Expert insight on racing thoughts, cluttered thinking, intrusive thoughts, and focus problems, and what you can do.
Key Takeaways
- Recognizing racing or cluttered thoughts is an important part of managing bipolar disorder.
- Because these symptoms aren’t always visible, describing them clearly can help your doctor understand what’s happening.
- Focus problems may be tied to mood overactivity rather than a separate attention disorder, which can affect treatment.
- If racing thoughts interfere with sleep, work, or daily tasks, it’s worth talking to a healthcare provider.
What Are Racing Thoughts in Bipolar Disorder?
Thinking difficulties are some of the most impactful symptoms of bipolar disorder. When paying attention, focusing, or concentrating requires significant effort, these symptoms can negatively affect how you function by limiting your ability to use all your brainpower.
But like other symptoms, which often evolve over time, you may not even recognize that your process of thinking is atypical. As difficulty concentrating can often represent mental overactivity due to ongoing hypomania or mania, recognizing these shifts is critical.
Being able to self-report an altered thinking process is very important, because it’s difficult for an outside observer — be it a family member, spouse, or trained clinician — to notice it. Your clinician may not ask about thinking difficulties, or they may not ask in a way that is clear to you.
Here are some terms and definitions that may help you better understand thinking difficulties and discuss them with your doctor:
What Do Racing Thoughts Feel Like?
The speed of your thinking is rapid. You might describe your mind as “racing like an engine” or say, “I can’t shut my mind off.” This symptom may be noticed only at bedtime, when the external stimuli of daytime activities aren’t distracting you from the experience of your internal thought process. Many people play the radio or television to drown out their own thoughts until sleep comes.
Cluttered Thoughts and Mental Overload
You think of many different thoughts at the same time or in close succession. Some people report that their mind is extremely “busy” or their thoughts are “chattering.” Others describe this experience as having part of their attention on the task or conversation at hand, while another part of their mind is scampering from thought to thought.
Obsessive and Intrusive Thoughts
The content of your thinking tends to be ruminative or perseverative. You have difficulty putting a thought or concern out of your mind. What you are thinking about may be normal, but the degree of your preoccupation with the thought is blown out of proportion.
These thoughts tend to override other thoughts and intrude, unbidden, into your awareness. Obsessive thoughts are difficult or impossible to dismiss, or even temporarily put aside. The experience may be noticed particularly at bedtime.
Impaired Attention and Focus
Your thinking is distracted. You have difficulty maintaining focus on a task or conversation because you feel pulled away by external stimuli or your own thoughts. It’s like sitting in a multiplex theater where the walls between theaters are removed, and you’re distracted from the movie directly in front of you by the movies playing to either side. Often, people report having trouble with memory when, actually, they’re so distracted that they aren’t making memories.
Individuals frequently experience impaired attention long before seeking professional help. In adapting to their deficit, many people unconsciously avoid situations where sustained focus is critical, such as reading or classroom environments. As a result, many report to their clinician that their thinking is “normal” — which, to them, it is!
In many cases of bipolar disorder, people only realize they were experiencing altered thinking after they’re properly diagnosed and treated, when they notice the absence of any thinking difficulties.
Why Thinking Problems Are Hard to Recognize
It’s particularly challenging to identify and correctly diagnose attention problems in children with bipolar spectrum disorders. Many individuals can appear to be paying rapt attention, but when asked, report that their minds are drifting to or preoccupied with unrelated thoughts. These people may be incorrectly assessed as merely being absent-minded.
As can often occur in children, where mood symptoms aren’t predominant or aren’t yet recognized, the clinician may believe they are dealing purely with a problem of distractibility.
Sadly, this may be why many people are frequently misdiagnosed with nonspecific attention disorders like attention-deficit hyperactivity disorder (ADHD) and are only later in life correctly diagnosed with bipolar spectrum disorders.
Differentiating Attention Difficulties
Yet it’s important to note that not all difficulty with attention is a symptom of a mental health problem. If you’re not interested in the topic (or the speaker) or are distracted by a pressing matter, you would not want to identify that as a thinking problem per se.
When to Talk to a Doctor About Racing Thoughts
Make sure to bring up (remember, you may not be asked) any trouble you experience with thinking or attention at both your initial and follow-up appointments. Hopefully, some of the concepts above can help you observe your own thinking process and articulate to your clinician what’s going on inside.
UPDATED: Printed as “Clinician’s Corner: Straight Talk on “Bent” Thinking,” Winter 2010
