Bipolar disorders (formerly called manic-depressive illness or manic depression are classified as mood disorders which include characteristics of extreme mood shifts “highs and lows” including depressive symptoms and manic episodes separated by relatively normal periods of mood. These mood changes differ from the typical ups-and-downs most people experience. Because of the existence of co-occurring disorders, bipolar disorder is often misdiagnosed or mistreated. Additionally, more than two-thirds of people diagnosed with bipolar disorders have a relative with similar symptoms and characteristics.People with bipolar symptoms are at a greater risk of suicide if left untreated.It is common for bipolar individuals to enjoy the euphoric feelings and increased productivity attributed with manic and hypomanic episodes, but is important to remember that they’re impermanent. Both hypomanic and manic episodes result in an emotional crash that leave individuals feeling depressed and worn out.
Signs and Symptoms
Symptoms and their severity can vary. A person with bipolar disorder may have distinct manic or depressed states but may also have extended periods, sometimes years, without symptoms. A person can also experience both extremes simultaneously or in rapid sequence.
Severe bipolar episodes of mania or depression may include psychotic symptoms such as hallucinations or delusions. Usually, these psychotic symptoms mirror a person’s extreme mood
To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Hypomania is a milder form of mania that doesn’t include psychotic episodes. People with hypomania can often function well in social situations or at work. Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.
Although someone with bipolar may find an elevated mood of mania appealing—especially if it occurs after depression—the “high” does not stop at a comfortable or controllable level. Moods can rapidly become more irritable, behavior more unpredictable and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks.Most of the time, people in manic states are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger because some people become suicidal even in manic states. Learning from prior episodes what kinds of behavior signals “red flags” of manic behavior can help manage the symptoms of the illness.
The lows of bipolar depression are often so debilitating that people may be unable to get out of bed. Typically, people experiencing a depressive episode have difficulty falling and staying asleep, while others sleep far more than usual. When people are depressed, even minor decisions such as what to eat for dinner can be overwhelming. They may become obsessed with feelings of loss, personal failure, guilt or helplessness; this negative thinking can lead to thoughts of suicide.
The depressive symptoms that obstruct a person’s ability to function must be present nearly every day for a period of at least two weeks for a diagnosis. Depression associated with bipolar disorder may be more difficult to treat and require a customized treatment plan.
Scientists have not yet discovered a single cause of bipolar disorder. Currently, they believe several factors may contribute, including:
- Genetics. The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder. But the role of genetics is not absolute: A child from a family with a history of bipolar disorder may never develop the disorder. Studies of identical twins have found that, even if one twin develops the disorder, the other may not.
- Stress. A stressful event such as a death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode. Thus, a person’s handling of stress may also play a role in the development of the illness.
- Brain structure and function. Brain scans cannot diagnose bipolar disorder, yet researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder.
To diagnose bipolar disorder, a primary or behavioral care provider may perform a physical examination, conduct an interview and order lab tests. While bipolar disorder cannot be seen on a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder, such as hyperthyroidism. If no other illnesses (or medicines such as steroids) are causing the symptoms, you may be referred to Mental or behavioral health care professionals.
To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Behavioral health care professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the “type” of bipolar disorder a person may be experiencing. To determine what type of bipolar disorder a person has, behavioral or mental health care professionals assess the pattern of symptoms and how impaired the person is during their most severe episodes.
Mood episodes are the distinct periods in which individuals experience intense emotional states along with unusual sleep habits, activity levels, thoughts, and/or behavior. Each episode denotes a drastic alteration from a person’s typical mood or behavior. During an episode, people will experience symptoms for the majority of the day and bipolar individuals usually experience multiple episodes.
The DSM delineated four particular types of mood episodes: manic episodes, hypomanic episodes, depressive episodes, and mixed episodes.
Mania and hypomania are two different types of mood episodes, but manifest the same symptoms.
Hypomania is simply a mild form of mania.
Mania is noticeably more severe, causes more problems in daily activity, and can even induce psychosis. It is important to note that without proper treatment, hypomanic episodes can develop into severe mania or depression. In order for an individual to experience a manic or hypomanic episode, they must exhibit three or more of the following symptoms for at least seven days or be so severe that hospitalization is required.
