Delusions in bipolar disorder are common. It depends on where you draw the line as to how many people actually get them. What I can say for sure is that the majority of people with bipolar disorder do experience psychosis, and delusions are commonly (although not necessarily) a part of that. Here is what we know about delusions in bipolar disorder.
What Are Delusions in Bipolar Disorder?
The concept of a delusion is a simple one: a delusion is a strongly-held false belief kept in spite of contrary evidence. For example, if I strongly believe that I am 10 feet tall, and I insist on keeping that belief even after you measure me and show me that I’m not, that is an example of a delusion.
Delusions are part of psychosis in bipolar disorder. Psychosis is defined as the presence of delusions and/or hallucinations. (Hallucinations being a topic for another day.) In other words, if you’re suffering from delusions in bipolar disorder, you are exhibiting psychosis.
Who Gets Delusions in Bipolar Disorder?
If really depends on who you ask as to how many people with bipolar disorder experience delusions.
As stated, delusions are part of psychosis. By definition, psychosis does not exist in bipolar disorder hypomania. Psychosis can exist in bipolar mania, depression or mixed moods, however. Bipolar mania is when delusions are most commonly experienced so delusions are more common in bipolar disorder type I.
(It was previously thought that psychosis couldn’t exist in bipolar disorder type II at all, but this is no longer thought to be true. Those with bipolar II can still experience psychosis, just not as a part of hypomania. This is clearly recognized by the latest Diagnostic and Statistical Manual of Mental Disorders wherein they note that the specifier “with psychotic symptoms” can be applied to moods regardless of diagnosis.)
In a decent-sized study in 2019, 73.8% of people with bipolar disorder type I had experienced psychosis in general over the course of their illness and 68.9% of people with bipolar disorder type I had experienced delusions specifically. As these numbers suggest, delusions are the more common symptoms of psychosis in bipolar disorder.
In short, if you’ve experienced delusions as a part of your bipolar disorder, you are not alone.
What Are Delusions in Bipolar Disorder Like?
There are parts of delusions in bipolar disorder that are a bit understudied and this is one of them. First-person accounts of bipolar delusions aren’t common in the literature. That said, delusions in bipolar tend to surround (source one, source two):
- Persecutory themes (thinking that harm is being done to the person or that harm will be done to the person and that there is someone intent on causing harm) E.g., My wife is trying to kill me by poisoning my food.
- Grandiose themes (also known as delusions of grandeur; beliefs that one is incredibly famous, omnipotent, a deity, etc.) — E.g., I am the returning savior and I can walk on water.
- Referential themes (thoughts that normal, everyday events and behavior have hidden meanings and relate to the person) — E.g., The billboards on the side of the road have hidden messages for me.
- Religious themes (obsession with religious subject incongruent with the person and mood) E.g., I am going to reconstruct the psyche of Christ based on every religious text.
- Paranoia (thoughts of persecution, threat or conspiracy; involves intense thoughts of suspicion which may bring on fear, anger and betrayal) E.g., The FBI is reading my thoughts.
While I know that each example of a delusion may seem unbelievable, what you have to understand is that when your brain is sick, the unbelievable becomes real. As real as I am sitting on my couch right now, a reader of mine believed she could talk to the wind. She believed this so strongly, that when she was speeding down the highway, she opened her window, stuck out her arm, closed her eyes and waited for the wind to tell her when to turn.
This person is okay now, but that illustrates how serious these beliefs are. Bipolar delusions don’t go away through logic or contrary information. That is why they are a symptom of a mental illness. They are very sticky and debilitating, indeed.
If you are suffering from bipolar delusions or you know someone who is, it is generally considered a psychiatric emergency and you should seek help as soon as possible. Remember, a person can die if they believe they can fly. A person can harm others if they believe those others are there to hurt them. Delusions in bipolar are not things to be taken lightly.
Banner image by Todd Huffman from Phoenix, AZ [CC BY 2.0], via Wikimedia Commons.
Image by Flickr user photographymontreal.
I was diagnosed in 1999 with Bipolar II. There is a lengthy history of bipolar illness on my maternal line. I have dated it back to my great grand mother. At the time of my dx I yelled at my therapist, “NO, I AM NOT LIKE MY MOM!” The thing I had dreaded for years. I was 38 yrs old at the time of my diagnosis but had suffered depression since about 19 yo. I work ALL THE TIME with my psychiatrist. It took years to get me stable and “dialed in” on the right meds and an the amount of the meds. I have seen him every month since last year.
I had a psychotic break just over a year ago in April 2021. They converted my diagnosis to Bipolar I. The experience has left me terrified of my disease. I took myself to the hospital after talking to my psychiatrist. I remember only flashes of the event in the beginning. Then I lost 2-3 days. No recollection at all. I was on the psychiatric ward at a large local hospital for 2-3 days and then transferred to the adult psychiatric hospital for 9 more days. I do not know if I could live through that again. I live with a lot of suicidal thoughts. Suicidal thoughts if not daily are many days per week.
I say life is just to hard. I struggle every day to feel balanced, to try to think clearly, to not be depressed. I have been diagnosed with Bipolar Depression. When I feel okay and I laugh with people I am afraid I am being hypomanic or going into a manic state. So I fear laughing too much. A fucked up boyfriend did not help. When I would laugh he would ask me “are you okay did you take your medicine” He is no longer in my life! And was a big part of my break.
