How to Treat Anxiety in Bipolar Disorder


The way to treat anxiety in bipolar disorder is to treat the bipolar disorder. Anxiety is a synonym for distress, and nearly all mental disorders cause distress, except perhaps the classic, euphoric manias that lift the patient into a carefree state of bliss.

Some mood episodes are more anxiety-provoking than others, and at the top of the list are mixed states. Although anxiety does not appear in the criteria for mixed states, it is often created when depression and mania mix together.1 The International Society for Bipolar Disorders has even calculated the exact proportions for this troubling recipe. It takes only 1 manic symptom during a depression, or 2 depressive symptoms during a mania, to spark anxiety.1

Mixed states tend to respond better to anticonvulsants and atypical antipsychotics than to lithium, which may be why anxiety predicts resistance to lithium in bipolar disorder.2 There are, however, 2 exceptions to this rule: suicide and panic disorder. Both mixed states and anxiety raise the risk of suicide in bipolar disorder, and lithium lowers that risk 6-fold.3 This preventative effect is independent of lithium’s mood benefits, so it is worth considering lithium in patients who are suicidal, even when it has a lower chance of reducing the core symptoms.

Although the classic lithium-responsive patient tends to have pure manias and hypomanias and no anxiety disorder comorbidities, a recent study identified panic disorder as a predictor of lithium response.4 Although anxiety is low in pure mania and hypomania, these patients are on high alert for threat, which is the essence of panic disorder. One study found that they had more phobias of panic sensations than patients in bipolar depression or mixed states.5

The next step in treating mixed states is to reduce antidepressants and anything else that contributes to manic symptoms (eg, drugs of abuse, steroids, and irregular circadian rhythms). Most patients who are in a mixed state have been on an antidepressant for a long time, and it can be difficult to tell if the drug is exacerbating the mixed presentation. Given these uncertainties, it is best to taper slowly, over weeks or months.6 Rapid discontinuation can trigger mania and other mood symptoms. The work is much like tapering a benzodiazepine. If the symptoms worsen, raise back the dose and slow down the taper.

Anxiolytic Mood Stabilizers

In bipolar disorder, anxiety is a non-specific symptom with multiple causes, including mood episodes, stress, and comorbid anxiety disorders. With so many different causes, can any mood stabilizer truly be said to be anxiolytic? Probably not, but we do have a few trials that may point the way when selecting a mood stabilizer for a patient with significant anxiety.

Among the anticonvulsants, valproate and lamotrigine improved anxiety in small controlled trials of anxious bipolar disorder.7-9 Valproate’s evidence here is more robust, and this medication also improved anxiety in patients who do not have bipolar disorder, perhaps because of its benzodiazepine-like gaba-ergic properties.10,11 Lamotrigine may also treat obsessive compulsive disorder through glutamatergic effects, based on a small placebo controlled and several uncontrolled studies.12

The atypical antipsychotics can also improve anxiety. Quetiapine and olanzapine reduced anxiety in large, randomized, placebo-controlled trials of patients with bipolar depression and non-specific anxiety (both were secondary analyses). The effect sizes were large enough to make them noticeable to the casual observer (0.35 for olanzapine and 0.56 for quetiapine).13,14Quetiapine had similar anxiolytic effects in the 300 mg and 600 mg doses, and olanzapine had similar anxiolytic effects as monotherapy or when paired with fluoxetine.

These anxiolytic properties do not seem to extend to other atypical antipsychotics. Ziprasidone and risperidone both failed in placebo-controlled trials of bipolar disorder with anxiety, and risperidone actually worsened anxiety in a study of bipolar with comorbid panic disorder.7

The unanswered question here is whether these medications were targeting anxiety directly or treating mild mixed states. Most of the patients had 1 to 2 manic symptoms along with their depression, judging from their average Young Mania Rating Scale of 5, and anxiety was higher as the manic symptoms went up.13,14 On the other hand, quetiapine has a large effect size in generalized anxiety disorder (GAD), suggesting a more direct effect.15 Quetiapine came close to FDA approval in GAD, but was held back because the FDA did not think this disorder was severe enough to warrant all the risks of an antipsychotic. That lesson applies to bipolar disorder as well. Quetiapine may be very effective for anxiety, but it should not be used in mild cases.

Anxious Distress

Anxiety may not offer a direct path to pharmacotherapy in bipolar disorder, but it does tell us something about the care of the patient. These patients are at greater risk for treatment dropout, adverse effects of medications, substance abuse, and suicide. Supportive psychotherapy, fast-acting treatment, and an extra phone call to make sure they are tolerating any new medication go a long way in these cases.

Dr Aiken is the Mood Disorders Section Editor for Psychiatric TimesTM, the editor in chief of The Carlat Psychiatry Report, and the director of the Mood Treatment Center. He has written several books on mood disorders, most recently The Depression and Bipolar Workbook. The author does not accept honoraria from pharmaceutical companies but receives royalties from PESI for The Depression and Bipolar Workbook and from W.W. Norton & Co. for Bipolar, Not So Much.

