"Oh my goodness, she's so crazy!" "Why are you being so mean all of a sudden?" "Ugh. You're so bipolar."
Have you ever heard someone say things like this, or have you ever said them yourself? The word bipolar is thrown around a lot, but what does it actually mean?
- What is bipolar disorder?
- What causes bipolar disoder?
- What are the different types of bipolar disorder?
- What are the symptoms of bipolar disorders?
- What are available treatments for bipolar disorder?
Definition of Bipolar Disorder
Bipolar disorder (BD) is a mental health condition that involves mood swings ranging from manic (or hypomanic) episodes to depressive episodes. You might think of bipolar disorder as a type of depression since it involves some depression-like symptoms, but bipolar disorders are their own category.
Bipolar Disorder’s acronym is BD. Remember that it’s not BPD! Borderline Personality Disorder is BPD.
How do you know if someone has depression or bipolar disorder? If the person ever experiences manic or hypomanic episodes, then their symptoms automatically fit BD and not depression. Manic or hypomanic episodes are the key feature of bipolar disorders. So, what are they?
A manic episode happens when someone has a mood disturbance (irritable, elevated, or different) lasting longer than one week and for the majority of each day. People who are in a state of mania are having such a mood disturbance that they may suffer from social impairment, hospitalization, and psychotic episodes. Someone has to have at least one manic episode to be diagnosed with bipolar I disorder.
A hypomanic episode happens when someone has a mood disturbance lasting longer than four days and for the majority of the day. People who are in a hypomanic episode experience impairment from it, but not as severe as a manic episode (it cannot include psychotic episodes or hospitalizations).
Two friends named Jerry and Tom are checking in with each other. Jerry tells Tom that he feels like he is on top of the world for the past couple of weeks; he can complete anything he wants to. He isn't not sleeping as much as he used to, but that's okay because he doesn't need to. However, when Jerry's talking, Tom notices that he seems a lot more irritated than usual, and doesn't seem to be paying any attention to what Tom's saying.
What Causes Bipolar Disorder?
As with other mental health disorders, there are a variety of potential causes of bipolar disorder. One factor is genetics, with some sources saying that genetics accounts for 80 percent of the risk for this disorder. If one of your parents has or had BD, you have around a 10 percent chance of getting it as well.
Research also shows that those with BD have different levels of certain chemicals in the brain than those without the disorder. In general, people are at a higher risk of developing a bipolar disorder if they are going through an extremely stressful time in their life, or abusing substances. This is especially true if they have a family history of BD!
Manic and depressive episodes, pexels
Types of Bipolar Disorders
Four disorders fall under the bipolar category: Bipolar I, Bipolar II, Cyclothymic Disorder, and substance/medication-induced bipolar and related disorder.
Bipolar I and Bipolar II involve either manic or hypomanic episodes and depressive episodes. What are the other two disorders?
Cyclothymic disorder is diagnosed when someone experiences mild episodes of hypomania and depression. These episodes don't meet the full criteria for hypomania or depression, but their symptoms are significant enough to cause problems. These symptoms have to persist for two years in adults before a diagnosis can be made.
Substance/medication-induced bipolar and related disorder is diagnosed when someone experiences symptoms of Bipolar I or Bipolar II due to a substance or medication. Several substances can cause symptoms of bipolar disorder, especially if they are misused or abused.
Symptoms of Bipolar Disorders
The main symptom of Bipolar I (BD 1) is the presence of at least one manic episode. It also typically involves hypomanic episodes and full depressive episodes.
Symptoms of Bipolar I
These symptoms include:
Manic Episodes
Bipolar symptoms need to be severe enough to cause problems in life or relationships. Manic episodes include increased energy and activity that last for at least one week. Manic or hypomanic episodes are the "high" side of the highs and lows of bipolar disorders. Manic episodes also need to include three or more of the following:
Increased or inflated self-esteem.
Decreased need for sleep.
Increased talking.
Racing thoughts.
Easily distracted.
Increased motivation to meet goals.
Increased involvement in risky behaviors.
Other Symptoms
BD 1 does not require periods of depression after the manic episode, but many people experience them. During a depressive episode, people might experience less interest in things they enjoy, feelings of hopelessness, and suicidal ideation. People with BD 1 may enter a hypomanic episode instead of a depressive one, or experience both at different times. The person cycles through different kinds of symptoms: manic and/or hypomanic and/or depression. Sounds like a rollercoaster ride, right?
Symptoms of Bipolar II
In order for someone to be diagnosed with Bipolar II (BD 2), they have to experience at least one hypomanic episode and one depressive episode. If they experience any manic episodes, they do not qualify for BD 2. Instead, they would be diagnosed with BD 1.
