is a lifelong goal, and it affects everyone on the bipolar spectrum. It means taking basic care of yourself to the best of your ability, following treatment plans, and hopefully seeking to meet your potential in life. It is a commitment of a lifetime.
Thriving with bipolar disorder is going to be as wide and broad as the spectrum of bipolar disorder itself. For a severe case of bipolar disorder, thriving with bipolar disorder is going to look much different than someone with a simpler case.
Someone who is high functioning with bipolar disorder may be high functioning at times and just getting by at other times. That’s okay. No matter what you’re experiencing, your feelings are valid.
Overall, you may be high functioning on the bipolar spectrum and not know it, you may be aware of it, or maybe you are more on the survival side. Whatever it may be, there is always help available.