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Being alone
Constantly telling you are not good enough
pushing people away
Sleeping lots
Feeding us negative thoughts
Casting a shadow over any positivity

Opening up to people
peope being nice to us
goinbg out
allowing us to ask for help
Letting us out of the gloomy darkness
being kind to us
anything positive happening to us….

The support team….

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Present Tense Affirmations

I am courageousI am braveI am fearlessI always stand up for myselfI am developing courageI am ready for anything that comes my wayI am strong and full of courageI push through my fear and do it anywayI am courageous when others are scaredMy courage helps to inspire others

Future Tense Affirmations

I will develop courageI will smash through fear and rise to the occasionI am becoming more courageous with each passing dayI will transform into a strong and fearless personFearlessness is developing within meEach day I feel stronger and more courageousOthers will notice my fearlessness

Natural Affirmations

I am naturally courageousCourage comes easily to meI always find a way to call forth courage when I need itI am the kind of person who feels fear but does it anywayBeing brave comes naturally to meDeveloping courage is something I just know I can doBeing strong in the face of adversity is one of my best

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Help and support




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If you can’t HELP try to find one of our centers in your area, please try one of the following Organizations:

Samaritans UK & ROI 

Netherlands Suicide Prevention 

National Suicide Prevention Lifeline (USA)

Lifeline International

Child Helpline International

International Federation of Telephone Emergency Services – IFOTES

Telephone Helplines Association (UK)

Teléfono de la Esperanza

Papyrus (UK)

Canadian Crisis Lines – Click Here

Other Associations

American Association of Suicidology – AAS

Canadian Association of Suicide Prevention – CASP

International Association for Suicide Prevention – IASP

Malatavie Prévention – Centre d’étude et de prévention du suicide


Special issue of The Drum Beat – February 2005 – Addressing Suicide

Tsunami learning from the humanitarian response

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How to get help Read this First




JaN Avatar

Mike and I are getting along better. Hope it lasts. Rogi is hot and cold….


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Nov 9, 2016 at 6:28am  Quote

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Post by JaN on Nov 9, 2016 at 6:28am

If you are feeling suicidal now, please stop long enough to read this. It will only take about five minutes. I do not want to talk you out of your bad feelings. I am not a therapist or other mental health professional – only someone who knows what it is like to be in pain.

I don’t know who you are, or why you are reading this page. I only know that for the moment, you’re reading it, and that is good. I can assume that you are here because you are troubled and considering ending your life. If it were possible, I would prefer to be there with you at this moment, to sit with you and talk, face to face and heart to heart. But since that is not possible, we will have to make do with this.

I have known a lot of people who have wanted to kill themselves, so I have some small idea of what you might be feeling. I know that you might not be up to reading a long book, so I am going to keep this short. While we are together here for the next five minutes, I have five simple, practical things I would like to share with you. I won’t argue with you about whether you should kill yourself. But I assume that if you are thinking about it, you feel pretty bad.

Well, you’re still reading, and that’s very good. I’d like to ask you to stay with me for the rest of this page. I hope it means that you’re at least a tiny bit unsure, somewhere deep inside, about whether or not you really will end your life. Often people feel that, even in the deepest darkness of despair. Being unsure about dying is okay and normal. The fact that you are still alive at this minute means you are still a little bit unsure. It means that even while you want to die, at the same time some part of you still wants to live. So let’s hang on to that, and keep going for a few more minutes.

Start by considering this statement:

Suicide is not chosen; it happens
when pain exceeds 
resources for coping with pain.

That’s all it’s about. You are not a bad person, or crazy, or weak, or flawed, because you feel suicidal. It doesn’t even mean that you really want to die – it only means that you have more pain than you can cope with right now. If I start piling weights on your shoulders, you will eventually collapse if I add enough weights… no matter how much you want to remain standing. Willpower has nothing to do with it. Of course you would cheer yourself up, if you could.

Don’t accept it if someone tells you, “That’s not enough to be suicidal about.” There are many kinds of pain that may lead to suicide. Whether or not the pain is bearable may differ from person to person. What might be bearable to someone else, may not be bearable to you. The point at which the pain becomes unbearable depends on what kinds of coping resources you have. Individuals vary greatly in their capacity to withstand pain.

When pain exceeds pain-coping resources, suicidal feelings are the result. Suicide is neither wrong nor right; it is not a defect of character; it is morally neutral. It is simply an imbalance of pain versus coping resources.

You can survive suicidal feelings if you do either of two things: (1) find a way to reduce your pain, or (2) find a way to increase your coping resources. Both are possible.

Now I want to share with you five things to think about…

You need to hear that people do get through this — even people who feel as badly as you are feeling now. Statistically, there is a very good chance that you are going to live. I hope that this information gives you some sense of hope.

Give yourself some distance. Say to yourself, “I will wait 24 hours before I do anything.” Or a week. Remember that feelings and actions are two different things – just because you feel like killing yourself, doesn’t mean that you have to actually do it right this minute. Put some distance between your suicidal feelings and suicidal action. Even if it’s just 24 hours. You have already done it for 5 minutes, just by reading this page. You can do it for another 5 minutes by continuing to read this page. Keep going, and realize that while you still feel suicidal, you are not, at this moment, acting on it. That is very encouraging to me, and I hope it is to you.

