Anything that changes how we view ourselves and the identity we’ve created can feel unsettling—especially when it’s a mental health diagnosis later in life. The term “bipolar” often gets thrown around casually in everyday conversation, leading to misconceptions and associations that don’t reflect the reality of the condition. It’s not surprising, then, that many individuals feel apprehensive when they receive an official bipolar disorder diagnosis.
Key Article Takeaways
Whether you or a loved one have been recently diagnosed or believe you have bipolar disorder, here’s what’s important to know: with proper understanding and treatment, there is hope.
We sat down with Jacqueline Lord, LMSW, Lead Senior Therapist at The Dorm NYC, to discuss how bipolar disorder (Type I, Type II, and Cyclothymic) affects young adults, what diagnoses look like, and if it truly is possible to develop it later in life.
What is the first thing people should keep in mind with bipolar disorder?
Jackie Lord, LMSW: One of the key things to understand about bipolar disorder is that it can involve mania, hypomania, and sometimes depressive episodes.
At times, this diagnosis is determined during or shortly after experiencing symptoms of euphoria, a really elevated mood, and risky behavior — to name a few features of mania and hypomania. This can include risky sexual behavior, reckless driving, excessive spending, rapid speech, and little to no sleep (sometimes for days or even weeks on end).
During a manic or hypomanic episode, we often see individuals with bipolar disorder experiencing grandiose thoughts. If they have Bipolar 1, they might experience more psychotic symptoms, which can include thoughts of having superior intelligence, superior talent, superior knowledge, or hallucinations.
These symptoms can be difficult to make sense of—whether you have the diagnosis yourself or are supporting a loved one.
For loved ones, it might seem confusing because they’re not witnessing those symptoms all the time and may even be witness to both sides of the spectrum (mania to depression). The manic episode would be marked by lasting a week or more (nonstop), with a depressive episode potentially following this.
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What signs should people watch for if they suspect that they, or a loved one, may have bipolar disorder?
Before jumping to conclusions, it’s important to know that a diagnosis is really just a framework for understanding what’s happening and how to support yourself or a loved one. Once you are aware, then you and your provider(s) can move through treatment in a way that is tailored to your needs, goals, and preferences.
Boiled down, bipolar disorder is characterized by a distinct amount of mood dysregulation—extreme highs and lows.
Low lows, or major depressive episodes, can include:
- Isolation and withdrawing
- Loss of interest in activities or things that used to be important or passionate about
- Low sense of self
- Loss of appetite or overeating
- Apathy or numbness—sometimes depression isn’t just sadness, it’s marked by not feeling anything at all
High highs, or manic episodes, are normally characterized by:
- Euphoric elevated mood
- Risky sexual behavior
- Recklessly driving
- Impulsively spending excessive amounts of money
- Grandiose thoughts and psychotic features
With grandiose thoughts and psychotic features, people can see themselves as having superior intelligence or superior talent. With psychotic features, people can be hearing things or seeing things, feeling things or smelling things that are not actually present.
How would you treat someone with bipolar disorder?
The first thing is often medication. This is a big part of treating bipolar disorder, at least in the initial stages.
There are a couple of stages with medication that a psychiatrist would help a client go through; first, treating it for the acute episode. Initially with bipolar disorder, someone may be a harm to themselves or a harm to others, without always recognizing this harm in the midst of the experience, so a lot of the time there would be a hospitalization and a period where they’re able to recover and have significant support around them.
If someone were to come to The Dorm for bipolar disorder treatment, for example, treatment would include:
- Individual therapy (CBT & DBT)
- Group therapy
- Family therapy
- Psychotherapy / Psychoeducation
- Trauma therapy, if necessary
- PM Process (Psychosis/Mania Group)
Individual therapy involves CBT (cognitive behavioral therapy) to explore how experiences and beliefs influence feelings and behaviors.
In psychotherapy, we’re exploring some of the experiences that have led to beliefs about self, others, and the world around you. Someone with bipolar disorder may need time in therapy to understand what was going on leading up to that manic episode or the depressive episode. There might be trauma therapy involved, but the initial part of treatment has more to do with understanding psychoeducation and what’s going on, especially if this is someone who has recently gotten a bipolar disorder diagnosis.
In group therapy, it’s really important that clients are also learning DBT skills because dialectical behavioral therapy teaches them concrete ways, in all different types of settings, to check in with themselves and learn how to regulate when they’re feeling triggered, overwhelmed, or withdrawn. It’s a mix of psychodynamic work and skills-based work.
We also like to pair that with family therapy because when we think about what it means to support a loved one who has bipolar disorder, it’s really important that the entire family is on board with understanding it as much as the person who has the disorder. This way, there’s open communication that’s not stigmatizing, but really supportive.
How do you help clients process a bipolar diagnosis received later in life?
When coming to a therapy session, sometimes clients may feel fear or distrust: Is this person actually going to understand me? Am I meeting with a therapist who is going to look at me like some sort of science experiment?
