Bipolar disorder: What clues you in to the difference between legitimate fear/paranoia and symptomatic or imagined attacks?

It feels like a genuine issue that stimulates a “flee or die” response. People are against me, I know it! I have to get away.

Then there’s the sudden swings from giddy “It’s all cool, I’ve got this handled.” to “I can’t go on.” There’s no identifiable trigger. It simply changes.

If you have experience with this, what do you do to let yourself know it’s not real, it’s only symptoms? Also, what has helped as far as therapy or pharmaceutical intervention?

Yes, this is a serious question but I’m posting in Social rather than General to allow for less restrictive moderation.