People often turn to suicide because they are seeking relief from pain. Remember that relief is a feeling. And you have to be alive to feel it. You will not feel the relief you so desperately seek, if you are dead.

Some people will react badly to your suicidal feelings, either because they are frightened, or angry; they may actually increase your pain instead of helping you, despite their intentions, by saying or doing thoughtless things. You have to understand that their bad reactions are about their fears, not about you.

But there are people out there who can be with you in this horrible time, and will not judge you, or argue with you, or send you to a hospital, or try to talk you out of how badly you feel. They will simply care for you. Find one of them. Now. Use your 24 hours, or your week, and tell someone what’s going on with you. It is okay to ask for help. Try:

Send an anonymous e-mail to The Samaritans
Call the National Suicide Prevention Lifeline at 1-800-273-8255 (TTY:1-800-799-4TTY)
(In Australia, call Lifeline Australia at telephone: 13 11 14
Teenagers, call Covenant House NineLine, 1-800-999-9999
Look in the front of your phone book for a crisis line
Call a psychotherapist
Carefully choose a friend or a minister or rabbi, someone who is likely to listen
But don’t give yourself the additional burden of trying to deal with this alone. Just talking about how you got to where you are, releases an awful lot of the pressure, and it might be just the additional coping resource you need to regain your balance.

Suicidal feelings are, in and of themselves, traumatic. After they subside, you need to continue caring for yourself. Therapy is a really good idea. So are the various self-help groups available both in your community and on the Internet.

Well, it’s been a few minutes and you’re still with me. I’m really glad.

Since you have made it this far, you deserve a reward. I think you should reward yourself by giving yourself a gift. The gift you will give yourself is a coping resource. Remember, back up near the top of the page, I said that the idea is to make sure you have more coping resources than you have pain. So let’s give you another coping resource, or two, or ten…! until they outnumber your sources of pain.

Now, while this page may have given you some small relief, the best coping resource we can give you is another human being to talk with. If you find someone who wants to listen, and tell them how you are feeling and how you got to this point, you will have increased your coping resources by one. Hopefully the first person you choose won’t be the last. There are a lot of people out there who really want to hear from you. It’s time to start looking around for one of them.

Now: I’d like you to call someone.

And while you’re at it, you can still stay with me for a bit. Check out these sources of online help.

Additional things to read:

How serious is our condition? …”He only took 15 pills, he wasn’t really serious…” if others are making you feel like you’re just trying to get attention… read this.

Why is it so hard for us to recover from being suicidal? …while most suicidal people recover and go on, others struggle with suicidal thoughts and feelings for months or even years. Suicide and post-traumatic stress disorder (PTSD).

Recovery from grief and loss …has anyone significant in your life recently died? You would be in good company… many suicidal people have recently suffered a loss.

The stigma of suicide that prevents suicidal people from recovering: we are not only fighting our own pain, but the pain that others inflict on us… and that we ourselves add to. Stigma is a huge complicating factor in suicidal feelings.

Resources about depression …if you are suicidal, you are most likely experiencing some form of depression. This is good news, because depression can be treated, helping you feel better.

A 4 minute depression quiz …maybe you have depression and want to find out right now, scientifically, at no cost.

Depression symptoms …the specific symptoms of a full blown episode of clinical depression

Bipolar symptoms …the specific symptoms of a full blown episode of bipolar disorder, which includes mania (highs) and the lows of depression

Do you know someone who is suicidal… or would you like to be able to help, if the situation arises? Learn what to do, so that you can make the situation better, not worse.

Handling a call from a suicidal person …a very helpful ten-point list that you can print out and keep near your phone or computer.

What can I do to help someone who may be suicidal? …a helpful guide, includes Suicide Warning Signs.

Other online sources of help:
The Samaritans – trained volunteers are available 24 hours a day to listen and provide emotional support. You can call a volunteer on the phone, or e-mail them. Confidential and non-judgmental. Short of writing to a psychotherapist, the best source of online help.

Talk to a therapist online – Read this page to find out how.

Depression support group online: Psych Central Depression Support Group – Please note: this is a very big group, but amidst all the chatter, it is possible to find someone who will hear you and offer support.

Psych Central has a good listing of online resources for suicide – and other mental health needs.

Still feel bad? These jokes might relieve the pressure for a minute or two.

If you want help finding a human being to talk with in person, who can help you live through this, try reading this article about how to Choose a Competent Counselor.

Sometimes people need additional private help before they are ready to talk with someone in person. Here are a few books you could read on your own in private. I know from personal experience that each one has helped someone like you.

Suicide: The Forever Decision by Paul G. Quinnett, PhD (Continuum, ISBN 0-8264-0391-3). Frank and helpful conversation with a therapist who cares.

Choosing to Live: how to defeat suicide through cognitive therapy by Thomas E. Ellis PsyD and Cory F. Newman PhD (New Harbinger Publications, ISBN 1-57224-056-3). Another conversational book with practical help for suicidal persons.