Hypomanic Episodes
These episodes involve a significant change in mood (more irritable, elevated, or different than usual) lasting longer than four days and for the majority of each day. These symptoms have to impact the person’s life, but they can't be severe enough to require hospitalization. Hypomanic episodes also require three or more of the symptoms of manic episodes.
Major Depressive Episodes
Major depressive episodes in BD 2 include either a depressed mood or a significant lack of interest in things you usually enjoy. This has to last for at least 2 weeks. They also have to include at least five or more of the following symptoms:
Depressed mood for most of the day, almost every day.
Loss of interest in activities for most of the day, almost every day.
Weight loss.
Insomnia.
Slower movements.
Fatigue or lower energy levels.
Feelings of worthlessness.
Decreased ability to think clearly.
Suicidal ideation.
Symptoms of Cyclothymic Disorder
A diagnosis of cyclothymic disorder includes symptoms similar to those of BD 1 and BD 2, but not as severe. Someone with cyclothymic disorder will experience milder hypomanic and depressive episodes, more often or more rapidly than those with BD 1 and BD 2. The symptoms never become severe enough to meet the criteria for a different bipolar disorder. These mild episodes still cause struggles socially, and in other aspects of life.
Treatments for Bipolar Disorder
There are different options for treating bipolar disorders, but medication is often recommended as the first step in treatment.
Medication
Medications help stabilize mood and even prevent manic, hypomanic, or depressive episodes. Depending on a person's symptoms, a psychiatrist might prescribe an antipsychotic, antidepressant, or anti-anxiety medication. It might take some time and trial-and-error to figure out which type, brand, and dosage of medication works best.
When someone is experiencing a manic episode, they may refuse treatment or stop taking their medication because they feel really good. They may feel extremely motivated, productive, and feel as if they can tackle anything! These symptoms can cause them to think that they don't need to take medication anymore.
Psychological Treatments
Therapy is another treatment option for bipolar disorders. A person may need systematic care for their bipolar disorder that includes medication, personal therapy, and group therapy in a residential setting. For more serious cases of psychotic episodes or suicidal thoughts, hospitalization may be needed until those symptoms improve. Psychoeducation on bipolar disorders and treatments can also be helpful, including information on a specific diagnosis and how medication can help.
Types of therapy for bipolar disorders include cognitive therapy, family-focused therapy, and interpersonal and social rhythm therapy. Cognitive therapy focuses on how to reshape negative thoughts and identify thoughts that are too positive during a manic episode. Family-focused therapy educates the whole family about the bipolar diagnosis and works with the family on communication skills. Interpersonal and social rhythm therapy focuses on the relationships in someone's life. Therapists help clients to resolve interpersonal issues and help them develop strong routines and social support systems.
Examples of Bipolar Disorder
When you think of bipolar disorder, you might think of someone who is sad one week and energetic the next. This is usually not the case. The mood swings for someone with BD 1 or BD 2 can last months before their mood changes again. Over the last few decades, movies and TV have featured more accurate depictions of people with bipolar disorders.
For some time, characters with bipolar disorder were called crazy. All of their unfavorable actions were attributed to their diagnosis. What is it actually like to live with BD?
Gary is a college student who recently received a diagnosis of BD 1 due to a manic episode. During his manic episode, he claimed that he was more intelligent than all of his professors (inflated self-esteem), slept significantly less than he had before, became very aggravated when people disagreed with him, and engaged in risky behaviors like drinking too much and having unsafe sex.
A few celebrities have publicly revealed their diagnoses of bipolar disorder. In 2010, Demi Lovato was diagnosed with bipolar disorder. Kanye West has also been diagnosed with BD. Recently, Lovato released a documentary on YouTube called "Dancing with the Devil" about her struggles with mental health and substance use. Kanye's struggles with his disorder have been extremely public.
Highly publicized experiences of BD are not the norm for everyone. However, being able to talk more openly about mental health is great! Each individual's symptoms and experiences are different from another person's with the same diagnosis.
Bipolar Disorder - Key takeaways
- Bipolar disorder is a mental health condition that involves mood swings ranging from manic (or hypomanic) episodes to depressive episodes.
- Bipolar I includes manic episodes followed by hypomanic or depressive episodes.
- Bipolar II includes hypomanic and depressive episodes. BD 2 is less severe than BD 1.
- Cyclothymic disorder features frequent mood swings that never become severe enough to be called hypomanic or depressive episodes.
- Medication and therapy (cognitive therapy, family-focused therapy, and interpersonal and social rhythm therapy) are some recommended treatments for bipolar disorders.
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