What is Bipolar Disorder?

Overview

Just under 3% of adults in the U.S were suffering from bipolar disorder last year. (NIMH 2018). Considering this statistic it is crazy to think about how little the average person actually knows about the disorder and how much is built by stereotypes. For instance, most people don't know that there are technically four different kinds of bipolar disorder. Bipolar I disorder, which people are most familiar with, bipolar II disorder, cyclothymia, and unspecified bipolar. Also, like depression, there is a substance induced form of bipolar. In the next section I will break down the differences between each disorder.

Symptoms

Bipolar I disorder is the most common and sever form of bipolar disorder. All forms of bipolar center around the two states of being, mania/hypomania and depression. Mania is an elevated mood accompanied with many other symptoms that I'll list below. Although it's important to know that mania is present in bipolar I disorder while hypomania is present in all other forms of bipolar. The main difference between mania and hypomania is that hypomania is less severe and lacks the psychosis present in mania.

Cyclothymia - a less severe but more chronic form of bipolar both hypomanic and depressive symptoms don't quite fit a full blown episode of either. There are also longer periods between cycling, a two year depressive episode is necessary for diagnosis.

Unspecified Bipolar Disorder - Basically most mixes of symptoms of mania/hypomania and depression fit into this category. Rapid cycling bipolar is often considered a part of unspecified bipolar disorder.

Mania:

- Elevated mood, euphoria

- Talkativeness, pressured speech (the mind moves faster than the mouth and words come out jumbled)

- Jump from topic to topic in conversation

- Reduced need for sleep, can go without sleeping for days without noticing a difference

- Increased activity, specifically goal directed activity

- Risk taking behavior (risky sex, gambling, shopping excessively, etc.)

- Irritability

- Grandiosity, high self esteem

- Lack of concentration

- Psychotic features (delusions, hallucinations)

Depression:

- Anhedonia (loss of interest or pleasure in activities that were once fulfilling and a normal part of life)

- Suicidal ideation or persistent thoughts related to death - If you feel you or a loved one experiencing suicidal ideation and live in the U.S contact the National Suicide Prevention Lifeline (1-800-273-8255), contact a loved one, and/or contact your doctor. If you or a loved one is at risk of attempting suicide or has made an attempt call 911.

- Guilt

- Sleep problems (insomnia or sleeping to often)

- Changes in appetite (eating too much or too little)

- Fatigue

- Feelings of sadness, worthlessness, hopelessness

- Self-harm

- Difficulty concentrating

Diagnosis

Unfortunately, diagnosis can be very hard for someone with bipolar. An individual typically goes 10 years from the onset of their disorder before receiving the proper diagnosis. This is because of either shame associated with symptoms, believing the manic symptoms aren't negative and not reporting them, therefore being falsely diagnosed with depression. There is a discrepancy as far as gender goes in diagnosis, with women typically being misdiagnosed with depression, and men with schizophrenia.

When seeking treatment for bipolar disorder, some people may see a primary care doctor and be referred to a mental health professional from there but there are two more common routes, one is via hospitalization. It isn't uncommon for an individual to be hospitalized for psychosis or attempted suicide which can typically get them en route to diagnosis and treatment. Another way is through treatment for a current misdiagnosis, as mentioned before. An individual might already be seeking treatment for what they think is depression and then through therapy or medication intervention they are diagnosed bipolar.

Similarly to any mental illness, a therapist is going to diagnose a client using the DSM - 5, which catalogs the criteria for mental disorders and includes treatment options. The diagnostic criteria for bipolar disorder requires 5 depressive symptoms present for a two week period that is a marked change from previous functioning. The requirement for mania are four or more symptoms present for a one week period (American Psychiatric Association, 2013). Like with depression there is no test for bipolar disorder, but there are tests to rule out possible medical conditions causing symptoms of mania and/or depression. Either set of symptoms has been seen in thyroid dysfunction, Parkinson's disease, HIV/AIDS, STIs, etc.

Treatment

There is no cure for bipolar disorder, but there is treatment. Pharmacological treatment is especially effective in bipolar disorder, and is even more effective in combination with psychotherapy. Bipolar can be treated with several different kinds of medications most commonly mood stabilizers or anti-psychotic medications to limit mania in combination to treat the depressive episodes. Lithium is the most common and effective mood stabilizer currently, and it has been so for decades.

What can you do?

Individual with Bipolar Disorder

Do not be so hard on yourself, you didn't choose this illness, and its doesn't define you
Do not be afraid to seek help, things won't get better if you don't. Therapists are understanding and ethically bound to remain judgement free, empathetic, and confidential. Anything you say to a therapist (aside from threatening to harm oneself or others) is held in complete confidence between you and the therapist.
Asking for help does not make you weak, you can't get over other diseases without going to the doctor. Why is this different?
Don't be disappointed if treatment doesn't work immediately, medications and therapy take time to be effective. It also might take time to find the right medication and/or therapist.
Try to make lifestyle changes. There are many smaller factors that people overlook that when combined with proper treatment make is more effective. Things like eating well, exercising, being social, having a schedule, etc.
Try to abstain from alcohol
Don't underestimate how damaging mania can be
Drink plenty of water, often mood stabilizes can have nasty side effects that are made worse by dehydration

Loved One

Stay informed about bipolar disorder and recognize the symptoms. Recognizing warning signs such as giving personal items away, becoming isolated, and any of the symptoms listed above are important for a loved one to notice and take action.
Talk to that person, don't pressure them if they are uncomfortable but make them aware that you love them and are there for them if they need to talk.
Pay attention to warning signs of suicidal ideation and call the National Suicide Prevention Hotline (1-800-273-8255) if necessary.
Be accepting and understanding, help them understand that this is not their fault and they don't need to seek treatment alone
Don't always assume a good moment is a manic episode starting. Bipolar individuals can have happy moments without mania, especially when medicated.

Things you shouldn't say to those with bipolar:

- Have you taken your meds?

- You don't act like you're bipolar

- Calm down

- Others have it worse than you

- Just be happy

- I'm bipolar too sometimes

- It must be your time of the month

- But you seem normal

Removing Stigma

Like any mental illness there is a lot of stigma that comes associated with bipolar disorder. A lot of this stigma comes largely due to stereotypes that are inaccurate and offensive. Many people still hold the idea that bipolar disorder is simply one's mood switching off between happy and angry. Once again, the way to combat the stigma associated with bipolar is to change the phrases we use. Referring to oneself or others as bipolar when they aren't for doing something erratic or bothersome is only furthering the stereotype and stigma.

Sources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Bipolar Disorder. (2016, April). Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Shelby Chapman

Interdisciplinary Artist