Understanding State Changes: Why They’re Often Confused for Bipolar Rather Than Trauma

It’s not uncommon for people living with trauma to be told, “You might have bipolar disorder.” On the surface, it makes sense — there are visible shifts in mood, energy, and engagement with life. One day you feel alive and motivated, the next you’re withdrawn and flat. But while bipolar disorder is a real and valid condition, not every dramatic change in state comes from a mood disorder.

State Changes: The Nervous System’s Language

Trauma lives in the nervous system. It’s not just in your memories — it’s in your body’s instinctive survival responses. When you’ve experienced overwhelming or unsafe situations, your nervous system can become sensitised. This means it can swing quickly between different states:

• Hyperarousal (high alert, high energy, agitation, racing thoughts)

• Hypoarousal (numbness, shutdown, fatigue, disconnection)

To an untrained eye, this can look like the manic and depressive phases of bipolar disorder. But these state shifts are often protective strategies your nervous system learned to survive, not a cyclical psychiatric illness.

Why Misdiagnosis Happens

From the outside, both bipolar and trauma-related state changes share some similarities:

• Periods of high productivity or impulsivity can look like mania, but may actually be a hypervigilant drive to “outrun” feelings or stay safe by staying busy.

• Low mood and withdrawal can look like depression, but may actually be a dorsal vagal shutdown — the body conserving energy and numbing to avoid overwhelm.

Without looking at the context — when these changes happen, what triggers them, and the person’s history — it’s easy to make the wrong call.

The Role of Triggers and Safety

In trauma, mood and energy shifts are often linked to triggers or changes in perceived safety. Someone might be energetic and connected when they feel safe, then rapidly shut down after a conflict, a memory, or even subtle environmental cues. Bipolar disorder, on the other hand, tends to follow its own internal rhythm and is less directly tied to situational triggers.

Why This Distinction Matters

If trauma-based state changes are mistaken for bipolar disorder, treatment may focus primarily on mood stabilising medication — which might help some symptoms but won’t address the root cause. Trauma recovery requires a different approach:

• Building nervous system regulation skills

• Processing traumatic memories

• Learning to detect and respond to state shifts

• Creating safety in the body and relationships

  
  

A More Nuanced View

We need to remember that not all intense changes in mood and behaviour are pathological in the same way. Sometimes, they’re the residue of survival adaptations that were once life-saving. When we see someone through a trauma-informed lens, we stop asking, “What’s wrong with you?” and start asking, “What happened to you?”