Bipolar disorder, formerly known as manic depression, is a mental illness characterized by extreme shifts in mood and energy levels. People with bipolar disorder alternate between episodes of mania (elevated mood and energy) and depression (low mood and energy). These mood shifts can impact a person’s ability to make sound decisions.
What is bipolar disorder?
Bipolar disorder is a chronic mental health condition that causes dramatic fluctuations in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. There are several types of bipolar disorder:
- Bipolar I disorder involves episodes of severe mania and depression.
- Bipolar II disorder involves milder episodes of hypomania (less intense mania) and depression.
- Cyclothymic disorder involves fluctuating hypomanic and depressive symptoms that don’t reach full manic or depressive episodes.
- Other specified and unspecified bipolar disorders apply to cases that don’t fit the clinical criteria for bipolar I, II, or cyclothymic disorder.
During manic episodes, a person may experience symptoms like:
- Feelings of euphoria, extreme optimism, or inflated self-esteem
- Racing thoughts and rapid speech
- Increased physical and mental activity and energy
- Impulsiveness and poor judgment
- Reduced need for sleep
- Reckless behavior such as spending sprees, unsafe sex, or risky business investments
During depressive episodes, a person may experience symptoms like:
- Feelings of sadness, hopelessness, or emptiness
- Loss of interest in activities once enjoyed
- Changes in appetite and sleep patterns
- Difficulty concentrating or making decisions
- Fatigue and lack of energy
- Thoughts of death or suicide
Episodes can last weeks or months. The extreme mood shifts of bipolar disorder can disrupt relationships, career goals, and day-to-day life.
How might bipolar disorder impair decision making?
Some key aspects of sound decision making include:
- Carefully considering alternatives
- Evaluating the pros and cons of each option
- Thinking through potential consequences
- Making choices in line with long-term goals and values
During manic or depressive phases, these aspects of decision making may be compromised in the following ways:
Mania and impulsive decision making
When experiencing mania, a person often exhibits poor judgment and impulsivity. The manic state is characterized by racing thoughts, inflated self-confidence, and a reduced need for sleep. This can lead to impulsive and potentially dangerous decisions.
For example, a person may:
- Spend large sums of money on unnecessary purchases due to impulsiveness and feelings of euphoria
- Make risky business or investment decisions due to inflated optimism and self-confidence
- Engage in reckless activities like substance abuse, unsafe sex, or dangerous driving due to poor impulse control
- Make major life choices like quitting a job or ending a relationship on a whim rather than rationally evaluating the options
Depression and indecision
During periods of depression, making any decision at all can feel impossible. Depression is characterized by lack of energy, loss of interest, and difficulty concentrating. A person may experience:
- Analysis paralysis – the inability to weigh options and make choices due to sadness, apathy, and poor concentration
- Avoidance – delaying or avoiding necessary decisions entirely
- Low motivation – lacking the drive to follow through on choices due to feelings of hopelessness
As a result, major life decisions and responsibilities may be neglected. For example, a person may:
- Put off seeking treatment for their bipolar disorder due to feelings of hopelessness
- Avoid social interactions and isolate themselves from friends and family
- Struggle to perform well at work or in academics due to difficulty concentrating, following through, and meeting deadlines
How do mood stabilizers for bipolar affect decision making?
Medications used to treat bipolar disorder, such as lithium and certain antipsychotic drugs, can also impact decision making abilities. These medications are used to regulate mood and prevent manic and depressive episodes. Possible side effects include:
- Drowsiness and fatigue – May impair ability to pay attention to details and carefully consider options
- Dizziness or lightheadedness – Can make it hard to focus while weighing pros and cons
- Mental fog – The feeling of cloudy, sluggish thinking; can slow down speed of processing information needed to make timely choices
- Lack of coordination or unsteady gait – May impact physical actions needed to carry out decisions
- Flat affect or emotional blunting – Reduced ability to experience emotions; may lead to seeming indifference and inaction
These potential medication side effects can negatively interact with the symptoms of bipolar disorder during depressive episodes, exacerbating issues like fatigue, motivation, and indecision.
Can therapy and lifestyle changes improve decision making in bipolar disorder?
Yes, certain psychosocial treatments and lifestyle habits can support healthy decision making for those with bipolar disorder.
Psychotherapy
Talk therapy approaches like cognitive behavioral therapy (CBT) aim to provide tools for making balanced decisions by:
- Slowing down racing thoughts to evaluate all options during mania
- Setting manageable goals to overcome avoidance and inaction during depression
- Re-framing negative thought and behavior patterns
- Practicing progressive muscle relaxation to reduce impulsiveness
Interpersonal and social rhythm therapy helps create daily routines and behavioral patterns that support effective decision making.
Psychoeducation
Education about bipolar and its effect on moods, thinking, and judgment can provide greater insight into one’s behavior. This allows for:
- Recognizing when mania or depression is influencing decisions
- Identifying triggers for impulsive or avoidant choices
- Planning ahead for periods of vulnerability
- Communicating openly with loved ones about impaired decision making ability
Lifestyle habits
A healthy lifestyle can also foster sound decision making by:
- Regulating sleep – Getting adequate, consistent sleep prevents mania-fueled late nights and depression-induced hypersomnia.
- Managing stress – High stress exacerbates symptoms, impacting judgment. Yoga, meditation, and relaxing hobbies can help.
- Exercising regularly – Routine physical activity boosts endorphins and stabilizes mood. It also enhances concentration and motivation.
- Eating a nutritious diet – Providing the body and brain with essential nutrients supports overall mental health and cognition.
- Practicing mindfulness – Staying present in the moment reduces impulsiveness and knee-jerk decision making.
How can loved ones support the decision making process for someone with bipolar?
Family and friends can help a loved one with bipolar make sound choices by:
- Providing perspective during manic or depressive episodes
- Staying patient and offering encouragement to combat avoidance
- Reminding them of long-term goals and values
- Helping research options and evaluate pros and cons
- Ensuring any decisions align with treatment plans
- Being a sounding board before finalizing major choices
- Celebrating successes and offering non-judgmental support if choices don’t work out
However, it’s important not to be overly restrictive or controlling. The goal is to empower your loved one to make their own informed decisions.
When is someone with bipolar incapable of making their own decisions?
In severe cases of mania or depression, an individual may exhibit such poor judgment that they are legally incapable of making competent decisions about their wellbeing and finances. Warning signs include:
- Active suicidality or threats of self-harm
- Extreme impulsiveness that poses imminent danger to self or others
- Psychosis – detached from reality, experiencing hallucinations
- Catatonia – lack of speech, movement, and response to stimuli
- Severely compromised ability to care for oneself; not eating, bathing, etc.
- Recklessly spending through all assets and resources
In these scenarios, seeking guardianship through the legal system may be necessary to protect the individual. This decision should be made in consultation with mental health professionals and attorneys. With proper treatment and support, the person can often regain the capacity for autonomous decision making.
Conclusion
Bipolar disorder can significantly impact decision making abilities. Impulsiveness, avoidance, racing thoughts, poor concentration, and extreme shifts in mood or energy levels can all impair judgment during manic or depressive episodes. However, through comprehensive treatment plans, psychotherapy, lifestyle changes, social support, and understanding warning signs, many people with bipolar learn to successfully navigate their choices and lives.
