Today, the label of bipolar is thrown around in a hurtful way. To call someone bipolar is derogatory, no matter how commonplace it has become. But bipolar disorder is far from a joke about mood swings or a nasty way to talk about someone. It is a genuine and challenging chronic mood disorder, which can have severe implications for someone’s quality of life.
Over the years, the definition and diagnostic criteria for the disorder has evolved, as has our scientific understanding of the condition. Bipolar disorder is the modern understanding of a mental health condition formerly called manic-depressive disorder.
The Diagnostic and Statistical Manual of Mental Disorders places “Bipolar and Related Disorders” somewhere between depression and psychotic disorders. It often has a cyclical nature of symptoms, including manic episodes followed by depressive ones.
Under today’s modern understanding of the condition, there are actually several subtypes of bipolar disorder. These include mania, hypomania (mild mania), major depression, and others.
Like with many mental health disorders, there is no physical test capable of confirming the diagnosis. Bipolar diagnosis and proper treatment require attentive behavioral and emotional assessment by an experienced psychiatrist.
In this ultimate guide to the realm of bipolar disorders, we go in-depth to answer the following questions:
- What is Bipolar Disorder?
- What are the Facts of Bipolar Disorder?
- What Are the Different Types of Bipolar Disorder?
- What are the Signs and Symptoms of Bipolar Disorder?
- What Does Bipolar Disorder Feel like?
- What are the Causes of Bipolar Disorder?
- What are the Bipolar Treatment Options
- When to Talk to a Professional
What is Bipolar Disorder?
What is a bipolar disorder based on the correct medical definition? Most people would describe it as a mental illness with a period of manic behavior, followed by a period of depression. While sometimes the case, this isn’t always true. It’s one of the most common misconceptions of this mood disorder.
Many people are surprised to find out that only mania or hypomania (mild mania) are required for a bipolar I disorder. Depressive episodes may follow a diagnosis, but not always.
As we shall see, there are at least six different varieties, each with a nuanced diagnosis. The differences between each type of bipolar disorder come down to the frequency, severity, and sometimes cause of the symptoms.
What is bipolar disorder? The definition looks much different today than our historical understanding. As per the authors behind a paper published in The Lancet in 2016, “Bipolar disorder is a lifelong episodic illness with a variable course that can often result in functional and cognitive impairment and a reduction in quality of life.”
The Brain & Behavior Research Foundation describes this chronic mood disorder as a “brain and behavior” condition “characterized by severe shifts in a person’s mood and energy, making it difficult for the person to function.” It does not have a cure, but thankfully, symptoms are often extremely manageable through medication and therapy.
What are the Facts of Bipolar Disorder?
In the 2016 Lancet piece, the authors detail how bipolar disorder has the second most significant impact on employment out of all illnesses tracked in the WHO’s World Mental Health survey. The DSM-5 details how almost one percent of American’s have experienced an episode in the last year, although the National Institute of Mental Health (NIMH) suggests as much as 2.8 percent of the population may have dealt with it in the same time frame.
Both men and women are roughly equally at risk for the disorder. The mean age of diagnosis is 18, which happens to be when people enter the workforce. Therefore, it makes sense that this lifelong condition has such a significant and long-lasting impact on working days.
Statistics provided by the NIMH paint a dire picture of the impact a bipolar episode can have on someone. The data details of the people who reported experiencing symptoms in the last 12 months, a full 82 percent had a severe degree of impairment on their day to day lives.
Interestingly, rates of this mood disorder are markedly higher in high income than in low-income countries. It is also striking how while rates are almost equally split between men and women. But, women often experience more rapid cycling between manic and depressive episodes. Women are also more likely to experience a second or third mental health issue at the same time, with depression and anxiety common.
What Are the Different Types of Bipolar Disorder?
- Bipolar I Disorder
- Bipolar II Disorder
- Cyclothymic Disorder
- Substance-Induced Bipolar Disorder
- Bipolar Disorders Induced by Another Medical Condition
According to the DSM-5, there are several different types of bipolar disorder, all nestled in under the broader definition. The following represent the most common variants, including the most notable signs of each.
Bipolar I Disorder
Psychiatrists may diagnose this first type following a single manic episode. While there may also be a history with major depressive or hypomanic episodes, a single lifetime episode of mania is the requirement for this type of bipolar disorder. The mania is significant enough to cause serious impairment to daily functioning.
Bipolar II Disorder
The second type of bipolar disorder requires both the lifetime experience of at least one hypomanic episode and a major depressive episode. A full-blown manic episode is not typical.
Cyclothymic Disorder
A relatively new introduction into the realm of bipolar disorders, cyclothymic disorder explains symptom which may not meet the full diagnostic definitions in the DSM-5. The signs must persist for two years to qualify under this diagnosis.
