One of the critical thinking skills that can be affected by bipolar disorder is decision making. This goes along with other aspects of cognitive functioning such as memory, attention, some motor skills and social skills. People are affected in different ways and to different extents depending on the severity of the disorder. Decision making in people with bipolar disorder also depends on whether the person is manic, depressed or between episodes.
Decision making has a great deal to do with impulsive behavior. One of the criteria for a manic episode is that the person is that the person engages in risky behavior. This can be anything from gambling or money spending to sexual behavior. Again, the extent of the behavior depends on the person and the severity of the disorder, but impulsivity is generally present in some form across all phases of bipolar disorder, including between episodes.
Making a decision is a fight between logic and emotion. Logic requires significant amounts of energy and thoughtfulness. It takes time. There are generally seven steps in making any decision.
- Identify exactly what the decision entails and the desired end goal.
- Gather relevant information.
- Examine the options available using both logic and emotion.
- Weigh each alternative option based on the best way to reach the end goal.
- Make a decision based on the best option.
- Turn the decision into action.
- Evaluate that decision and its consequences.
During mania, action is often the end goal.
Another symptom of mania is racing thoughts. When the mind is moving quickly, stopping to think hard about a decision can be incredibly difficult. People may not consider the consequences of their actions, which can lead to poor decision making. There is a sense of urgency, a driving need to act immediately based on impulse, not on logic.
During depression, it’s about the lack of planning.
Hopelessness is a large part of depression. Without hope, there can be a lack of a sense of the future. It feels like depression is all that has existed and all that will exist. It’s tiring. Fatigue weighs on the mind and body. In this state, there is little energy left to think and plan ahead, so decisions are made in the now, without forethought. This combination of hopelessness and impulsivity increases the risk for suicide.
During euthymia, it doesn’t go away.
Euthymia is the state between episodes. It’s a misconception that between manic or depressive states, people with bipolar disorder are symptom-free. Cognitive function can still be affected and patients may have mild symptoms. Again, it depends on the person how severe this is. People with more advanced bipolar disorder will have more problems between episodes, as will people who do not follow treatment plans. Poor decision-making can be a part of this problem.
For people with bipolar disorder, good decision making can be especially difficult. It is up to the patient to attempt to keep it in check, but a strong support system of doctors, friends and relatives should also be in place to help out in hard times.
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