How I Stayed Alive When My Brain Was Trying to Kill Me: One Person’s Guide to Suicide Prevention by Susan Rose Blauner (William Morrow, ISBN 0066211212). A very practical survival guide by an actual survivor.

Out of the Nightmare: Recovery From Depression And Suicidal Pain, by David L. Conroy, PhD (Authors Choice Press, ISBN 0595414974). As if suicidal persons weren’t feeling bad enough already, our thoughtless attitudes can cause them to feel guilt and shame, and keep them from getting help in time. Dr. Conroy blasts apart the myths of suicide, and looks at suicidal feelings from the inside, in a down to earth, non-judgmental way. This is a book that will save lives by washing away the stigma of suicide and opening the door to a real way out of the nightmare.

Suicide: The Forever Decision, Paul G. Quinnett, PhD Choosing to Live, Thomas E. Ellis PsyD How I Stayed Alive When My Brain Was Trying to Kill Me Out of the Nightmare, David L. Conroy, PhD
I make no money whatsoever on recommending these books… they are simply recommendations.

Want to share your suicide story? 
Please visit the Suicide Project and leave your story

Have feedback? Please write us 

24,832,235 visitors

This page is provided as a public service by Metanoia, and is dedicated with gratitude to David Conroy, Ph.D. whose work inspired it. Metanoia cannot provide counseling to suicidal persons. If you need help please use the resources outlined above.

© Copyright 1995-2002 Martha Ainsworth. All rights reserved. Reprints: Please feel free to link to this page. Please do not reproduce this page on the Internet; you may link to it instead. You may reproduce this page in print media for non-commercial, non-profit use only, if you meet the following three conditions: (1) you must use the full text without alteration up to and including the words “Now: I’d like you to call someone.”; (2) please consider making a donation to The Samaritans (see above); and (3) you must print the following notice verbatim: “Reprinted with permission. Suicide: Read This First ( was written by Martha Ainsworth based on work by David Conroy, Ph.D. To talk with a caring listener about your suicidal feelings, in the U.S. call 1-800-SUICIDE any time, day or night. Online, send an anonymous e-mail to for confidential and non-judgmental help, or visit”

The original white on black suicide – read this first page is here.

Site Index:
Return to Suicide: Read This First
How serious is our condition?
Why is it so hard for us to recover from being suicidal?
Recovery from grief and loss for suicidal persons
The stigma of suicide that keeps us from getting help
Online depression resources for suicidal persons
Handling a call from a suicidal person
Nine ways to help a suicidal person; and Suicide Warning Signs

This resource is hosted by mental health information at Psych Central.

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Self care

Self-care is more than just a trendy buzzword. Setting aside time for yourself can make a huge difference in your physical, emotional and mental health. But sometimes, your self-care routine may not be so caring after all.

A recent study found that the way some people schedule time for leisure can take the fun out of it. Doing things like setting rigid time limits on activities and worrying too much about what you’re going to do afterward can put a damper on your time to unwind, according to research.

In other words, your habits may be turning your relaxing routine into anything but. We consulted experts on how to make time for yourself without turning it into a chore. Take a look at their suggestions below:
Do things you actually want to do

“Plenty of people have an idea of what self-care looks like ― yoga and quinoa might be involved ― but if those aren’t your things, you won’t stick with it,” said Laura Vanderkam, author of Off the Clock: Feel Less Busy While Getting More Done. 

While there’s nothing wrong with getting your daily dose of downward dog, doing something you have no real interest in defeats the purpose of self-care.

One of the first things you should do when creating your routine is to ask yourself what makes you feel like the best version of you, according to Vanderkam. “What makes you feel whole and energized? And then, what are some little ways you can build these routines into your life?” she added.

Vanderkam emphasized the importance of being reasonable when choosing what to include in your practice. She also suggested that including short activities that take 10 to 15 minutes can make you more likely to keep up your practice than if you do something that takes hours.
Get back to the basics

“Self-care can involve basic rituals that ensure health and optimal performance,” said Leah Lagos, a clinical and sports psychologist based in New York. One of the biggest, most essential ones? Sleep.

While the American Sleep Association states that there is no universal number of hours you need to sleep, not getting enough will result in sleep deprivation, which could also affect your diet. Lagos personally tells her clients to map out their sleep schedule ahead of time and plan the rest of their day around it.

A proper eating schedule is also important to maintain. Lagos recommended eating three meals and two small snacks at the same time every day. A regular eating routine can stabilize your body and make it feel secure, she added.
Focus on the present

Amalea K. Seelig, a clinical psychologist based in New York, said that when you are doing something you enjoy, you should try to stay as connected to the experience as possible.

“One of the best ways to remain in your experience is to notice when you are having thoughts that are unrelated to it,” Seelig said. “This is the practice of mindfulness.”

Being mindful simply means paying close attention to what’s happening in the moment and learning how to take pleasure in activities related to your self-care without worrying about all of the things you have to do when they’re over. So instead of stressing over your to-do list while you’re hanging out with a friend, try putting that energy into having a good time.
Make the most of the free time you do have

The early bird catches the worm ― and also has a great opportunity to recharge before beginning the day.

