Delusions: a Symptom of Psychosis in Bipolar Disorder

Causes, warning signs, and treatment options

Man gesturing to woman leaving.
Sanna Lindberg / Getty Images

Delusions are false beliefs that a person firmly holds to be true, despite what other people may think or say. They are one aspect of the psychotic features of bipolar disorder, schizophrenia, and schizoaffective disorder, as well as some other psychiatric and medical conditions.

Types of Delusions

Some common delusions include:

  • Delusions of grandeur: Believing that you're famous or publicly important or that you're a god.
  • Delusional jealousy: Believing that your spouse or partner is unfaithful when it's not true.
  • Persecutory or paranoid delusions: Believing you are being followed, spied on, secretly listened to, or the like.
  • Somatic delusions: Believing that you have some medical condition or physical defect.
  • Delusions of referenceThinking that random events contain a special meaning for you alone.
  • Bizarre delusions: Believing in things that are impossible, such as thinking you're a werewolf, that your sister is an octopus, or that giant worms make subway tunnels.

Psychosis in Bipolar Disorder

Psychosis occurs when you lose touch with reality. In other words, your thinking and beliefs become distorted and not based on what's really happening around you. It's not an illness in and of itself, but a symptom of something else.

Signs that you're having a psychotic episode include delusions or hallucinations, which are seeing and/or hearing things that no one else does.

In bipolar disorder, psychosis typically occurs during a manic episode but it can occur during a depressive episode as well. If you have psychosis, you will likely be given a diagnosis of bipolar disorder with psychotic features.

One recent large study showed that bipolar disorder with psychotic features doesn't mean that your disorder is necessarily more severe than someone with no history of psychosis, nor does it mean that your outlook is bleaker.

Rather, this study showed that psychosis is associated with more rapid cycling between mania and depression, as well as more chronic mood disturbances, such as depression and anxiety, than people without psychosis have.

Warning Signs of Psychosis

Psychosis doesn't normally happen suddenly. There are often warning signs that can let you know that it's coming, including:

  • Suddenly losing interest in the things you used to enjoy
  • Strong, unreasonable emotions or feeling no emotion at all
  • Extreme changes in your sleeping patterns
  • Being unable to do things you normally can
  • Isolating yourself more than normal
  • Your grades or work performance suddenly dropping
  • Becoming suspicious of others
  • Bizarre behavior or speaking that don't reflect reality 
  • Not bothering to invest time in personal hygiene
  • Having trouble focusing and concentrating
  • Beginning to be unable to tell what's real and what's not
  • Problems communicating, such as changing topics rapidly or speaking incoherently

Prevalence of Psychosis

Roughly 3 percent of the U.S. population will experience psychosis during their lifetime, according to the National Institute of Mental Health. Remember, you don't have to have bipolar disorder or schizophrenia or any other mental health disorder to develop psychosis.

Other Causes of Psychosis

Along with mood disorders like bipolar disorder, depression, and schizophrenia, there are other conditions or illnesses that can cause psychosis, including:

  • Being sleep deprived
  • Drug use
  • Delusional disorder
  • Head injury
  • Temporal lobe epilepsy
  • Thyroid disorders
  • Bad reactions to medications
  • Vitamin B12 deficiency
  • Huntington's disease

Treatment Options

Psychosis is treatable and most people who experience it can live fulfilling, normal lives. Early intervention makes a big difference in recovery. Treatment may include antipsychotic medications and psychotherapy, such as cognitive-behavioral therapy (CBT), supportive psychotherapy, and cognitive enhancement therapy.

If your safety is in question, hospitalization may be necessary for a time. If you're hospitalized, you will be evaluated to make sure there are no physical reasons for your psychosis.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.

Burton CZ, Ryan KA, Kamali M, et al. Psychosis in Bipolar Disorder: Does It Represent a More "Severe" Illness? Bipolar Disorders. August 23, 2017;00:1-9. doi: 10.1111/bdi.12527 .

Early Assessment & Support Alliance. What is Psychosis? 2016.

National Institute of Mental Health. RAISE Questions and Answers. National Institutes of Health.