Responding to Bipolar Psychotic Symptoms

JUN. 24, 2019

By Amy Willer


A first experience with psychosis can be terrifying, exhilarating, disorienting or feel just plain ordinary. Sometimes it can seem ordinary because it was your reality for a while. Your senses and brain colluded to fabricate something that wasn’t actually there. It certainly felt real, though.

For example, during my first psychotic break, it felt as though my cognitive abilities had reduced to that of a toddler. I couldn’t understand what people said to me, and I couldn’t talk. It felt like I had lost my ability to process language. I locked myself in my bedroom for 48 hours and used a coloring book I had; I did this because it comforted me, and it was also the only thing I could focus on or understand. I had no sense of time—many hours would pass, and I thought it had only been a few minutes. I didn’t eat during this time, and it never occurred to me that I should eat or that I was even hungry.

Now that I have more experience managing my illness (bipolar disorder with a psychotic feature), I can look back on this experience and understand it. At the time, though, I didn’t understand anything was wrong, and even if I had, I lacked the language to communicate what I was experiencing. This was because I was not educated about psychosis—even if I understood the situation was odd, I would not have known exactly what it meant. 

Accepting a Complex Condition

The scary part of psychosis is usually the aftermath, when you realize what happened. When you first experience it, you may remember stigmatizing jokes about “crazy people” you’ve heard or news stories of violent, “psychotic” people. But the reality is more complex, and a little more painful than all that. The reality is that you are just a human being—a beautiful one, who also happens to have a mental illness.

This can be painful to accept, and there is a certain grief in admitting we don’t always have control of ourselves. However, effective treatment is available, and over time we may come to recognize the warning signs of an episode. During these signs, we may learn how to intervene for ourselves.

For example, I have many (now) predictable warning signs. I may become clumsy, lack spatial awareness and feel as though I don’t know where I am. I could become lost in a place I have been in hundreds, or even thousands, of times. I can become paranoid someone is in my house, when I know no one is. Even the sensation of sound seems to ebb and flow—seeming at first inaudible, then unbearably loud. It feels like I am drunk, when I am perfectly sober. 

As you learn how to manage your own illness, you might start noticing your set of symptoms. It can be scary to realize that you are headed for a psychotic break, but it is possible to do things that lessen the severity of, or even avert, psychosis. It’s like using an inhaler when your breath becomes heavy, rather than waiting to go to the ER with an asthma attack.

It’s not always that simple, but learning to respond effectively and without fear offers us some of the dignity we sometimes feel we lack. It empowers us to realize that we can confront this medical issue like any other—without shame. Here are some practical ways to incorporate safeguards into your own life: 

  1. Notice your condition’s patterns. How does psychosis manifest in your life?
  2. Tell somebody. Develop spaces in your close relationships for the ability to say you are slipping into a psychotic episode or that things don’t seem quite right. If it feels safer, develop a code for talking about it in public.
  3. Take medication. Establish in advance with your doctor what medication you can take. You might be able to have an as-needed medication, or agree with your doctor to take a daily, maintenance medication.
  4. Call your doctor. They are there to help. If you are afraid of hospitalization, realize that this is not always the outcome of telling your doctor about psychosis. I’ve experienced psychosis as an aspect of my illness for seven years and only been in the hospital once for it; and even then, it was my choice.
  5. Absolutely avoid alcohol. This is generally wise with mental illness, but critical in regards to possible psychosis.
  6. Know your potential hazards and act accordingly. If you experience “black outs” (dissociative amnesia), try not to drive. Ask a friend for a ride, instead. It is possible to lose total awareness of what you are doing while driving.
  7. Get sleep. Sleep deprivation is a trigger for psychosis, and quality sleep can help abate active symptoms.
  8. Develop routines around sleep, eating, medications and social time. It may seem overly strict, but it can go a long way towards preventing future episodes. For instance, I don’t answer the phone before nine in the morning, and I limit social time at night to get enough sleep.
  9. Watch something that can keep you grounded. Like your favorite movie or television show—even if you watch it on repeat! Something about the familiarity can help if you are having trouble focusing.
  10. Have a sense of humor. And finally, if you do hear voices or hide in a parking lot from the police or imagine yourself to be like Winnie the Pooh because you’ve just realized your head is made of fluff (all experiences I’ve had), learn to laugh at yourself! After all, you were Winnie the Pooh for a day.


Amy Willer is an advocate, writer, volunteer, friend and community member with bipolar I with psychotic feature and PTSD. She has survived suicide attempts twice and has overcome addictions to self-injury and anorexia. She lives in southern Arizona, and loves hiking and spending time with her friends.

