3 Clues to Recognize Bipolar Disorder Mania in the Eyes
How to notice the signs that a loved one or client may be manic.
Posted Aug 31, 2017
It’s easy to recognize depression – at least the kind 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.
The pictures at left were taken in the same year. I’m euphoric hypomanic in one and depressed in the other. I started charting my facial changes during mood swings over 20 years ago. I knew my face changed depending on my mood, but until I actually took pictures, I wasn’t sure how much it changed.
Digital cameras naturally revolutionized this process and I eventually noticed that the major changes happened in my eyes. My smile could lie. I often smiled when depressed so that the world wouldn't know how sick I was in the moment. But my eyes never lied. I started to take pictures with my eyes as the focus and my mania management plan soon had another strategy I and the people close to me could use to keep mania from ruining my life and my relationships.
Once I figured out my own pattern, I created three clues loved ones and health care professionals could use to spot mania in a person with bipolar disorder, simply by observing the eyes. I started to share these with my readers and my coaching clients as well as my health care team.
What is Mania?
There are two levels of mania in bipolar disorder. Bipolar disorder 1 has hypomania and full blown mania. Bipolar disorder 2, which is what I have, only has hypomania, but even this form of mania can be very intense.
There are two types of mania—euphoric and dysphoric. (Dysphoric mania is also called mixed mania.) In simple terms, euphoric mania is an energized good mood. Dysphoric mania is an energized bad mood. Mania describes a change in energy. The hallmark of mania is sleeping a lot less and not being tired the next day.
My vision changes profoundly with euphoric mania: Colors become very vivid and start to move around as though they are vibrating. The world is in technicolor when I’m euphoric. (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 world view narrows. I rarely notice colors when I'm dysphoric.
Looking for Mania in the Eyes
After a few years of research with myself and others with mania, I determined that mania can affect the entire eye, from the distance between the brow and eye and changes in the lids to pupils changing size and the iris changing color. Once a person starts looking for mania in the eyes, it's easy to spot a person's episode (or your own) often way before other manic symptoms become more pronounced. One example: I often overexaggerate my eyes during euphoric mania to the point that I look unnatural.
Mania is devious. When I’m manic, I want to make you think I’m not. I will say and do anything to deny my mania: “I’m just finally better! Do you want me to stay depressed? This is the real me! Get off my back!” Looking for physical clues of mania in the eyes created an objective tool that helped me cut through this lying as well as the lack of insight most of us have when mania gets too strong.
3 Clues to Recognize Mania in the Eyes
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. I see what look like silver, shimmering flecks 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. Research is needed to assess if the changes are simply perception changes due to mania or if there truly is a change in the liquid coating of the eyes.
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. An eye doctor explained, “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 the all black eye.” And yet, I don't see this in euphoric mania. What causes our eyes to change shape and look darker during dysphoric mania?
3. The Eyes Change Shape.
The eyes often widen as if surprised with euphoric mania and often appear 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. My entire face brightens in euphoric mania, so it makes sense I would open my eyes wider as well. The following picture captures the difference. Neither picture was taken with a flash. On the topic, I'm euphoric. One week later, the bottom picture shows my eyes in a dysphoric manic episode.
A thought to ponder: People also report eye color changes when manic. One reader sent me a picture where her normal blue eyes turned brown during a dysphoric manic episode. It wasn’t the pupil. I heard from hundreds of people about changes in the eyes after I posted a Bp Magazine for Bipolar Disorder post a few years ago. I knew it was time to get some research to back up my idea. I'm excited to announce this has now happened.
Exciting Research News
I'm currently part of a team at Southern Methodist University researching my idea that we can recognize signs of mania by looking at the eyes. The study is open for public participation. We are looking for 1,000 images of the eyes from people who have manic episodes. We are also ask that people with bipolar disorder submit images from depressive and stable times as well. (Learn more about the SMU Mania in the Eyes research project.)
I often think of the scanners used on Star Trek: The Next Generation and imagine the possibilities this research holds for the future. If our study can show that mania is measurable through universal changes in the eyes, we can remove the stigma surrounding this very physical illness.
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 in an episode. I still hate telling the truth, but recognizing that I’m in a manic episode from looking in my own eyes has made a huge difference to my stability. I know learning to look for the three clues has helped my family and health care team recognize the signs of mania as well.