It’s all in the eyes! Mania profoundly affects the entire eye, from lids and lashes to pupils and color rings.
Physical Signs of Bipolar Depression & Mania
It’s easy to see depression—at least the kind of depression we associate with slumped shoulders, feeling dead inside, and crying. Depression shows on our faces like a book cover. But mania! Oh, mania! It can look like happiness! Or rage! Or someone finally coming out of a depression and feeling real again! Mania is tricky.
Tracking Facial Changes during Mood Swings
The above pictures were taken in the same year. I’m hypomanic in one and depressed in the other. I started charting my facial changes during mood swings over ten years ago. I thought my face changed depending on my mood, but until I actually took pictures, I wasn’t sure how much it changed.
It changes a lot.
Once I figured out my own pattern, I created three clues to help family members and health care professionals spot mania in a person with bipolar disorder, simply by observing the eyes.
The first step is to understand the basics of mania. There are two levels of mania in bipolar disorder. Bipolar I has hypomania and full-blown mania. Bipolar II, which is what I have, only has hypomania, but let me tell you: Hypomania can be very, very intense.
There are two types of mania: euphoric and dysphoric. (Dysphoric mania is also called “mixed mania.”) In really simple terms, euphoric mania is an energized good mood. Dysphoric mania is an energized bad mood. The hallmark of mania is not sleeping and not being tired the next day.
It’s all in the eyes! Mania profoundly affects the entire eye—from lids and lashes to pupils and color rings. Once you start looking for mania in the eyes, you can spot a person’s mania (or your own) often way before other manic symptoms become more pronounced.
My vision changes profoundly with euphoric mania—colors become very vivid and start to move around. The world is in technicolor when I’m manic. (I swear I see in black-and-white when severely depressed.) Conversely, dysphoric mania narrows my vision, and I squint and look angry around the eyes. I don’t see the big picture and my worldview narrows.
3 Clues to Recognize Mania in the Eyes
Here are three clues you can use to recognize mania in yourself, in a loved one, or in a client. It’s important to remember that mania is devious. I can tell you for a fact that when I’m manic, I want to make you think I’m not. I will say and do anything to make you believe me, “I’m just finally better! Do you want me to stay depressed! This is the real me! Get off my back!” If mania makes us lie to ourselves, think of how great we can be when lying to the people who want to help us! This is why looking for physical clues is a good first step if you’re trying to figure out whether someone is manic.
Clue #1 Sparkling Eyes in Euphoric Mania
Euphoric mania often creates a shimmering quality to the liquid in the eyes. We sparkle! When I look in the mirror during a euphoric manic episode, I’m entranced with my face. I see NO flaws. My skin is perfect. My eyes are brilliant. My hair shines. Believe it or not, this is often physically true as well. Mania does make those changes. I have seen what look like silver, shimmering flicks in the whites of my eyes when euphoric. People find this very attractive. We all know how easy it is to get a relationship when you’re euphoric. How we look at people is a big part of this. We focus these sparkling eyes on our unsuspecting prey and they are lost!
Clue #2 Darker Eyes in Dysphoric Mania
Once I started asking clients to notice eye changes in a loved one, I heard many stories of how dysphoric mania turned the eyes black. I tried to figure this out on my own and finally asked an eye doctor about it. She said, “Oh, I’m not surprised by that. It’s documented that adrenaline can make the pupil take over the eye. Mania sounds like it’s something to do with adrenaline, so I would think the eye is the same color, but the pupil is huge. This creates the all-black eye.”
Clue #3 The Eyes Change Shape
The eyes can widen with euphoric mania and often get mean and narrow with dysphoric mania. I’m not talking about a few minutes of this—the changes can last for months. I know my own dysphoric mania makes me as mean as a snake and as suspicious as a jealous husband. Suspicion narrows the eyes and purses the lips. In contrast, I’m open to the world when euphoric, and this widens my eyes. I have seen it in pictures. My entire face brightens in euphoric mania, so it makes sense I would open my eyes wider as well.
A Thought to Ponder: Changes in Eye Color?
People also report actual eye-color changes when manic. One reader sent me a picture in which her normally blue eyes turned brown during a dysphoric mania episode. It wasn’t the pupil but the iris. I’m interested to see what you find in your own eyes. Let me know in the comments section if you have noticed changes in your eyes when manic, or if you see this happen in someone you know.
Other Physical Clues of Bipolar Mania
The eyes are only the first step to recognizing mania through physical changes. I advise looking at yourself and your loved one while stable. Take a picture with a resting face and a smiling face. Then note the changes when someone gets ill. Take a picture when the person is ill. This becomes part of a successful management plan. Pictures don’t lie and can be remarkable conversation starters when the person with bipolar disorder is ready to talk.
Other physical changes in mania include the shoulders—they tend to move back with euphoric mania and move forward with dysphoric mania. Walking and hand movements change, and many physical behaviors speed up. The body can tell us so much about mania!
After years of practice, I can look in the mirror and easily see when I’m manic. This doesn’t mean I want to believe I’m manic. I hate telling the truth, but recognizing that I’m sick from looking in my own eyes has made a huge difference to stability, and I know it has helped my family recognize the signs of mania as well.
Julie A. Fast is the author of Loving Someone with Bipolar Disorder, Take Charge of Bipolar Disorder, Get It Done When You’re Depressed, and The Health Cards Treatment System for Bipolar Disorder. She is a columnist and blogger for bp Magazine, and she won the Mental Health America journalism award for the best mental health column in the US. Julie was also the recipient of the Eli Lilly Reintegration Achievement Award for her work in bipolar disorder advocacy. Julie is a bipolar disorder expert for ShareCare, a site created by Dr. Oz and Oprah. Julie is CEU certified and regularly trains health care professionals, including psychiatric residents, social workers, therapists, and general practitioners, on bipolar disorder management skills. She was the original consultant for Claire Danes for the show Homeland and is on the mental health expert registry for People magazine. She works as a coach for parents and partners of people with bipolar disorder. Julie is currently writing a book for children called "Hortensia and the Magical Brain: Poems for Kids with Bipolar, Anxiety, Psychosis, and Depression." You can find more about her work at JulieFast.com and BipolarHappens.com.
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