Note: This piece was originally published in April 2017. 


We’re always accepting submissions to the NAMI Blog! We feature the latest research, stories of recovery, ways to end stigma and strategies for living well with mental illness. Most importantly: We feature your voices

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JUL, 07, 2018 06:45:12 AM
please see a psychiatrist dear. i can’t diagnose, I am not a doctor. my daughter was diagnosed with bipolar manic and psychosis at first. now she is Schizaffect. some of your symptoms sound familiar. Please get help.

JUN, 24, 2018 03:32:16 AM
My mother was diagnosed bipolar and I recently found out from my father that my great grandmother was hospital for 10 years (I’m not sure for what). On a daily basis I’m physically exhausted. Don’t care about personal hygiene I can go..days without showering . I’ll clean my room only if someone comes over and hours later it’s back to it’s previous state. At work I can’t focus or retain any information cognitively I feel like..I’m declining somehow. I smoked marijuana twice last week and when I do..I automatically become distrustful of everyone around me and I’m convinced everyone is talking about me and laughing at me. It’s like I anticipate it so I hear it. And I get so overwhelmed I retreat inside my self and have to shut down and try to fall asleep to make my brain stop. Without marijuana I feel like this but with it it feels impossible to escape and never ending. Last night my boyfriend had to pull me off of the train tracks. I tuned him out and kept thinking what it would feel like and at what percentage is the average person ready to kill themselves. 10? 15% ? Later that night he talked to me and he was looking at me and crying saying he loved me and he was scared but I didn’t feel anything. I don’t know where I was going with any of this but I wondered if any of this sounded like bipolar

MAR, 10, 2018 12:31:19 PM
Hi Summer,

Unfortunately nothing can make someone commit to their treatment plan. That is very scary about your mom trekking all the way across the country.

The thing is that when she is not psychotic and/or manic, she can appreciate the need for medication because she likes how she functions. But when the manic comes, as it always will (though hopefully less often), she feels great and unless a person can identify warning signs that a manic phase might be coming on, they will usually wind up in a fully manic and possibly psychotic phase. One of the biggest signs and problems of mania is an impaired judgement. By the time it becomes a full mania, there are going to be many judgements that might not be the best ones for her.

So my suggestion would be to work with her and a therapist, and other professionals as needed, in developing a treatment plan that she has ownership in. People who design their own treatment plans or at least have an active voice in it have much better outcomes in general over a longer period of time. I’d also work on that overall self-awareness, so that she knows what her indicators are, what her triggers might be and then finding ways to keep things in a relative balance.

MAR, 08, 2018 01:48:38 PM
My mother is bipolar.. had a break stayed on meds for 6 years got off got very manic then broke again quit her job didn’t get back on meds got aressted break again. She is currently being held for 10 days in a psych ward across the country after we filed a missing persons for her !;( Do u think 10 days is enough time to realize u had a break and need to take meds.. she was just hospitalized 2 months ago they only held her 5 days and she said she will take meds.. got out still manic(not psychotic anymore) and didn’t continue to take meds when released now break 2 months later , again! will 10 days make her want to really take the meds or will she still be manic and chose to stay “crazy” as she said last time????
Signed, a very tired, worried daughter of a bi polar Mom

JAN, 12, 2018 09:01:07 AM
Thank you for sharing, my daughter is bipolar w/psychosis and has been a hell for me and my family for 20 years. She refuses to listen to the people who love and care for her and now we are going on with our own lives as this has taken a serious toll on us. I appreciate you being open about it for people like us who don't know quite what's going on inside a mentally ill brain.

DEC, 22, 2017 08:45:34 AM
Thank you so much for posting/sharing. I have a dear friend who experienced a psychotic break a couple of years ago and she can't or won't talk to me anymore (hasn't since it happened). I miss her, and I wish I could tell her that I don't blame her or hold anything that she said/did against her, but I have to respect that she doesn't want to talk to me. I just don't know what is happening in her mind now. This post gives me some idea of what she might be thinking or feeling. Thank you.

SEP, 21, 2017 11:57:26 PM
Jose Barrios Vanegas
Very useful, specially when you don't know how to react. Thanks,

SEP, 10, 2017 12:05:23 AM
Hi Amy,
Looks like I'm late to the party, but that's ok. Thanks for your article.

