Bipolar Disorder Mixed Episodes are the Most Severe and Dangerous Type of Bipolar Disorder

What is Bipolar Disorder?

In most forms of Bipolar Disorder, moods alternate between manic and depressed episodes over time.

  1. A manic episode or mania is a mood state characterized by a period of at least one week where an elevated, elated, expansive or unusually irritable mood exists, with decreased need to sleep, high energy and racing thoughts.
  2. A depressive episode is a primarily depressed mood for two or more weeks and a loss of interest or pleasure in everyday activities, accompanied by other symptoms such as feelings of despair, hopelessness, worthlessness, emptiness, anxiety, guilt, irritability, changes in appetite, problems concentrating, remembering details or making decisions, insomnia or sleeping too much, and thoughts of suicide (suicide ideations) and suicide attempts.

What is Bipolar Disorder With Mixed Episodes?

  1. A mixed episode (DSM-IV) is not a disorder itself, but rather is a description of a component of a specific type of Bipolar Disorder. A mixed episode is defined by meeting the diagnostic criteria for both a manic episode as well as a major depressive episode nearly every day for at least a full week.
  2. A person with mixed episodes experiences symptoms of both mood “poles” of mania and depression simultaneously.
  3. The term”mixed episode” was changed to “mixed features” in the last edition of the Diagnostic and Statistical Manual (DSM-5) published by the American Psychiatric Association in 2013. The new term “mixed features” means the same as the term “mixed episodes” and may apply to either episodes of mania with additional symptoms of depression or episodes of depression with additional symptoms of mania.
  4. The presence of both mania and depression can exist in a person with Bipolar Disorder at the same time.
  5. Mood episodes with mixed features can last from days to weeks or sometimes months if untreated correctly for that individual. They may recur and recovery can be slower than during episodes of “pure” bipolar depression or “pure” bipolar mania or hypomania.
  6. Mixed episodes are the most severe and dangerous type of Bipolar Disorder to have. Mixed episodes or mixed moods severely impair judgement and carry a more significant risk for suicide.

I have Bipolar Disorder 1 with mixed episodes and rapid cycling (usually ultra rapid cycling) and I also have some occasional psychotic features. I will discuss both rapid cycling and psychotic features in future posts.

What Does Living with Bipolar Disorder with Mixed Episodes Feel Like?

  1. My brain is in a constant battle within itself fighting over everything and nothing and no one ever wins.
  2. Inside my body I feel the surge of excess energy without the ability to turn it off or turn my excess energy into something good or productive. The mania gives me high energy and my depression causes me to have no energy causing my energy circuit breakers to explode, spark and ignite into nothingness.
  3. The fighting of both mania and depression at the same time actually causes my brain to stop and shut down until I become stuck unable to do anything.
  4. My energy becomes worthless wasted energy swirling around and around bombing my body internally hitting the edges of my inner layers of fat, nerves and skin ricocheting repeatedly and bouncing around until it forms an electricity of some wasted kind. The currents go off like painful bombs exploding like shrapnel inside my mind and body wasting my time, days, and life.
  5. I become immobilized within myself until I become stuck and the war inside my brain is a constant losing battle of painful gunfire and electricity surging throughout my body feeling like sharp tacks constantly stabbing at my body from the top of my head and out my strands of hair down to the bottom tip of my uncut toenails.
  6. I feel like I am running a marathon while I am sitting still becoming more exhausted with each passing mile I do not run.
  7. It is a gigantic horrific scary challenge for me to make myself do anything. I usually don’t want to do anything and most of the time I can’t. It becomes a huge battle within myself to make myself do anything causing a daily internal war of wasted unwanted dialog within in my mind.
  8. I usually isolate myself alone in my house. I want to be alone, but then feel extremely lonely at the same time. I wish I had friends, but I can’t have friends. I can’t be around people because I know they will eventually hurt me anyway, like they always do and have done in the past. It is so much easier and safer to be alone, even though I am extremely lonely.
  9. When I force myself to be around others, it is sometimes very difficult to act that I am well and happy and functioning normally within my brain and thoughts. Most people with Bipolar Disorder have learned to be wonderful actors or actresses. I actually should have won numerous Academy Awards for my acting ability by now. I have to pretend I am well by putting on makeup and hiding behind my smile even though I am crying and wounded on the inside and sometimes battling my suicidal ideations and rambling rapid racing thoughts constantly yelling at me in my brain.
  10. I talk rapidly and my thoughts travel rapidly from thought to unrelated thought.  Sometimes I talk too much. I think since I am usually alone that when I finally have someone to talk to I have so much to say that I start talking and rambling on and I just can’t stop.
  11.  Some of my racing thoughts make some sense, but most of the time they are just a bunch of loud noises and words firing around inside my brain randomly yelling at me. Some of the words are bad and unkind words to myself and about others and sometimes they are not real words at all but are strange utterances of sounds. Sometimes my brain is full of racing thoughts playing in my mind of things like fxcx, fuxx, fuxx, fuxk you, fxxk you, fxxk you, fuxx, fxcx, fuxx, stop, stop, ugh, help me, ugh, help, help, help, fxxk you, I hate you, I hate everyone, I hate you, hate you, hate you, ahhh, ahhhh, bleehhh, ba, ba, fa, fa, up, paaaa, puuu, blah,blah blah, ugh and aaaaaah! Those are just some examples of the random worthless noises filling up my brain causing anxiety and making me uncomfortable and angry.
  12. My anger and rage usually and gradually increase over time but then at the same time can change to feelings of happiness and love. The unpredictability of my feelings make it very hard to ever know what to expect each day. What do I do? Help? Someone just help me to escape the hell I am living in inside of my mind.

…..and that is what it feels like to live with Bipolar Disorder with Mixed Episodes. Ugh! It is kind of confusing, eh?

I am a survivor. I choose to live everyday, every minute, one minute at a time. I want to survive and I want to thrive and I will… and so will you.


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