Dr. Andrew Mohanraj

BIPOLAR disorder is a complex mental health condition characterised by extreme shifts in mood, energy levels and behaviour. Among the various types of bipolar disorder, high-functioning bipolar disorder is a subtype that often goes undetected or misunderstood due to its less extreme presentation. 

Unlike classic bipolar disorder, individuals with high-functioning bipolar disorder can lead seemingly normal lives while experiencing intense internal struggles. Also known as bipolar II disorder, it is a psychiatric condition that is characterised by recurrent episodes of depression and hypomania, which are less severe than the full-blown manic episodes seen in classic bipolar disorder. 

Hypomania is marked by elevated mood, increased energy and heightened productivity. 

It can often be mistaken for a positive, creative state, making it challenging to recognise as a mental health issue.

Frequently overlooked
During depressive episodes, individuals with high-functioning bipolar disorder may experience overwhelming sadness, loss of interest in previously enjoyable activities, changes in sleep patterns, difficulty concentrating, and thoughts of hopelessness or suicide. 

These depressive states can lead to impaired social and occupational functioning, making it challenging for individuals to maintain their high-level performance. Meanwhile, hypomanic episodes are characterised by a euphoric or irritable mood, increased self-esteem, racing thoughts and a decreased need for sleep. 

While hypomania may seem like a productive phase, it can lead to recklessness, impulsive decision-making and strained interpersonal relationships. One of the primary challenges faced by those with high-functioning bipolar disorder is the underdiagnosis or misdiagnosis of their condition.  Their ability to maintain a semblance of normalcy can mask the underlying struggles, leading healthcare professionals to overlook or misattribute their symptoms.

Possible consequences
Many individuals with high-functioning bipolar disorder may intentionally try to be guarded about their symptoms. 

This behaviour may be driven by the fear of being judged or stigmatised due to mental health issues that might lead individuals to try to appear “normal” to others.
Some may feel compelled to fulfil social and professional obligations, even during mood episodes, to avoid drawing attention or negative consequences.  Worrying about potential repercussions in the workplace or personal life may lead individuals to keep their condition private.

It is understandable that people often want to preserve their self- image, and admitting vulnerability due to a mental health condition may challenge their self-perception as competent and capable. 
Many with high functioning bipolar disorder may also be in self-denial that they need professional help. 

Some have been reported to enjoy the high energy hypomanic state they experience, as otherwise life may appear to be too boring for them.
Individuals with high-functioning bipolar disorder can occasionally find themselves in legal trouble. 
Although they may appear to manage their condition well and lead seemingly normal lives, during hypomanic episodes, individuals with high-functioning bipolar disorder may experience increased impulsivity and engage in risky behaviours. 
This could include reckless driving, overspending, substance abuse, or engaging in confrontations that lead to altercations or violence.
On the other hand, severe depressive episodes may also cause individuals to engage in self-harm and other self-destructive behaviour, such as substance abuse or public disturbances, which can also result in legal consequences.

What it is like
The following is a fictional example that illustrates how a person with high-functioning bipolar disorder might experience life, based on my experiences with such patients.
Alice was a 34-year-old senior manager in a large company. 
She was always known for her high energy, creativity and dedication to her work. 
Colleagues admired her ability to take on challenging projects and produce outstanding results. 

In her personal life, Alice was the life of the party, always up for adventures and socialising. 
She was well-liked among friends for her upbeat and engaging personality.
However, what most people did not realise was that Alice had been struggling with high-functioning bipolar disorder for years. While her hypomanic phases allowed her to thrive at work and be the centre of attention in social settings, her depressive episodes often went unnoticed.

During those times, Alice withdrew from social activities, struggled to find joy in things she used to love, and experienced feelings of hopelessness. 

Despite her internal struggles, she managed to keep her condition hidden from most people, fearing judgment or being labelled as “unstable”. She became adept at masking her depressive episodes, maintaining a facade of positivity and productivity.  This constant effort to appear “normal” took a toll on her mental and emotional well-being, contributing to additional stress and anxiety. One day, Alice got herself into a situation because she became abusive at the workplace. She impulsively assaulted one of her junior colleagues because she felt her seniority was not being respected by that colleague, 

The police was called, but the case was eventually settled amicably.
Alice was encouraged to see a mental health professional.  With the support of therapy and medication, she started to understand her condition better and learned coping mechanisms to manage her ups and downs. 
Over time, Alice found stability and acceptance for her condition.  She discovered that she could continue to excel in her career and maintain meaningful relationships, while acknowledging and addressing her mental health needs.

Creating a supportive environment
This example highlights how high-functioning bipolar disorder can impact an individual’s life. 
It emphasises the importance of awareness, support and understanding to create an environment where individuals with mental health conditions can thrive and seek help. 

Not all individuals with bipolar disorder exhibit violent behaviour, extreme mood swings and aggressive tendencies that lead to altercations. However, people with high-functioning bipolar disorder are more likely to experience communication difficulties during certain episodes, leading to misunderstandings that escalate into conflicts with others.  For such individuals, it is essential to consider their mental health condition if they are drawn into the criminal justice system.

Individuals with high-functioning bipolar disorder may also feel ashamed or guilty about their condition, fearing the stigma associated with mental illness.  This self-stigma can prevent them from seeking help, exacerbating their symptoms and impacting their overall well- being.

Even their loved ones may struggle to understand the sudden mood shifts and interpret them as intentional, leading to conflicts and misunderstanding, and putting a strain on relationships. Public awareness and understanding of high-functioning bipolar disorder are crucial for several reasons.
For one, increased awareness can lead to earlier detection and intervention, improving the long-term prognosis for individuals with high-functioning bipolar disorder. 

For another, timely treatment can help manage symptoms effectively and minimise the impact on their daily lives.

Also, it might be a challenge to promote empathy and support for those living with this condition as they could be seen as arrogant high achievers, but surely a more compassionate society should foster an environment where all individuals feel comfortable seeking help without fear of judgment. Individuals with high-functioning bipolar disorder could need that extra support to recognise the importance of seeking professional help, as they may be reluctant to do so.

Regular therapy sessions with mental health professionals would involve developing coping strategies and managing their mood swings effectively, so that they can set boundaries in certain situations. 
Therapy may also involve the prescription of psychotropic medications known as mood stabilisers.

Even during therapy, open communication with trusted individuals about their mental health allows them to seek support when needed and reduces the burden of hiding their struggles.  Finally, effective time management can help individuals with high functioning bipolar disorder balance their activities and responsibilities, reducing stress and potential mood triggers.

Datuk Dr Andrew Mohanraj is a consultant psychiatrist, the Malaysian Mental Health Association president and an adjunct professor of psychiatry at Taylor’s University. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.