Bipolar Disorder (Thinking, Mood & Energy)
Michael Conner, PsyD
A Conceptual Model
Bipolar Waves
The chart serves as a useful conceptual model for visualizing the interplay between mood, energy, and intellect and their role in shaping psychological states. The underlying principles are supported by research on mood disorders, mixed states, and circadian rhythms. It is important to recognize this graph is not a definitive depiction.
The interaction between Mood, Energy, and Intellect, as depicted in the chart, aligns conceptually with established theories in psychology and psychiatry, particularly those addressing mood disorders like bipolar disorder. However, while the general principles are supported by research, the specific depiction of these oscillatory waves and their precise combinations remains is educational. Not all patients are the same but this captures the general nature of the disorder. This graph has clinical utility for clinicians who need to evaluate and educate patients about bipolar disorder and the diagnostic challenges and time it takes to diagnose patients.
Interpretation
Changes in Mood, Energy, and Intellect can result in a wide range of psychological and behavioral states, depending on whether each variable is low, normal, or high. Each of these combinations reflects a unique state of mind, with distinct implications for functioning and emotional well-being.
When Intellect is low, the individual may struggle with mental clarity or focus. In this state, if Mood and Energy are also low, the person may feel severely depressed, experiencing apathy, sluggishness, and cognitive fog. If Mood is low but Energy is normal, the individual might feel sad but functional, capable of completing basic tasks despite emotional distress. A more agitated state emerges when Mood is low, and Energy is high, leading to irritability or physical restlessness without mental clarity. In contrast, if Mood is normal, the low intellect may present as distractibility, with varying energy levels determining whether the person feels tired, balanced, or mildly energized. Finally, high Mood paired with low intellect might result in euphoric or impulsive behavior, with energy levels amplifying or tempering this state. For example, high energy could lead to recklessness, while low energy may create a paradoxical state of happiness without physical drive.
When Intellect is normal, the individual retains clear thinking even as Mood and Energy fluctuate. With low Mood and low Energy, they may experience a depressive episode but retain insight into their condition. When Energy increases, they may push through their emotional distress, functioning adequately despite sadness. If Energy is high, however, the combination of sadness and hyperactivity can lead to a mixed state where restlessness and irritability dominate. When Mood is stable, varying energy levels create states of physical tiredness, calm productivity, or heightened enthusiasm, with mental clarity remaining intact. If Mood is high, the individual may experience euphoria or joy, with energy levels determining whether this manifests as reflective contentment, functional enthusiasm, or an overly energized state that borders on hypomania.
High Intellect brings sharp mental clarity and focus, even as Mood and Energy fluctuate. When Mood and Energy are low, this can result in rumination, where the person feels emotionally and physically drained but is mentally overactive, often leading to excessive negative thoughts. When Energy increases slightly, the individual may turn to intellectual pursuits to distract themselves from sadness, maintaining productivity even during emotional distress. If Energy is high, this combination can result in a mixed state, with mental sharpness and hyperactivity fueling irritability or anxiety. When Mood is stable, high intellect paired with low energy can create a reflective or contemplative state, while normal or high energy can lead to periods of productive engagement or creativity. High Mood enhances this experience further, creating states of joy and intellectual flow. With normal energy, the individual may excel at creative or intellectual pursuits, while high energy can lead to extremely elevated productivity or even mania.
These interactions illustrate the complexity of psychological states, particularly for conditions like bipolar disorder, where mood, energy, and intellect oscillate dynamically. The alignment or misalignment of these factors determines whether an individual experiences stability, depression, hypomania, mania, or mixed states. Recognizing and understanding these patterns can help clinicians identify key features of a patient’s experiences, paving the way for effective diagnosis and intervention.
The interaction between Mood, Energy, and Intellect can result in a wide range of psychological and behavioral states, depending on whether each variable is low, normal, or high. Each of these combinations reflects a unique state of mind, with distinct implications for functioning and emotional well-being.