- Feeling very “up” or “high” for an extended period of time
- Feeling jumpy, wired, or abnormally upbeat
- Extreme irritability
- Difficulty concentrating or having racing thoughts
- Becoming more outgoing and talking faster or more than usual
- Increasing their amount of activity or thinking they can do a myriad of
things at once
- Decreased need for sleep or sleeping less
- Impulsivity in behavior and decision making – engaging in excessive risky behaviors deemed pleasurable like shopping sprees or reckless sex
Major depressive episodes are opposite of Manic episodes. During a depressive episodes, individuals become much more reserved and tend to isolate themselves. It’s common for depressive symptoms to become severe enough to disrupt their daily lives, and make the most routine tasks difficult. When someone is going through a Depressive episodes, they will experience five or more of the following nine symptoms for two or more weeks:
- Prolonged depressed mood – feeling sad or empty for the majority of the Day
- Decreased interest or pleasure in almost all activities, even those they previously enjoyed
- Significant weight fluctuations or altered appetite
- Insomnia or hypersomnia
- Restlessness or slowed behaviors
- Fatigue or loss in energy
- Feeling excessive/inappropriate guilt or worthlessness
- Inability to think or concentrate
- Suicidal ideation
A mixed mood episode or mixed state, is a manifestation of manic and depressive symptoms simultaneously. During a mixed state, individuals are likely to be more irritable than normal, have trouble sleeping, and experience a drastically changed appetite. People in a mixed state may feel very sad and hopeless while at the same time feel extremely energized. Thus, a mixed mood episode can be characterized by emotional uncertainty or confliction.
Types of Bipolar Disorder
- Bipolar I Disorder is defined by mood disorder in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person’s manic episodes must last at least seven days or be so severe that hospitalization is required.
- Bipolar II Disorder Defined by one or more major depressive episodes accompanied by at least one hypomanic episode. This excludes full-blown manic or mixed episodes.
- Cyclothymic Disorder or Cyclothymia Defined by at least two years of numerous periods of hypomanic symptoms that do not meet criteria for a manic episode, and numerous depressive symptoms that do not meet the criteria for a major depressive episode. This is a mild form of bipolar disorder People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.
- Bipolar Disorder, “other specified” and “unspecified” Diagnosed when symptoms of the illness do not meet the criteria for any of the specific bipolar disorders, but the symptoms are clearly out of the person’s normal range of behavior.
Bipolar disorder is highly treatable, if left untreated, bipolar disorder usually worsens. Living with untreated bipolar disorder can lead to problems in everything from your career to your relationships to your health. However, with a good treatment plan including psychotherapy, medications, a healthy lifestyle, a regular schedule and early identification of symptoms, many people live well with the condition.The most effective forms of treatment typically include a steady, prolonged combination of medication and psychotherapy.
- Psychotherapy, such as cognitive behavioral therapy, psychoeducation, Interpersonal & social rhythm therapy and family-focused therapy.
- Medications, such as mood stabilizers, antipsychotic medications and, to a lesser extent, antidepressants.
- Self-management strategies, like education and recognition of an episode’s early symptoms.
- Complementary health approaches, such as aerobic exercise meditation, faith and prayer can support, but not replace, treatment.
Coexisting Conditions & Complications with Bipolar Disorder
People with bipolar disorder frequently have other mental or behavioral conditions that significantly interfere with their bipolar disorder and overall treatment outcome:
People with bipolar disorder can also experience:
- Substance use disorders/dual diagnosis
- Anxiety Disorders
- Attention-deficit hyperactivity disorder (ADHD)
- Posttraumatic stress disorder (PTSD)
- Eating disorder
- Physical health problems- heart disease, thyroid problems, obesity, headaches.
Substance abuse problems are the most common conditions associated, and they are also the biggest complication attributed with bipolar individuals’ stability. Some people attempt treating their disorder by “Self-medicating “with alcohol or recreational drugs. But, this often triggers or prolongs their symptoms and the manic behavioral complications lead them to excessive indulgences.
Other common complications with bipolar disorder include but are not limited to:
• Damaged Relationships
• Legal or financial problems
• Poor work or academic performance
• Suicide or suicide attempts