“Mornings tend to be a great time to get things done because the day’s work and personal emergencies have yet to come up,” Vanderkam said. “Before you turn on your phone, spend 15 to 20 minutes doing something fun for you.”

If your schedule permits you to have some free time on the weekends, Vanderkam said, you should be intentional about that time too.

“A few days ahead of time, think about three things you could do over the weekend that would add to your energy levels,” she said. “Think about where these can go [in your plans] and the logistics that need to happen.”

By carving out time in advance for some self-care hobbies, you’ll be saving yourself from feeling overwhelmed when you have multiple events happening during the weekend.
Hold yourself accountable

The best thing you can do to show your loved ones that you care for them is to care for yourself first, said Naomi Ben-Ami, psychologist and assistant director at Williamsburg Therapy Group in New York. To illustrate the significance of prioritizing your own well-being, Ben-Ami said, she likes to use the metaphor of the airline safety message, “If you’re traveling with a child, please put on your own oxygen mask first.”

“We have to make sure that our own selves are nourished and whole in order to show up for our other responsibilities,” she stressed.

But If you feel as though you really don’t have any space in your schedule for some personal TLC, Vanderkam suggested finding an accountability partner.

“You can check in with each other [to make sure] that you’ve done your self-care routine,” Vanderkam said. “Sometimes knowing that someone else expects something from you can nudge you to do it.”
US Presidential Election 2020
Breaking news, analysis and the latest polls on the presidential race from HuffPost’s politics team

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Present Tense Affirmations 
I am a highly motivated person 
I am motivated at all times
I am always motivated and always get things done on time
I am a naturally motivated individual and motivation comes naturally to me
I am naturally motivated and energized at the beginning of every day
I am highly motivated, ambitious and driven
I find it easy to motivate myself and get myself in the right state of mind
I am always looked up to as someone with high energy, drive, and motivation
I stay motivated throughout a project no matter what
I am always motivated and my positive energy motivates and lifts those around me

Future Tense Affirmations 
I am becoming more and more motivated every single day 
I will find the motivation when I need it
I am finding myself more motivated every day
I am turning into someone who is naturally motivated
I am getting more and more driven and ambitious
Every day I become more driven, motivated and ambitious
I will be hugely motivated and productive
I will become someone who is always motivated and switched on
I will become a naturally motivated, highly ambitious person
I am becoming more and more motivated in all areas of my life

Natural Affirmations
Motivation comes naturally to me
Being naturally motivated is a normal part of my life
Each day I am more and more motivated
Every day I wake up refreshed, ready to go, and full of motivation
Being motivated and driven is a natural part of who I am
Being motivated and ambitious is a part of life I enjoy

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Post-Traumatic Stress Disorder (PTSD)

PTSD can leave you feeling stuck with a constant sense of danger and painful memories. But with new coping skills, you can feel safe again and move on from the trauma.

Distressed man standing and leaning against wall of bare-walled room, eyes closed

What is PTSD?

After a traumatic experience, it’s normal to feel frightened, sad, anxious, and disconnected. But if the upset doesn’t fade, you may be suffering from post-traumatic stress disorder (PTSD). PTSD can develop following any event that makes you fear for your safety. Most people associate PTSD with rape or battle-scarred soldiers—and military combat is the most common cause in men. But any event, or series of events, that overwhelms you with feelings of hopelessness and helplessness and leaves you emotionally shattered, can trigger PTSD—especially if the event feels unpredictable and uncontrollable.

PTSD can affect people who personally experience the traumatic event, those who witness the event, or those who pick up the pieces afterwards, such as emergency workers and law enforcement officers. It can even occur in the friends or family members of those who went through the actual trauma. Whatever the cause for your PTSD, by seeking treatment, reaching out for support, and developing new coping skills, you can learn to manage your symptoms, reduce painful memories, and move on with your life.

What causes PTSD?

When you experience a stressful event, your nervous system reacts with the fight-or-flight response. Your heart pounds faster, your blood pressure rises, and your muscles tighten, increasing your strength and reaction speed. Once the danger has passed, your nervous system calms your body, lowers your heart rate and blood pressure, and winds back down to its normal state.

PTSD occurs when you experience too much stress in a situation. Even though the danger has passed, your nervous system is “stuck,” unable to return to its normal state of balance and you’re unable to move on from the event. Recovering from PTSD involves helping your nervous system become “unstuck” so you can heal and move on from the trauma.

PTSD vs. a normal response to traumatic events

Following a traumatic event such as a natural disaster, traffic accident, terrorist attack, or assault, almost everyone experiences at least some of the symptoms of PTSD. When your sense of safety and trust are shattered, it’s normal to feel unbalanced, disconnected, or numb. It’s very common to have bad dreams, feel fearful, and find it difficult to stop thinking about what happened. These are normal reactions to abnormal events.

For most people, however, these symptoms are short-lived. They may last for several days or even weeks, but they gradually lift. But if you have post-traumatic stress disorder, the symptoms don’t decrease and you don’t feel a little better each day. In fact, you may start to feel worse.

