Am I happy, or is this the start of something?
Second-guessing your own mood is one of the most exhausting parts of living with bipolar disorder. Here is how a personal map of early warning signs makes it easier.
A good week arrives. You have energy, ideas, you are sleeping a little less and getting more done, and somewhere underneath the pleasure of it there is a question you cannot put down. Is this me, well? Or is this the beginning of something?
The same question comes from the other direction. You are tired, flat, not much interested in things. Is this an ordinary bad patch, the kind everyone has? Or is it the start of a low?
If you have bipolar disorder, you know this second-guessing. It is exhausting in a way that is hard to explain to anyone who has not done it, because it means you cannot fully trust your own read on how you are. Every good mood is suspect. Every bad day is a possible warning. It is a bit like being asked to monitor yourself constantly for signs of yourself.
Why the question has no general answer
Part of what makes this so tiring is that the question, asked in general, cannot be answered. Happiness and the early edge of elevation can feel similar. Tiredness and the early edge of a low can feel identical. Asking "is this normal?" of a feeling in isolation just produces more uncertainty, and the uncertainty is its own drain.
What can be answered is a much more specific question: does this look like the start of my pattern? And that question has an answer, because your pattern is particular to you, and it can be mapped.
Mapping your own early warning signs
Everybody's episodes have a run-up, and the run-up has signs. They are not the same as the textbook list, and they are not the same as anyone else's. For one person, the first sign of elevation is starting three projects in a weekend. For another it is buying things, or texting old friends at two in the morning, or a particular kind of irritation with slow people. For a low, it might be cancelling plans, or the shower becoming a task, or a specific way of talking to yourself that only appears when it is coming.
In the CBT work I do alongside psychiatric care for bipolar disorder, a large part of the early sessions is building this map in detail. We go back through past episodes, week by week where we can, and find what came first. What was different, days or weeks out? What did the people around you notice, if you ask them? What tended to precede it: a run of short nights, a big life event, a change in routine?
The result is a written list of your signs, in order, with a sense of how far out each one usually appears. It is a strange thing to look at, and most people find it steadying rather than frightening, because it converts a vague dread into something concrete.
What the map does to the question
Once the map exists, the good week gets a different question: "are any of my signs present?" If you are sleeping seven hours, have started nothing new, and the people around you have noticed nothing, then it is probably just a good week, and you can have it. If two of the early signs are there, that is information, and there is a plan for it.
The plan matters as much as the map. Each sign has an agreed response, decided in advance, when you were well and thinking clearly. Protect sleep. Tell a named person. Bring the next session forward. Contact the prescriber. Because the responses are already decided, the moment of noticing a sign does not have to become a moment of panic or of pretending it is not there.
Sleep and routine, again
Sleep loss is one of the most reliable triggers for mood elevation. Irregular days destabilise mood before anyone notices a symptom. In bipolar disorder, protecting sleep and a steady rhythm is part of the treatment, and it is usually the first sign on the map and the first response in the plan.
Being told
One question people ask is whether I will tell them if I notice a change. The answer is yes, against the signs we agreed, and in the way we agreed. Being told you might be becoming unwell is a lot easier when you were the one who wrote the plan, and when the person telling you is using your own words for your own signs.
Therapy here is an addition to psychiatric care, never a replacement for it. I do not prescribe, advise on medication or provide crisis cover, and I will ask that you stay connected to your GP or psychiatrist while we work.
If the second-guessing is wearing you down, there is more on how I work alongside bipolar disorder, and the map is usually where we start.