I don't really know if I've experienced psychosis, but I've been told I have exhibited signs noticeable to other people. I always like to read what others say about their psychosis because I know it is different for everyone and when I read about others' experiences, I can identify with bits and pieces of what I see. It is all very confusing to me. I am confusing to me. :)

I've had, on occasion (like I can count it on one hand), short periods where I kind of freeze, but I watch everything going on around me. It looks like an absence seizure,but it's not that. It's almost always happened when I've been hospitalized and it's hard to think if there's a trigger. When the nurses have noticed, they do their thing (some, sadly, ignore you and think you just want attention), but I'm frozen. I can hear and understand all the words, but I can't speak at all or move. My eyes are always the way to come back out of it, whatever it is. So now I know that if I can keep my eyes moving, it'll end faster and be easier. It just takes time. I know once, it seemed to take hours. Another time, maybe 30 minutes. The 30 minutes time, I think they might have given me a small dose ativan but I'm not certain. I do remember that nurse and the eye contact we made that was the start of it ending. She said they all thought mimicked as a mini-catatonia.

I live in AZ too; it would be neat to connect with you. I'm sure you have so many more experiences and wisdom to impart!

MAY, 19, 2017 08:06:52 AM
Catherine Ryan
Thanks so much I have borderline along with severe anxiety and depression.. these out of body unable to function situations are scary and have always made me second guess myself. Now I know why , it's my borderline...! Thankyou for your honesty and humour much needed at this very upsetting time!!! You're amazing xx

MAY, 17, 2017 01:35:02 PM
Extremely helpful information for our family. Thanks Amy.

MAY, 10, 2017 01:37:48 AM
Juliette Hirt
Amy, this is such a wonderful article! Thank you so much for sharing your insights. I will keep them in mind next time I turn into an angel. LOL!

MAY, 09, 2017 10:36:22 AM
I was diagnosed with bipolar disorder 1 after my mother passed away in my early twenties At that time I started to have bipolar disorder psychosis I heard things and saw things that weren't there.It was a very scary time in my life.I was hospitalized at the best hospitals and received treatment. Now I know my symptoms and triggers.This blog was helpful because it explained what happened when someone suffered from bipolar disorder psychosis.This was very useful information. It was well written and educating. I appreciate the time that spent on writing this blog.Thank you Amy Willer , I enjoyed reading your blogs on Nami website.

MAY, 06, 2017 06:51:57 PM
Add me to this list of resounding thanks for your article. Really helpful.

MAY, 02, 2017 01:46:25 PM
Shannon Vassiliki Iliadis
Amy, you are not alone. It is very impressive you have only been hospitalized once. You are stronger and have more depth and beauty than you ever imagined was possible. Please realize you make the world a better place with you in it. It's very important to not act on ideation. I want Matthew Nock to help you and I will help you too when I when sue the MacArthur Genius Grant foundation. Your story deeply moved me. I struggle myself at times. I have "A beautiful Mind." Whatever you desire I have just adopted you in my heart and I will help you with everything you need in this life. I promise you.

APR, 30, 2017 11:12:38 PM
Thank you. I have the same symptoms as you do along with schizoaffective disorder. Thanks to you and for the information. Its nice to know we are not alone.

APR, 29, 2017 08:10:43 PM
Great article. Thanks so much for your support and insight!!

APR, 28, 2017 04:20:53 PM
Thank you, Amy, for telling your story. My teenage daughter has bipolar I disorder, and her brain just shuts down when she has an episode. She can't think, has trouble talking, and can't retrieve information from her memory, although she knows it's there, she just can't find it. I am going to have her read your article. It is always good to know you are not alone!

APR, 27, 2017 11:02:47 PM
Anthony Hopkins
I can relate well with this blog because I suffer from Schizoaffective Disorder. I have problems sleeping at night. It is also my fault because I drink caffeinated drinks throughout the day. I sometimes take my medication with coffee and other energy drinks. Therefore, I am not able to sleep well at night. It is my fault sometimes because I have been having problems drinking water. The water inside of my apartment is very nasty. It taste very nasty. Thanks!!

APR, 27, 2017 04:41:42 PM
Great Article Amy,
Thanks so much for sharing. I look forward to the day, our son will have the clarity, will and skills (like you do) to managing his Bipolar 1 with psychotic features.

APR, 27, 2017 12:52:42 PM
Thank you so much for these facts and the help NAMI GIVES US.

APR, 27, 2017 12:41:15 PM
Joshua Sinclair
very helpful. Thank you!

APR, 27, 2017 10:11:02 AM
Francine Farina
I did have psychotic breaks during hospitalizations which did not help. I did not respond well to Risperdal! It was horrible. I need to read more articles like yours. Thank You.