Signs and symptoms of PTSD

PTSD develops differently from person to person because everyone’s nervous system and tolerance for stress is a little different. While you’re most likely to develop symptoms of PTSD in the hours or days following a traumatic event, it can sometimes take weeks, months, or even years before they appear. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell.

While everyone experiences PTSD differently, there are four main types of symptoms.

  1. Re-experiencing the traumatic eventthrough intrusive memories, flashbacks, nightmares, or intense mental or physical reactions when reminded of the trauma.
  2. Avoidance and numbing, such as avoiding anything that reminds you of the trauma, being unable to remember aspects of the ordeal, a loss of interest in activities and life in general, feeling emotionally numb and detached from others and a sense of a limited future.
  3. Hyperarousal, including sleep problems, irritability, hypervigilance (on constant “red alert”), feeling jumpy or easily startled, angry outbursts, and aggressive, self-destructive, or reckless behavior.
  4. Negative thought and mood changeslike feeling alienated and alone, difficulty concentrating or remembering, depression and hopelessness, feeling mistrust and betrayal, and feeling guilt, shame, or self-blame.

PTSD symptoms in children

In children – especially very young children – the symptoms of PTSD can differ from those of adults and may include:

  • Fear of being separated from their parent.
  • Losing previously-acquired skills (such as toilet training).
  • Sleep problems and nightmares.
  • Somber, compulsive play in which themes or aspects of the trauma are repeated.
  • New phobias and anxieties that seem unrelated to the trauma (such as fear of monsters).
  • Acting out the trauma through play, stories, or drawings.
  • Aches and pains with no apparent cause.
  • Irritability and aggression.

[Read: Helping Children Cope with Traumatic Events]

Do you have PTSD?

If you answer yes to three or more of the questions below, you may have PTSD and it’s worthwhile to visit a qualified mental health professional.

  • Have you witnessed or experienced a traumatic, life- threatening event?
  • Did this experience make you feel intensely afraid, horrified, or helpless?
  • Do you have trouble getting the event out of your mind?
  • Do you startle more easily and feel more irritable or angry than you did before the event?
  • Do you go out of your way to avoid activities, people, or thoughts that remind you of the event?
  • Do you have more trouble falling asleep or concentrating than you did before the event?
  • Have your symptoms lasted for more than a month?
  • Is your distress making it hard for you to work or function normally?

PTSD risk factors

While it’s impossible to predict who will develop PTSD in response to trauma, there are certain risk factors that increase your vulnerability. Many risk factors revolve around the nature of the traumatic event itself. Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety: the more extreme and prolonged the threat, the greater the risk of developing PTSD in response. Intentional, human-inflicted harm—such as rape, assault, and torture— also tends to be more traumatic than “acts of God,” or more impersonal accidents and disasters. The extent to which the traumatic event was unexpected, uncontrollable, and inescapable also plays a role.

Other risk factors for PTSD include:

Types of PTSD and trauma

Trauma or PTSD symptoms can result from many different types of distressing experiences, including military combat, childhood neglect or abuse, racism, an accident, natural disaster, personal tragedy, or violence. 

PTSD in military veterans

For all too many veterans, returning from military service means coping with symptoms of PTSD. You may have a hard time readjusting to life out of the military. Or you may constantly feel on edge, emotionally numb and disconnected, or close to panicking or exploding. But it’s important to know that you’re not alone and there are plenty of ways you can deal with nightmares and flashbacks, cope with feelings of depression, anxiety or guilt, and regain your sense of control.

Emotional and psychological trauma

If you’ve experienced an extremely stressful event—or series of events—that’s left you feeling helpless and emotionally out of control, you may have been traumatized. Psychological trauma often has its roots in childhood, but any event that shatters your sense of safety can leave you feeling traumatized, whether it’s an accident, injury, the sudden death of a loved one, bullying, domestic abuse, or a deeply humiliating experience. Whether the trauma happened years ago or yesterday, you can get over the pain, feel safe again, and move on with your life.

Rape or sexual trauma

The trauma of being raped or sexually assaulted can be shattering, leaving you feeling scared, ashamed, and alone, or plagued by nightmares, flashbacks, and other unpleasant memories. But no matter how bad you feel right now, it’s important to remember that you weren’t to blame for what happened, and you can regain your sense of safety, trust, and self-worth.

Racial trauma

Race-based traumatic stress stems from exposure to racist abuse, discrimination, or injustice. It can erode your sense of self-worth and lead to anxiety, depression, chronic stress, high blood pressure, disordered eating, substance abuse, and even symptoms of PTSD such as hypervigilance, negative thoughts, and mood changes. But there are ways to strengthen your resilience and protect your mental health.

Whatever your personal experiences or symptoms, the following tips can offer effective ways to help you heal and move on:

PTSD self-help tip 1: Challenge your sense of helplessness

Recovery from PTSD is a gradual, ongoing process. Healing doesn’t happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But there are many steps you can take to cope with the residual symptoms and reduce your anxiety and fear.

Overcoming your sense of helplessness is key to overcoming PTSD. Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times.

[Read: Surviving Tough Times by Building Resilience]

One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. Taking positive action directly challenges the sense of helplessness that is a common symptom of PTSD.