How do I get over this fear? My anxiety has been intense for the last year. Nausea every day. That has left me but I am having shortness of breath and dizziness when I feel anxious now. I feel like my body and mind can not handle this for much longer. We did just tweak my meds about 3 weeks ago and I seem to feel a bit better. But………I am terrified!
How can I accept my condition and live more peacefully with it? I am getting into counseling. But it will take another 3 months to get in. I have contacted so many psychologists. I can not believe I can not get into see someone next week. I have literally been trying. I have tried to make appts 3-4 months out just to get in. Only to be told they do not take my insurance any more. I am trying so hard to do things to help me cope.
What do I do? I have returned to work as a full time physical therapist. It is going ok.
I had hallucinations. I was paranoid that something was going to happen to my boyfriend, my pets, my dad and maybe to me. I didn’t care if it was me.
I have schizoaffective bipolar type with paranoid delusions-this diagnosis from my psychiatrist of 6 years. The thing is, the paranoia that I feel does not seem as drastic as you explain. I do feel very suspicious of all healthcare providers to the point that going to a regular doctor or ER (I have no insurance) causes me extreme anxiety. Almost to the point that I would rather suffer. I did not seem to feel this way when I had insurance. You see, I believe the moment they read my medication list and no insurance they become condescending jerks that treat me like I’m a mental case and my problem is all in my head. I’ve gone to the ER with critically low potassium and was accused of being drunk, gone to the ER with lumbar disc pressing on a nerve but was told it was a strain & refused an MRI, gone to the ER after passing out from a interaction of my medication and cipro and BP of 190/120 and was asked by the doctor if I took my anxiety medication when I felt anxious. Parts of those records mysteriously disappeared and I was told no one remembers me telling them about the cipro. There’s other experiences-one thing in common, they all gave me Ativan. Did I become belligerent and difficult. Of course. They don’t listen. They see something on a chart and assume. To this day it says that I drink-something a doctor wrote over 10 years ago. I have since been asked and said I stopped drinking in January 2014. The records have not changed nor will the hospital change them. Am I delusional? Paranoid? Am I having a psychotic break? You tell me.
I realize that birds to not chirp with a German accent. That was a delusion. One that I was quite amused with and kept to myself. I was able to function and psychiatrist had changed my meds and it stopped after a couple of weeks.
I know delusions can cause harm and are dangerous. My paranoia has gotten out of hand. But how I feel about doctors, I’m not sure that is delusional. Just a thought.
My brother is suffering from delusions but flat out refuses help bc there is nothing wrong with him. He is living out of his car and no job. Has anyone tried to hire a professional interventionist to try and get help for your loved one? I have inquired about their services but they are all so expensive and the treatment centers are even worse. How can the average person afford it. It feels like there is nothing I can do except wait for something bad to happen so someone takes him to a hospital.
Hi E,
I recommend you read this post: https://natashatracy.com/mental-illness-issues/person-mental-illness-accept-illness/
You might find something there helpful, especially the suggested books at the end.
– Natasha Tracy
My husband began having irrational thoughts about me and our marriage almost 2 years ago. His thinking has is not based on anything that is real or factual. I am at the point where I want to leave him. I told him he is suffering from mental illness. He does not want to accept it. He called a therapist and is waiting to get a call back. I have been married to him for 24 years and we have never experienced anything like this before. I have been on an emotional roller coaster. I never know what he will be upset by. I can’t take it any more. I pray he will follow up and see the therapist.
Thanks for the great info on delusions. My husband suffers from some form of bipolar, diagnosed as type 2, but after 4 year of living with him I know he suffers from delusions rom time to time. Mostly they take the form of everybody is out to get him, they are spreading lies, my friends are trying to break up the marriage. He may not think he can fly, but his paranoia impacts our life together negatively. The more I learn about these things the better off we both are. I bought Marbles a while ago and it has been so helpful in getting me inside the disorder as much as I’ll ever be able to. Thanks and goooood luck!
Hi Natasha.
Good article. My delusions have covered all those themes. Coming out of a psychotic episode for me was a time of weeding. Sifting through the chaos of psychosis and removing the unhelpful or unhealthy thoughts but retaining any gems that surfaced.
Psychosis, from my perspective, was a manifestation of dissonance within me. Dissonance between who I am at the core/essence and how I actually was living my life. Bipolar Disorder became a pathway to healing; ultimately. I say this because I am not convinced that BD is not something valuable. BD may ultimately be something we get to leave behind once it has served its purpose.
This concerns me as I have had many of these, not drastic as jumping out a building thinking I could fly level — that being said, does this get worse? *on meds and self care / education for therapy.
Hi Jesse,
It’s hard to say what might happen to any individual person. I will say that if you’re in treatment and that treatment is working, you shouldn’t see a worsening of delusions.
Of course, as you know, an episode can come out of nowhere and there’s no accounting for that. That said, I would recommend learning about delusions in bipolar disorder. Talk to a therapist about what you have experienced. You can always be more prepared for what might happen and that can help.
The fact that you’re concerned about it is a good sign. It means you proactively want to learn to handle it the best you can. That’s important.
– Natasha Tracy
I have been living with bi polar disorder for my whole life. The highs and lows are difficult to cope with. I use meditation, meds and deep breathing exercises to help. I get delusions of panic with this and fear travel and being in a car. I know it is not logical, but it exists nevertheless. I am working to get through this but have had this situation for over 30 years.I like your information about persecution and paranoia as I feel both of these.
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