What is Bipolar Disorder?

Bipolar disorder is a serious mental illness that causes pronounced changes in a person’s energy and mood. People with bipolar experience low and high moods. These mood changes are much more extreme than the normal highs and lows that everyone has from time to time. With bipolar, the mood shifts affect a person’s ability to think clearly, which can result in unpredictable behavior. These mood swings and disruptive behaviors can lead to problems with maintaining steady employment and disrupt a person’s relationships.

The symptoms of bipolar disorder often start in the late teens or early 20s. Although uncommon, symptoms can show up in childhood or adolescence. Bipolar disorder affects men and women about the same frequency. About 4.4 percent of people in the United States are diagnosed with bipolar at some time in their lives.¹

Types of Bipolar Disorder

Mental health practitioners use the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) to diagnose bipolar disorder. There are four main subtypes:²

1. Bipolar 1 Disorder: Characterized by at least one manic episode and one major depressive episode.
2. Bipolar II Disorder: Bipolar 2 disorder is characterized by major depressive episodes and hypomanic episodes, which are less severe episodes of mania. In bipolar II disorder, the “ups” never reach full mania.
3. Cyclothymic Disorder: This is the mildest form of bipolar disorder. It is given when a person has episodes of depression or hypomania that are too mild to be diagnosed as bipolar disorder. The person experiences at least two years of these episodes to be diagnosed with cyclothymic disorder.
4. Unspecified Bipolar and Related Disorder: This diagnosis is used when a person has symptoms of bipolar that do not meet the criteria of the other bipolar diagnoses.

Signs, Symptoms & Risk Factors

Scientists have not yet found a specific cause for bipolar disorder. However, it is probably due to a combination of genetics, hormonal, and environmental factors. Risk factors for bipolar include:²

• Having a first degree relative with the disorder.
• Drug or alcohol abuse.
• Periods of high stress, such as the death of a loved one.

According to the DSM-5, a person must have major depressive episodes and at least one manic or hypomanic episode to be diagnosed with bipolar disorder.  Severe episodes of depression or mania can include delusions or hallucinations, which can cause a person with bipolar to be incorrectly diagnosed with schizophrenia. With bipolar, the psychotic symptoms usually mimic the person’s extreme mood. For instance, a person with mania may believe that they have superpowers. The symptoms and their severity can vary but they must include at least one depressive and one manic or hypomanic episode.²

Major Depressive Episode

To be diagnosed with bipolar disorder I or II, a person must have at least one major depressive episode. These episodes are characterized by:

• Depressed or sad mood for most of the day
• Significant changes in appetite
• Little or no interest in normally enjoyable activities
• Problems concentrating or staying focused
• Loss of energy or fatigue
• Insomnia or other problems sleeping
• Feelings of worthlessness
• Frequent thoughts of death or suicide

Manic Episode

Manic episodes are characterized by an elevated or irritable mood and extreme behaviors. A person who is in a manic episode may have unprotected sex with strangers, go on frenzied shopping sprees or come up with ideas based in fantasy. In severe episodes, the person may become delusional and lose touch with reality.

Manic episodes can last anywhere from a couple of days to months. A person must experience at least one manic episode to be diagnosed with bipolar I. These symptoms must last for at least a week and be present nearly every day. Three of the following symptoms (or 4 if the mood is only irritable) are required for a bipolar I diagnosis. Here are the symptoms of a manic episode: ²

• A period of abnormally elevated or irritable mood
• Increase in goal-directed activity
• Racing thoughts
• Easily distracted
• More talkative than usual
• Rapid or pressured speech
• Inflated self-esteem
• A decreased need for sleep
• Engaging in behaviors that carry significant risks

Hypomanic Episode

Bipolar 2 is characterized by hypomanic episodes. These are less severe occurrences of mania. The symptoms are the same as for manic episodes but they need to be present only for four consecutive days.²

Treatment For Bipolar Disorder

Bipolar disorder can be managed with the right treatment. Treatment helps most people with the disorder manage mood swings and other symptoms. Because bipolar is a chronic illness, like diabetes or heart disease, treatment must be ongoing. Here are some of the most common treatments for bipolar.³

Medication

• Mood Stabilizers.  Mood stabilizers like lithium and Depakote can help prevent the extreme highs and lows associated with bipolar disorder. There is evidence that lithium can lower the risk of suicide in people with bipolar. However, that claim is still being investigated.
• Second-Generation Antipsychotics. Second-generation antipsychotic medications like Symbax and Abilify are often used to treat symptoms of bipolar. These are most often prescribed with other medications for bipolar.
• Antidepressants. Zoloft, Paxil, Prozac, and other antidepressants may be used to treat the depressive symptoms of bipolar disorder. Because these medications can increase the risk of mood swings, they are usually prescribed with mood stabilizers to prevent mood swings.

Therapy

Medication alone is usually not enough to fully control the symptoms of bipolar disorder. Psychotherapy is often used in combination with medication. These two treatments are a very effective combination for the treatment of bipolar disorder. Common psychotherapy treatments include:⁴

• Cognitive Behavioral Therapy (CBT). This treatment helps change negative thought patterns that are associated with episodes of depression or mania. The goal of therapy is to help the person recognize and change maladaptive thought patterns.
• Behavior Therapy. This therapy helps the person learn healthier ways of coping with bipolar symptoms. It helps to eliminate harmful behaviors.
• Interpersonal Therapy. Bipolar disorder often affects a person’s relationships. Interpersonal therapy helps people with bipolar understand how their behaviors impact relationships.
• Social Rhythm Therapy. Daily routines, such as sleep and eating, are often impacted by bipolar. This therapy helps people who have bipolar learn to manage their daily routines better.
• Family-Focused Therapy. This type of therapy helps address issues within the family that might impact a person with bipolar disorder. It helps family members learn ways to support their loved one with bipolar.

Other Treatments For Bipolar

• Support Groups. Support groups provide a place for people with bipolar disorder to share experiences with others going through the same thing. Group members learn coping skills and gain hope from one another.
• Psychoeducation. This type of therapy helps people with bipolar learn about the symptoms so they can recognize relapses and understand how to get help. This therapy can be done in a group or individual setting.

Getting Help For Bipolar Disorder

Coping with bipolar disorder isn’t easy. But, if you or a family member is struggling, we are here to help. Visit the TherapyTribe directory to connect with a local or online therapist who specializes in bipolar disorder.

References

1. National Institute of Mental Health. (2017). Bipolar Disorder. Retrieved April 23rd, 2019 from https://www.nimh.nih.gov/health/statistics//bipolar-disorder.shtml.
2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
3. National Institute on Mental Illness. (2019). Bipolar Disorder: Treatment. Retrieved April 23rd, 2019 from https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder/Treatment
4. WebMD. (2019). Psychotherapy for Bipolar Disorder. Retrieved April 23rd, 2019 from https://www.webmd.com/bipolar-disorder/guide/psychotherapy-bipolar-disorder#.