Positive ways of coping with PTSD:

  • Learn about trauma and PTSD.
  • Join a PTSD support group.
  • Practice relaxation techniques.
  • Pursue outdoor activities.
  • Confide in a person you trust.
  • Spend time with positive people.
  • Avoid alcohol and drugs.
  • Enjoy the peace of nature.

Tip 2: Get moving

When you’re suffering from PTSD, exercise can do more than release endorphins and improve your mood and outlook. By really focusing on your body and how it feels as you move, exercise can actually help your nervous system become “unstuck” and begin to move out of the immobilization stress response. Try:

Rhythmic exercise that engages both your arms and legs, such as walking, running, swimming, or dancing. Instead of focusing on your thoughts, focus on how your body feels. Notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin.

Rock climbing, boxing, weight training, or martial arts. These activities can make it easier to focus on your body movements—after all, if you don’t, you could get hurt.

Spending time in nature. Pursuing outdoor activities like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing helps veterans cope with PTSD symptoms and transition back into civilian life. Anyone with PTSD can benefit from the relaxation, seclusion, and peace that come with being out in nature. Seek out local organizations that offer outdoor recreation or team-building opportunities.

Tip 3: Reach out to others for support

PTSD can make you feel disconnected from others. You may be tempted to withdraw from social activities and your loved ones. But it’s important to stay connected to life and the people who care about you. You don’t have to talk about the trauma if you don’t want to, but the caring support and companionship of others is vital to your recovery. Reach out to someone you can connect with for an uninterrupted period of time, someone who will listen when you want to talk without judging, criticizing, or continually getting distracted. That person may be your significant other, a family member, a friend, or a professional therapist. Or you could try:

Volunteering your time or reaching out to a friend in need. This is not only a great way to connect to others, but can also help you reclaim your sense of control.

[Read: Volunteering and its Surprising Benefits]

Joining a PTSD support group. This can help you feel less isolated and alone and also provide invaluable information on how to cope with symptoms and work towards recovery.

Tip 4: Support PTSD treatment with a healthy lifestyle

The symptoms of PTSD can be hard on your body so it’s important to take care of yourself and develop some healthy lifestyle habits.

Take time to relax. Relaxation techniquessuch as meditation, deep breathing, massage, or yoga can activate the body’s relaxation response and ease symptoms of PTSD.

Avoid alcohol and drugs. When you’re struggling with difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But substance use worsens many symptoms of PTSD, interferes with treatment, and can add to problems in your relationships.

Eat a healthy diet. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious mealsthroughout the day. Omega-3s play a vital role in emotional health so incorporate foods such as fatty fish, flaxseed, and walnuts into your diet. Limit processed food, fried food, refined starches, and sugars, which can exacerbate mood swings and cause fluctuations in your energy.

Get enough sleep. Sleep deprivation can trigger anger, irritability, and moodiness. Aim for somewhere between 7 to 9 hours of sleep each night. Develop a relaxing bedtime ritual (listen to calming music, watch a funny show, or read something light) and make your bedroom as quiet, dark, and soothing as possible.

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What to know about bipolar disorderMedically reviewed by Janet Brito, Ph.D., LCSW, CST — Written by Tim Newman — Updated on July 21, 2020

A person with bipolar disorder will experience changes in mood, energy, and activity levels that can make day-to-day living difficult.

Bipolar disorder can cause severe disruption to a person’s life, but the impact varies between individuals. With appropriate treatment and support, many people with this condition live a full and productive life. 

According to the National Alliance on Mental Illness (NAMI), bipolar disorder affects over 10 million people in the United States or around 2.8% of the population.

On average, a person will receive a diagnosis around the age of 25 years, but symptoms can appear during the teenage years or later in life. It affects males and females equally.

What is bipolar disorder?

a woman with bipolar disorder looking into a mirror

Share on PinterestA person with bipolar disorder may experience “highs” and “lows” in quick succession.

The National Institute of Mental Health describe the main symptoms of bipolar disorder as alternating episodes of high and low mood. Changes in energy levels, sleep patterns, ability to focus, and other features can dramatically impact a person’s behavior, work, relationships, and other aspects of life.

Most people experience mood changes at some time, but those related to bipolar disorder are more intense than regular mood changes, and other symptoms can occur. Some people experience psychosis, which can include delusions, hallucinations, and paranoia.

Between episodes, the person’s mood may be stable for months or years, especially if they are following a treatment plan. 

Treatment enables many people with bipolar disorder to work, study, and live a full and productive life. However, when treatment helps a person feel better, they may stop taking their medication. Then, the symptoms can return.

Some aspects of bipolar disorder can make a person feel good. During an elevated mood, they may find they are more sociable, talkative, and creativeTrusted Source

However, an elevated mood is unlikely to persist. Even if it does, it may be hard to sustain attention or follow through with plans. This can make it difficult to follow a project through to the end.


According to the International Bipolar Association, symptoms vary between individuals. For some people, an episode can last for several months or years. Others may experience “highs” and “lows” at the same time or in quick succession. 