Although this definition may make it sound like cyclothymic disorder is less serious then the first two versions, this is an incorrect assumption. The DSM-5 has an extensive multi-level list of criteria for hypomania, mania, and major depression, and not all versions of mania or depression tick off all the official signs.
Substance-Induced Bipolar Disorder
The onset of bipolar symptoms, as triggered by a substance or drug use.
Bipolar Disorders Induced by Another Medical Condition
The onset of symptoms, caused by another medical condition (physical or mental).
Mental illness is often complicated, with no black and white overarching rules. As such, bipolar disorder can be challenging to diagnose. There is an entirely separate category within the DSM-5 that covers conditions that fall somewhere in bipolar disorders chapter but are less clear-cut.
Many of these related disorders have “symptoms characteristic of a bipolar and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria,” listed under any of the other disorders.
Types of Unspecified Bipolar and Related Disorders:
- Short-duration of either major depression or hypomania.
- Mania with extremely mild symptoms, followed by major depression
- Hypomania without a previous depressive episode.
- The short duration of mania, with no secondary episode of depression.
What are the Signs and Symptoms of Bipolar Disorder?
There are essentially three main signs (depending on the type of bipolar disorder in question)— each with its own set of symptoms:
- Manic Episode
- Hypomanic Episode
- Major Depressive Episode
Again, when it comes to specific subtypes of bipolar and related disorders, not every single one will require all three of these signs for diagnosis. For example, bipolar I disorder doesn’t need a lifetime depressive period to make the diagnosis (although depression is usually present).
Other types, like those falling under the unspecified category, also might not tick all the necessary symptoms for a clinical diagnosis. Maybe the period of mania didn’t last long enough, or only two of the four symptoms were noted for depression.
Beyond these subtleties, the DSM-5 characterizes the primary bipolar symptoms by the following signs:
Manic Episode
As per the DSM-5, mania is “A distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased activity or energy.” This period must last for at least a week to qualify as a manic period.
Some of the most noticeable signs of mania include:
- Skyrocketing self-esteem
- Feelings of grandiosity
- Talking a lot, and difficulty slowing down
- Racing thoughts
- Stream of consciousness of ideas
- Easily distracted
- High-risk behavior
- Low desire (or need) to sleep
A person experiencing mania may go on shopping sprees, foolish adventures, or start engaging in risky sexual activities. They have a never-ending stream of ideas about their future, and it can be difficult to follow their thoughts from one moment to the next.
While healthy people often have elevated moods, with periods of high productivity, mania is notable for its extreme change in personality. Mania will have a marked impairment to relationships, work-life, and other areas of a person’s daily life.
Hypomanic Episode
The primary difference between a full-manic and a hypomanic episode is the duration. Hypomania is the same series of “abnormally and persistently” elevated mood and energy, but only for four days.
The signs of hypomania are similar to those of mania but often less severe. They typically have less of an impact on day to day function. Others may notice a subtle change but perhaps mistake it as an eagerness, increased productivity, or a heightened mood.
- Again, the signs are as follows:
- Skyrocketing self-esteem
- Feelings of grandiosity
- Talking a lot, and difficulty slowing down
- Racing thoughts
- Stream of consciousness of ideas
- Easily distracted
- Increased goal-directed activity
- Low desire (or need) to sleep
Major Depressive Episode
To qualify as a bipolar depressive episode, the period of depression must last for at least two weeks. While people with bipolar I disorder don’t always experience this symptom, it is still quite common.
There is also a subtle but essential difference between what is called unipolar depression (that is, depression with no mania associated with it) and bipolar depression. In the Lancet paper mentioned earlier, the authors differentiate the bipolar variety by an earlier age of onset, rapid onset, and offset, and each episode is shorter in duration.
The signs of bipolar major depressive episodes are as follows:
- Feelings of sadness, hopelessness, or emptiness, which persist the majority of the time.
- Decreased interest in all activities, even formerly pleasurable ones
- Change in weight (increase or decrease)
- Difficulty sleeping (or difficulty waking up)
- Lack of energy
- Difficulting thinking clearly
- Recurrent thoughts of death
According to the DSM-5, someone must experience at least five of these symptoms for at least two weeks to classify as an official major depressive episode. But as we have heard, sometimes there are significant signs which don’t technically qualify under these strict definitions. The best bet is to speak with a psychiatrist should you experience any of these signs.
What Does Bipolar Disorder Feel like?
The cyclical nature of most types of bipolar disorder makes it difficult to define under a single description. At times people feel highly-energized and like they can conquer the world, while at others, they feel deflated and find it challenging to face those very same obstacles. Plus, in the middle, there can be long stretches of normality.