When Intellect is low, the individual may struggle with mental clarity or focus. In this state, if Mood and Energy are also low, the person may feel severely depressed, experiencing apathy, sluggishness, and cognitive fog. If Mood is low but Energy is normal, the individual might feel sad but functional, capable of completing basic tasks despite emotional distress. A more agitated state emerges when Mood is low, and Energy is high, leading to irritability or physical restlessness without mental clarity. In contrast, if Mood is normal, the low intellect may present as distractibility, with varying energy levels determining whether the person feels tired, balanced, or mildly energized. Finally, high Mood paired with low intellect might result in euphoric or impulsive behavior, with energy levels amplifying or tempering this state. For example, high energy could lead to recklessness, while low energy may create a paradoxical state of happiness without physical drive.
When Intellect is normal, the individual retains clear thinking even as Mood and Energy fluctuate. With low Mood and low Energy, they may experience a depressive episode but retain insight into their condition. When Energy increases, they may push through their emotional distress, functioning adequately despite sadness. If Energy is high, however, the combination of sadness and hyperactivity can lead to a mixed state where restlessness and irritability dominate. When Mood is stable, varying energy levels create states of physical tiredness, calm productivity, or heightened enthusiasm, with mental clarity remaining intact. If Mood is high, the individual may experience euphoria or joy, with energy levels determining whether this manifests as reflective contentment, functional enthusiasm, or an overly energized state that borders on hypomania.
High Intellect brings sharp mental clarity and focus, even as Mood and Energy fluctuate. When Mood and Energy are low, this can result in rumination, where the person feels emotionally and physically drained but is mentally overactive, often leading to excessive negative thoughts. When Energy increases slightly, the individual may turn to intellectual pursuits to distract themselves from sadness, maintaining productivity even during emotional distress. If Energy is high, this combination can result in a mixed state, with mental sharpness and hyperactivity fueling irritability or anxiety. When Mood is stable, high intellect paired with low energy can create a reflective or contemplative state, while normal or high energy can lead to periods of productive engagement or creativity. High Mood enhances this experience further, creating states of joy and intellectual flow. With normal energy, the individual may excel at creative or intellectual pursuits, while high energy can lead to extremely elevated productivity or even mania.
These interactions illustrate the complexity of psychological states, particularly for conditions like bipolar disorder, where mood, energy, and intellect oscillate dynamically. The alignment or misalignment of these factors determines whether an individual experiences stability, depression, hypomania, mania, or mixed states. Recognizing and understanding these patterns can help clinicians identify key features of a patient’s experiences, paving the way for effective diagnosis and intervention.
Evidence
The interaction between Mood, Energy, and Intellect, as depicted in the chart, aligns conceptually with established theories in psychology and psychiatry, particularly those addressing mood disorders like bipolar disorder. However, while the general principles are supported by research, the specific depiction of oscillatory waves and their precise combinations remains more theoretical than directly evidence-based.
There is strong evidence supporting the idea that mood, energy, and cognition (intellect) are interrelated dimensions that fluctuate in psychiatric conditions. For instance, fluctuations in mood—from depressive to stable to manic states—are well-documented in disorders like bipolar disorder and major depressive disorder. Similarly, energy levels are central features of these conditions, with hyperactivity often defining mania and lethargy characterizing depression. Cognitive changes, such as increased creativity during hypomania or mental fog during depression, are also frequently observed and supported by research. For example, studies have shown that depressive episodes impair executive functioning and memory, while manic states can enhance or impair cognitive abilities depending on their intensity.
The cyclical nature of mood disorders provides further support for the chart’s oscillatory framework. Bipolar disorder, for instance, is often associated with disruptions in circadian rhythms, which regulate daily patterns of energy and mood. Research has shown that these biological rhythms are frequently dysregulated in bipolar disorder, contributing to the predictable cycling of manic and depressive episodes. In some individuals, this cycling can occur rapidly, a phenomenon known as ultradian cycling, which resembles the rapid changes depicted in the waves. The kindling hypothesis, which posits that mood episodes become more frequent and predictable over time, also aligns with the notion of recurring patterns in mood, energy, and intellect.
The concept of mixed states—where manic and depressive symptoms coexist—is widely recognized in clinical research and fits well within this framework. Mixed states are often characterized by high energy paired with low mood or irritability, which aligns with the chart’s depiction of overlapping waves that are out of sync. For example, someone in a mixed state might feel physically restless but emotionally distressed, reflecting a combination of elevated energy and negative emotions.