In “rapid cycling” bipolar disorder, the person will have four or more episodes within a year.

Mania or hypomania

Hypomania and mania are elevated moods. Mania is more intense than hypomania. 

Symptoms can include:

  • impaired judgment
  • feeing wired
  • sleeping little but not feeling tired
  • a sense of distraction or boredom
  • missing work or school
  • underperforming at work or school
  • feeling able to do anything
  • being sociable and forthcoming, sometimes aggressively so
  • engaging in risky behavior
  • increased libido
  • feeling exhilarated or euphoric
  • having high levels of self-confidence, self-esteem, and self-importance
  • talking a lot and rapidly
  • jumping from one topic to another in conversation
  • having “racing” thoughts that come and go quickly, and bizarre ideas that the person may act upon
  • denying or not realizing that anything is wrong

Some people with bipolar disorder may spend a lot of money, use recreational drugs, consume alcohol, and participate in dangerous and inappropriate activities. 

For more on the differences between mania and hypomania, click here.

What are the early signs of bipolar disorder in children and teens?

Depressive symptoms

During an episode of bipolar depression, a person may experience:

  • a feeling of gloom, despair, and hopelessness
  • extreme sadness
  • insomnia and sleeping problems
  • anxiety about minor issues
  • pain or physical problems that do not respond to treatment
  • a sense of guilt, which may be misplaced
  • eating more or eating less
  • weight loss or weight gain
  • extreme tiredness, fatigue, and listlessness
  • an inability to enjoy activities or interests that usually give pleasure
  • difficulty focusing and remembering
  • irritability
  • sensitivity to noises, smells, and other things that others may not notice
  • an inability to face going to work or school, possibly leading to underperformance

In severe cases, the individual may think about ending their life, and they may act on those thoughts.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.

Click here for more links and local resources.

Is it bipolar disorder or depression? Find out more.


If a “high” or “low” episode is very intense, the person may experience psychosis. They may have trouble differentiating between fantasy and reality.

According to the International Bipolar Foundation, psychosis symptoms during a high include hallucinations, which involve hearing or seeing things that are not there and delusions, which are false but strongly felt beliefs. A person who experiences delusions may believe they are famous, have high-ranking social connections, or have special powers.

During a depressive or “low” episode, they may believe they have committed a crime or are ruined and penniless.

It is possible to manage all these symptoms with appropriate treatment.

Bipolar disorder can also affect memory. Learn more here. a top-rated app for meditation and sleep

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Types of bipolar disorder

A person may receive a diagnosis of one of three broad types of bipolar disorder. According to NAMI, symptoms occur on a spectrum, and the distinction between the types is not always clear-cut.

Bipolar I disorder

For a diagnosis of bipolar I disorder:

  • The individual must have experienced at least one manic episode.
  • The person may have had a previous major depressive episode.
  • The doctor must rule out other disorders, such as schizophrenia and delusional disorder.

Bipolar II disorder

Bipolar II disorder involves periods of hypomania, but depression is often the dominant state.

For a diagnosis of bipolar II disorder, a person must have had: 

  • one or more episodes of depression
  • at least one hypomanic episode
  • no other diagnosis to explain the mood shifts

A person with hypomania may feel good and function well, but their mood will not be stable, and there is a risk that depression will follow. 

People sometimes think of bipolar II disorder as a milder version. For many, however, it is simply different. As NAMI indicate, people with bipolar II disorder may experience more frequent episodes of depression than people with bipolar I disorder.


The National Health Service (NHS) in the United Kingdom note that cyclothymia has similar features to bipolar disorder, but the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) classifies it separately. It involves hypomania and depression, but the changes are less intense.

Nevertheless, cyclothymia can impact a person’s daily life, and a doctor can provide treatment.

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A medical professional will diagnose bipolar disorder using criteria set out in the DSM-5.

The National Institue of Mental Health (NIMH) explain that in order to receive a diagnosis of bipolar I disorder, a person must have had symptoms for at least 7 days, or less if symptoms were severe enough to need hospitalization. They may also have had a depressive episode lasting at least 2 weeks.

To receive a diagnosis of bipolar II, a person will have experienced at least one cycle of hypomania and depression. 

A doctor may carry out a physical examination and some diagnostic tests, including blood and urine tests, to help rule out other causes. 

It can be challenging for a doctor to diagnose bipolar disorder, as people are more likely to seek help with a low mood than a high mood. As a result, it can be hard for them to distinguish it from depression.

If the person has psychosis, a doctor may misdiagnose their condition as schizophrenia

Other complications that may occur with bipolar disorder are:

NIMH urge healthcare providers to look for signs of mania in the person’s history, to prevent misdiagnosis. Some antidepressants can trigger mania in susceptible people.

A person who receives a diagnosis of bipolar disorder has a lifelong diagnosis. They may enjoy long periods of stability, but they will always live with the condition.

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Louise hay affirmations

Affirmations are inspirational, positive statements you say or think about yourself. Saying daily affirmations helps reprogram our negative self-talk so we can manifest more positive thinking, feeling and experiences in our lives. Use these powerful affirmations by Hay House authors like Louise Hay to enhance your life today!

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