Bipolar disorder involves extreme mood swings between manic/hypomanic highs and depressive lows, but the most severe symptoms can be life-threatening and disruptive. In mania (bipolar I) or hypomania (bipolar II), the worst include psychosis delusions of grandeur (believing you're a deity or invincible) or paranoia (feeling persecuted) leading to dangerous behaviors like reckless spending, hypersexuality, or aggression. Impulsivity peaks, causing financial ruin, job loss, or accidents (e.g., driving at 100 mph). Sleep drops to near-zero, fueling irritability and hallucinations. Untreated, mania risks suicidal ideation during crashes or homicidal impulses.

Depressive episodes rival mania in severity: profound hopelessness and anhedonia (inability to feel pleasure) trap individuals in bed for weeks. Suicidal thoughts are rampant bipolar carries a 15-20% lifetime suicide risk, per NIMH data, with attempts often lethal due to access to means during prior manias. Cognitive fog impairs memory and decision-making; physical symptoms like leaden paralysis ( limbs feeling heavy) or psychomotor retardation slow movement to a crawl. Mixed episodes combine both, amplifying agitation and self-harm risk.

Rapid cycling (4+ episodes/year) worsens outcomes, eroding relationships and health. Comorbidities like substance abuse (60% prevalence) intensify symptoms. Worst overall: suicide completion bipolar patients are 20-30 times more likely than the general population to die by suicide (CDC/WHO). Early lithium/mood stabilizers, therapy, and crisis intervention mitigate these, but stigma delays help.

Seek immediate care for psychotic or suicidal symptoms via 988 (US) or emergency services. Bipolar is manageable with treatment 80% stabilize on meds (APA guidelines).