The real picture of this chronic mood disorder is complicated, colorful, and highly individualized. In 2017, Self magazine interviewed several people with bipolar diagnoses. Each of the personal histories could not be more different or telling of how varied this mood disorder is in real life.
For example, Julianne, a 25-year-old, talked about her incredible years in middle school. She was a great student, active in extracurricular activities, and had tons of friends. In high school, however, her go-getter and adventurous side got her into trouble with drugs and alcohol. She began extremely risky behavior and failing her classes.
As she explained, “Every night I’d scream into my pillow, shaking and crying. My emotions were so uncontrollably heightened that I wanted to die. I kept telling myself it would get better, but this continued for months.”
Another interviewee, Eryn, who was diagnosed later in life, painted a picture of the extreme mood swings. She said, “In a manic phase, I would clean non-stop and talk incessantly, always plotting the next grand scheme for my life.” In these stages, she would eventually begin drinking in excess to calm herself, which would ultimately swing her into a major depressive episode.
But, despite the challenging experiences each of the interviewees detailed, bipolar treatment has helped them return to a state of stability. Eryn stated, “I want people to know that though it can be a difficult disorder, most of us can lead perfectly ‘normal’ lives.” Another woman said, “being bipolar is one of my favorite aspects of myself. I am creative and enthusiastic. I am passionate and ambitious.”
What are the Causes of Bipolar Disorder?
Beyond the two types of bipolar disorder which are triggered by substance abuse or by another medical condition, are there specific causes? Based on the latest research, it seems that both genetics and environment both play roles in this mood disorder’s development.
Bipolar disorder is one of the most “heritable psychiatric disorders” according to The Lancet. People with a direct relative with the condition are at higher risk of developing it themselves.
But genetics aside, environmental factors still can influence its eventual evolution. Scientists are discovering through brain imagery and advanced analysis that people who have bipolar disorder have statistically significant changes in their brain chemistry. This is a relatively new area of research, and the cause of these changes is still uncertain.
What are the Bipolar Treatment Options?
Bipolar disorder is a lifelong diagnosis with no known cure. Treatment for bipolar disorder is all about symptom management.
While initially, this can come as a grim prospect, with proper treatment, many people find it possible to manage the symptoms and severity of the condition. As Self magazine demonstrated, treatment helps people stay in a long period of normalcy for much of their life, with only mild fluctuations in mood.
What happens following initial bipolar diagnosis? Following the first diagnosis, a trained healthcare professional will take the time to define your current mood state “because the therapeutic approach differs considerably for hypomania, mania, depression, and euthymia,” according to the Lancet. Treatment options will also take into consideration any other mental health conditions, including anxiety, unipolar depression, or unrelated psychosis.
The initial treatment stage, called acute treatment, requires medications to “ensure the safety of the patient and people nearby and to achieve clinical and functional stabilization with minimum adverse effects.” Once stability is achieved, then you can begin longer-term treatment options – like therapy.
Medication is a crucial aspect of symptom management. It may take several attempts to get the right balance of prescriptions, which is why it’s so important to work with an experienced psychiatrist.
One of the most significant issues facing patients taking medications for bipolar disorder is the effect of mood fluctuation on adherence. Maintaining the same prescribed protocol during both high and low moods is essential for preserving normalcy and stability. Some patients who feel better during a manic period end up believing it’s not necessary to continue their prescriptions.
If you have questions about your medication, it’s always best to follow the direction of your doctor before changing your medication routine yourself.
Beyond pharmaceuticals, there are conjunctive bipolar treatment options, including psychological and lifestyle approaches. These practical approaches provide therapeutic support on top of pharmaceutical support to even out the peaks and valleys of the manic or depressive episodes.
According to The Lancet, several therapeutic approaches have proven successful, including cognitive behavioral therapy, interpersonal and social rhythm therapy, and family-focused therapy.
When to Talk to a Professional
Unlike other common mental health conditions, it can be difficult (if not impossible) to treat the symptoms of bipolar disorder without the guidance of a professional. If you or someone you know is demonstrating progressively persistent and elevated mood changes, which do not seem within the usual pattern, it may be time to seek professional advice.
Interestingly, you may not initially notice your mood shift, should it swing into the manic end of the spectrum. One of the challenges with mania is how it can make people feel like they are on top of the world – capable of conquering anything.
Unless someone else sees the signs, you may only come to the realization when the mania fades and depression sets in. In these cases, it is likely others will begin to notice the signs well before you do.
There is no messing around with bipolar disorder, and there are severe consequences if left untreated. People with bipolar disorder see massive disruptions to their daily life, during both manic and depressive episodes. Plus, the suicide risk during depressive periods is genuine.
Through the proper treatment, you can smooth out the extreme mood fluctuations and cyclical nature of this lifelong chronic mood disorder. It may not ever entirely disappear, but you can achieve normalcy with medication and therapy.
