Author: Jillian LaFrance, Ph.D.

Bipolar disorder is often portrayed as dramatic swings in mood and behavior, typically characterized by episodes of mania or hypomania and depression. But for many, bipolar disorder exists quietly behind a guise of competence, productivity, and achievement. This version of the condition is frequently referred to as “high-functioning bipolar disorder.” While not a formal diagnosis listed in the DSM-5, the concept of being “high functioning” with bipolar disorder captures the experience of individuals who maintain careers, relationships, and responsibilities while managing a serious mental illness. Despite their outward appearance of success, they may still struggle privately with intense emotional dysregulation, exhaustion, and the burden of maintaining a false sense of wellness.

High-functioning bipolar disorder does not imply a milder or less serious condition. Rather, it reflects an individual’s ability to manage the external demands of life despite ongoing internal challenges. The term is commonly used to describe individuals who meet the criteria for Bipolar I or Bipolar II disorder but continue to work, parent, maintain relationships, and perform daily tasks at what appears to be a high level.

There is a common misconception that someone who is successful cannot also be mentally ill. This belief contributes to underdiagnosis and undertreatment. A person may cycle through hypomania and depressive states, appear organized and successful during episodes of elevated mood, and continue to function during depressive phases while privately battling symptoms like irritability, fatigue, suicidal ideation, and impaired concentration (Swartz & Suppes, 2020). The effort to maintain this balance can be emotionally and physically exhausting, and it often delays access to proper support.

Clinical Features and Challenges

High-functioning individuals with bipolar disorder might mask their symptoms by developing highly structured routines, using cognitive strategies to stay on task, or working excessive hours to manage the productivity bursts of hypomania. These behaviors can be praised by society, which further obscures the seriousness of the underlying condition (Rowland & Marwaha, 2018). However, the intensity of maintaining this functional veneer can worsen symptoms over time.

Moreover, stigma plays a critical role. People who are perceived as competent often fear being seen as unstable or incapable if they disclose their diagnosis. As a result, many choose to suffer in silence. Research shows that individuals with bipolar disorder already experience high levels of stigma and self-stigma, and this can be especially intense for those in high-pressure or helping professions (Michalak et al., 2011).

Diagnostic and Treatment Implications

Diagnosis of high-functioning bipolar disorder can be challenging. Hypomanic episodes are often misinterpreted as being highly productive, energetic, or charismatic, especially in people who are high achievers. Depressive episodes might be dismissed as burnout or stress. Without an accurate diagnosis, individuals may be misdiagnosed with unipolar depression or anxiety, leading to inappropriate treatment.

When diagnosed properly, treatment typically involves a combination of mood stabilizers or atypical antipsychotics, psychotherapy, and lifestyle modifications. Psychotherapy modalities, such as cognitive behavioral therapy (CBT), have shown efficacy in helping individuals regulate mood and maintain stability (Miklowitz et al., 2007). It’s important that treatment plans consider the unique stressors high-functioning individuals face, including their tendency to internalize pressure and overcommit.

One significant barrier to effective treatment is the internalized belief that “if I’m still getting things done, I must be fine.” This cognitive distortion can delay seeking help until the disorder becomes more acute or results in a crisis. Encouraging earlier intervention and normalizing therapy for high-functioning individuals is crucial for long-term stability and well-being.

The Emotional Cost of Functioning

The term “high functioning” can be misleading. It suggests that a person’s external achievements are a reliable indicator of their internal health. In reality, individuals with high-functioning bipolar disorder often operate under extreme emotional strain. Their “functioning” can come at the expense of rest, emotional regulation, and relationships.

For many with bipolar disorder, each day may involve hours of emotional and mental work just to appear composed and capable. This can lead to increased fatigue, worsened symptoms, and even burnout. The high standards individuals set for themselves often lead to self-criticism when symptoms do interfere with functioning, creating a cycle of guilt and shame.

To better support individuals with high-functioning bipolar disorder, society must revise its understanding of what mental illness looks like. It is possible to manage a classroom, lead a team, or raise children while battling a serious mental health condition. Success should not be used as evidence that someone is “fine.”

Mental health professionals and institutions should move toward a more nuanced understanding that functioning is not binary. An individual may be doing well in some areas while struggling deeply in others. Creating space for these contradictions helps reduce stigma and allows for more honest conversations about mental health.

My Experience Living and Working with Bipolar Disorder

I live with bipolar disorder, and from the outside, most people wouldn’t guess it. I have a Ph.D., work as a remote professor, and work with justice-involved individuals who live with severe mental illness and substance use disorders. I also raise a teenage daughter and care for two dogs. My days are full of engaging with students and clients, managing deadlines, and staying on top of tasks. I’m responsive and I keep showing up, even on days when it’s hard.

But privately, there are days when depression feels like I am dragging my body through quicksand. Other days, hypomania tempts me to take on too much, speak too fast, and live in overdrive. I’ve learned to recognize the subtle signs, the internal cues, and the red flags. I work hard to manage my medication, sleep, and boundaries. But it’s not always smooth. The idea that I must perform at a high level to prove I am okay is a narrative I’ve had to unlearn.

What has helped me the most is self-compassion and structure. I am honest with a few trusted people. I’ve had to stop pretending that resilience means pushing through everything. Living with bipolar disorder means knowing my limits, respecting them, and still finding ways to contribute meaningfully to my work and family life.

References

Michalak, E. E., Yatham, L. N., Kolesar, S., & Lam, R. W. (2011). Bipolar disorder and quality of life: A patient-centered perspective. Quality of Life Research, 15(1), 25–37. https://doi.org/10.1007/s11136-005-0376-7

Miklowitz, D. J., Otto, M. W., Frank, E., Reilly-Harrington, N. A., Kogan, J. N., Sachs, G. S., … & Wisniewski, S. R. (2007). Intensive psychosocial intervention enhances functioning in patients with bipolar depression: Results from a 9-month randomized controlled trial. American Journal of Psychiatry, 164(9), 1340-1347. https://doi.org/10.1176/appi.ajp.2007.07020311

Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251-269. https://doi.org/10.1177/2045125318769235

Swartz, H., & Suppes, T. (2019). Bipolar II disorder: Recognition, understanding, and treatment. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9781615379224

The content of the International Bipolar Foundation blogs is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician and never disregard professional medical advice because of something you have read in any IBPF content.