The first thing is always creating a space that is safe, while expressing empathy and awareness for all of the nuances around the impact of this disorder. If someone was diagnosed years ago but never connected with it or felt terrified by it, revisiting the diagnosis can bring up a lot of emotions. There’s stigma in society, loved ones who have been impacted by it, and at times traumatic experiences that have been connected to or repressed by the symptoms of bipolar disorder.
Building rapport with someone who has bipolar disorder—especially someone really creative—involves understanding:
- What are their passions?
- What do they love?
- What in the arts do they feel so drawn to and connected to?
In treatment, there’s often a strengths-based approach around learning what this person is interested in and empathizing with the complicated feelings—understanding the parts of the manic episode that also felt really good and satisfying to the person. At the same time, understanding the high highs can also open up doors and unveil that prior to the manic episode, they may have been feeling really lonely.
A lot of times when I’m sitting with a client processing their manic episode and we push back further in the timeline to understand where they were before it escalated, there’s often a sense of isolation, discontentment, anxiety, or feeling unstable in life. The scariest part about recovering from the manic episode is sometimes being brought back to those memories and sitting with the self-doubt or insecurities that were hidden beneath/before the manic episode took place.
We eventually want to get to a place where in recovery, they’re starting to feel more comfortable in social, school-related, career-related, or volunteering-related environments, and feeling connected to the things they’re passionate about. This is only made possible by all the different facets of treatment working together: group work, individual work, family work, medication, and exploring talents and interests that they value.
What misconceptions do clients have about bipolar disorder?
There’s a long history of people with bipolar disorder being labeled ‘crazy.’ Part of this stigma is due to a lack of information and awareness, and another part can also stem from people who’ve been negatively affected by someone with untreated bipolar disorder.
What can be really difficult is when someone is coming to terms with what this diagnosis means: Wait, it’s chronic and I have it for the rest of my life. There’s something to be said about it feeling like a death sentence and feeling like, “Well, I’ve had multiple hospitalizations. It’s just going to be the rest of my life.”
But here’s the thing: If someone is really open to treatment recommendations and understanding what their diagnosis means and requires—doing the hard work of individual therapy, group therapy, medication management, family therapy—there is hope.
The beauty of taking that time is to be able to slow down in a treatment setting, and get to know themself, the nature of how to work with and not against this disorder, and to experience life in a more balanced yet creative way. After moving through the initial stages of treatment, a season may come in the future where hypomania or some depressive symptoms are triggered, and with the new insight, awareness, and caring habits, you have learned what you need and how to manage what’s coming up alongside your support system.
This means that the more someone is going through life and experiencing bouts of these symptoms, they actually feel a lot of safety, knowledge, and comfort in what needs to happen next—which does not necessarily mean going back to treatment. It might just mean a different regimen for what their lifestyle has to look like temporarily and ways to take care of themselves.
A big misconception is that it’s this thing that’s doomed to be this cycle where you’re falling back into the most severe place you’ve been in the past. That’s not the reality with proper treatment and support.
Can bipolar disorder develop later in life, or was it always there?
It’s common that bipolar disorder was present earlier but went undiagnosed. Someone may have lived with symptoms for years, thinking “this is just my MO” or “this is normal for me”—especially if a family member also experienced similar patterns without treatment or diagnosis.
The disorder can become more apparent in young adulthood when life stressors intensify. The pressure of school, work, relationships, or major transitions can bring a spike of mania or a depressive episode, leading someone to finally seek help and receive a diagnosis. It’s not that the disorder suddenly appeared—it’s that the symptoms became impossible to ignore.
What advice do you have for young adults who were diagnosed with bipolar disorder later in life?
It’s really important that first and foremost, you’re creating a safe and empathetic space for yourself. This diagnosis at the end of the day comes with a lot of stigma and lack of awareness, and it can feel really isolating. I always see this disorder in people who are so lovely and creative and see the world in a way that can go against the norm or the grain—which is something we value in the world. But in certain settings growing up, maybe in a school setting, people have not always felt understood and seen.
Be open to treatment, even if it only feels like a small part of you is open to it. It can thoroughly change your life. When you’re open to understanding more about yourself and your story, you will feel more strength and freedom in life. It’s hard work, but taking it a day at a time with someone who cares about you will make all the difference. Over time too, you’ll have the awareness, skills, and knee-jerk response to how you’re going to respond the next time symptoms come up, and this time it won’t feel like you’re drowning and coming up for air, or stopping yourself on the high of a roller coaster. You’ll feel safety, knowledge, and comfort in what needs to happen next.
Thank you, Jackie, for taking the time to talk with us about the treatment and development of bipolar disorder in young adults.
Young Adult Bipolar Disorder Treatment at The Dorm
Living with bipolar disorder can feel overwhelming with periods of extreme highs and lows, especially when you don’t have the tools to manage your emotions. At The Dorm, we use evidence-based approaches to help young adults with bipolar disorder learn to manage their symptoms, build confidence, and engage more independently in life. Our approach has helped clients achieve an 37% reduction in depressive symptoms, creating meaningful progress toward stability and independence.
Learn more about who we treat and our unique community model.