APR, 26, 2017 07:36:47 PM
I can relate to a lot of this. Thank you!

APR, 26, 2017 07:12:16 PM
Having Bipolar 2 for so many years-different meds. finally in retirement at 65-I take much less meds-small xanax down alot -and an Viibrid which does the job at 40mgs. so much in life has lightened up-still have symptoms at waking and sometimes during the day but real improvement

APR, 26, 2017 06:10:36 PM
Jennifer Newhouse
Thank you for being so candid and so detailed in your descriptions. I think it really helps to be able to understand my daughters disorder more clearly. You are the only other person I have heard from besides my daughter that lost the ability to speak, lost personal information, like how old they were etc and needed to be fed. All these happened with her first very major break. She hasn't had one for about 15 years now. Some small reversals but none that were difficult to catch and manage. Thanks for being so open!

APR, 26, 2017 06:03:14 PM
I really enjoyed reading part of your story Amy. I believe I have had psychotic breaks throughout my childhood. One of those times I was in play yard of my elementary school and had been going through a lot of stress from verbal and physical abuse from my mom at home and bullying from my classmates at school. One day I remember walking in the play yard and standing just looking forward for I don't know how long, not knowing where I was or who I was. I tend to have had something like this over the years when I became severely stressed. At times I have gotten so frustrated I would feel anger clench my teeth and start to yell at whoever is close to me and say things I may or may not remember and I would regret it later. After the episode I would have a huge high of happiness that would be exhilarating. After having studied about brain disorders and trauma I believe I may have Bipolar Disorder, PTSD, Moderate Anxiety disorder, and Depression. Non of these have been officially diagnosed. I have reached out for help several times through mental health, but I always am told I keep it together very well and I should just work through it. That's just it I have tried to work through it and have suffered through, addictions, loss of close relationships, family, friends. The worst feeling over all is the pain from being misunderstood.Most people really do not understand me. Even those closest to me. It has hurt so much. I have managed to get through life, but I am so tired of the anxiety and not being able to accept change and allow myself to be in close relationship, by putting up strong boundaries. Thanks so much for your informative and supportive story Amy. I look forward to reading more about your journey. Your story was very helpful.

APR, 26, 2017 11:34:28 AM
Great info, however for people who are experiencing this for the first time and are scared to talk with someone what do you suggest?

APR, 20, 2017 05:49:01 PM
Elisa Waggoner
Thanks to Ms. Willer for solid recommendations and for sharing some of the specific things she has experienced. Personal experiences are educational and enlightening, and I identified with many of them. They also give more shades of meaning to words, such as diagnoses, that are otherwise vague and misunderstood by a lot of people.

APR, 20, 2017 02:30:41 PM
Marilee Eaves
Amy, I love the clarity of your descriptions of the way things have been and what you have learned. I've managed to avoid episodes through medication for 30 years, but I never associated some clumsiness with the bp disorder. Thank you! one more mystery resolved. Keep writing!

APR, 20, 2017 12:02:47 PM
I can't seem to leave my house to make friends how can I get through it.

APR, 19, 2017 02:10:38 PM
ann kurian
good Information. It's really useful information for daily living with a Bipolar patient.

APR, 19, 2017 02:09:10 PM
ann kurian
it's really informative. Good information.

APR, 19, 2017 02:07:52 PM
ann kurian
Good information. it's really informative.

APR, 18, 2017 04:03:14 PM
This article was so helpful . Thank you for being candid. I just got out of the hospital today for the second time in a month and I had a lot of similar issues but no one seems to listen☹️ Hopefully my therapist can help tomorrow. I have had psychotic breaks before but they were very extreme and obvious. Thank you for letting people know that they are not always obvious. God bless you and keep you safe!

APR, 18, 2017 09:47:45 AM
Amy's description of learning to recognize symptoms of psychosis and her recommendations are truly a gift to anyone wanting to learn about recovery and what it takes! Thanks, Amy!!

APR, 18, 2017 09:42:41 AM
Thanks, Amy, for your very special and thoughtful account. Such a gift for others working to understand symptoms!

APR, 18, 2017 06:40:58 AM
Carole hart
Thank you for sharing. That helped me better understand psychosis.

APR, 18, 2017 05:41:40 AM
Justin Carroll
Thank you. He's finally tired now and every word is a heavy burden. But thank you. I'd like to talk one day7

APR, 17, 2017 09:13:38 PM
Thank you for sharing your story and offering tips to manage! It helps knowing me and my son are not alone!

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