What is bipolar?
Bipolar disorders are brain disorders that cause changes in a person’s mood, energy and ability to function.
A roller coaster
People with bipolar experience high and low moods—known as mania and depression—which differ from the typical ups-and-downs most people experience.
People with bipolar disorders have extreme and intense emotional states that occur at distinct times, called mood episodes. These mood episodes are categorized as manic, hypomanic or depressive. People with bipolar disorders generally have periods of normal mood as well.
Different kind of disorders
Bipolar disorder is a category that includes four different conditions — bipolar I, bipolar II, cyclothymic disorder and Bipolar not otherwise (NOS).
The main difference between bipolar I disorder and bipolar II disorder has to do with the intensity of the manic period and the presence of psychosis.
Can you live a “normal” life?
If left untreated, bipolar disorders usually worsens. However it can be treated (though not cured), and people with these illnesses can lead full and productive lives.
FOUR TYPES OF BIPOLAR DISORDER
Bipolar I Disorder is an illness 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 is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a “full” manic episode.
Cyclothymic Disorder or Cyclothymia is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.
Bipolar Disorder, “other specified” and “unspecified” is when a person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation. Read more here.
What is it like to be bipolar?
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. Symptoms of both mania and depression can occur simultaneously.
A manic episode is a period of at least one week when a person is very high spirited or irritable in an extreme way most of the day for most days, has more energy than usual and experiences at least three of the following, showing a change in behavior:
- Exaggerated self-esteem or grandiosity
- Less need for sleep
- Talking more than usual, talking loudly and quickly
- Easily distracted
- Doing many activities at once, scheduling more events in a day than can be accomplished
- Increased risky behavior (e.g., reckless driving, spending sprees)
- Uncontrollable racing thoughts or quickly changing ideas or topics
The changes are significant and clear to friends and family. Symptoms are severe enough to cause dysfunction and problems with work, family or social activities and responsibilities. Symptoms of a manic episode may require a person to get hospital care to stay safe. The average age for a first manic episode is 18, but it can start anytime from early childhood to later adulthood.
A hypomanic episode is similar to a manic episode (above) but the symptoms are less strong and need only last four days in a row. Unlike mania, hypomania is not associated with psychosis. Commonly, depressive episodes are more frequent and more intense than hypomanic episodes. Additionally, when compared to bipolar I disorder, type II presents more frequent depressive episodes and shorter intervals of well-being. The course of bipolar II disorder is more chronic and consists of more frequent cycling than the course of bipolar I disorder.
Finally, bipolar II is associated with a greater risk of suicidal thoughts and behaviors than bipolar I or unipolar depression. Although bipolar II is commonly perceived to be a milder form of Type I, this is not the case. Types I and II present equally severe burdens.
What is it like to be depressed?
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.
What causes bipolar disorders?
- 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.
How do you treat bipolar disorders?
Bipolar disorder is treated and managed in several ways:
Psychotherapy, such as cognitive behavioral 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.
People with bipolar disorder can also experience:
- Attention-deficit hyperactivity disorder (ADHD)
- Posttraumatic stress disorder (PTSD)
- Substance use disorders/dual diagnosis
People with bipolar disorder and psychotic symptoms can be wrongly diagnosed with schizophrenia. Bipolar disorder can be also misdiagnosed as Borderline Personality Disorder (BPD).
These other illnesses and misdiagnoses can make it hard to treat bipolar disorder. For example, the antidepressants used to treat OCD and the stimulants used to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode. If you have more than one condition (called co-occurring disorders), be sure to get a treatment plan that works for you.