The interplay between mood, energy, and intellect is further supported by research on the distinct features of manic, depressive, and mixed episodes. During mania, individuals often exhibit elevated mood, high energy, and sharpened or impaired cognition. Early stages of mania are frequently associated with heightened creativity and productivity, but as mania intensifies, cognitive impairments may emerge. Conversely, in depression, low mood and energy are often accompanied by difficulties with concentration and decision-making. Mixed episodes, on the other hand, may involve racing thoughts (high intellect) combined with irritability or sadness (low mood) and physical agitation (high energy). These clinical observations align with the conceptual combinations shown in the chart.
The oscillatory nature of mood, energy, and intellect also draws from broader psychological and neurobiological models. The Behavioral Activation System (BAS) theory links overactivation of motivational systems to mania and underactivation to depression. Similarly, energy-expenditure models suggest that fluctuations in energy influence emotional and cognitive states. On a biological level, neurotransmitters like dopamine, serotonin, and norepinephrine regulate mood, energy, and cognition, while brain regions such as the prefrontal cortex and the hypothalamic-pituitary-adrenal (HPA) axis play critical roles in managing cognitive control, decision-making, and stress responses.
While these conceptual underpinnings provide a strong foundation, the specific graphical representation of oscillating waves remains largely theoretical. There is no direct empirical study that validates the exact sinusoidal depiction of mood, energy, and intellect interactions. Real-life fluctuations in these factors are rarely as regular or predictable as the graph implies. Additionally, the subjective nature of mood, energy, and intellect means that their measurement can vary widely across individuals and contexts. External factors, such as stress, environment, or medications, also influence these dynamics in ways that may not align neatly with the chart.
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Publishing.
Describes the diagnostic criteria and characteristics of mood disorders, including bipolar disorder and mixed states.
Kupfer, D. J. (2005). The increasing medical burden in bipolar disorder. JAMA, 293(20), 2528-2530.
Discusses the features of bipolar disorder, including energy dysregulation and mood cycling.
Martino, D. J., Marengo, E., Igoa, A., & Strejilevich, S. A. (2015). Cognitive and motor features in euthymic bipolar disorder: A systematic review. Psychiatry Research, 229(3), 720-726.
Explores cognitive impairments and changes in bipolar disorder during different phases.
McClung, C. A. (2007). Circadian genes, rhythms, and the biology of mood disorders. Pharmacology & Therapeutics, 114(2), 222-232.
Highlights the role of circadian rhythm dysregulation in mood and energy oscillations.
Vieta, E., Valenti, M. (2013). Mixed states in bipolar disorder: A clinical and therapeutic review. Journal of Affective Disorders, 148(1), 17-26.
Discusses the clinical features and treatment of mixed states, emphasizing the overlap of depressive and manic symptoms.
Depue, R. A., & Iacono, W. G. (1989). Neurobehavioral aspects of affective disorders. Annual Review of Psychology, 40(1), 457-492.
Examines the behavioral activation system (BAS) in the context of mood disorders and energy regulation.
Hockey, G. R. J. (2013). The psychology of fatigue: Work, effort and control. Cambridge University Press.
Provides insights into energy-expenditure models and how energy levels affect emotional and cognitive functioning.
Johnson, S. L., Tharp, J. A., Peckham, A. D., & Carver, C. S. (2012). Energization and mania risk: Performance on a speeded reaction task predicts prospective increases in manic symptoms. Behavior Therapy, 43(2), 307-314.
Explores the relationship between energy and mania, including hyperactivity and impulsivity.
Rock, P. L., Roiser, J. P., Krug, A., & Sahakian, B. J. (2014). Cognitive impairment in depression: A systematic review and meta-analysis. Psychological Medicine, 44(10), 2029-2040.
Provides evidence of cognitive impairments in depression, including reduced attention and executive functioning.
Alloy, L. B., Nusslock, R., & Boland, E. M. (2015). The development and course of bipolar spectrum disorders: An integrated reward and circadian rhythm dysregulation model. Annual Review of Clinical Psychology, 11, 213-250.
Discusses how reward sensitivity and circadian rhythm dysregulation contribute to bipolar disorder.