Bipolar disorder refers to several types of chronic mental illnesses that cause extreme shifts in mood, activity level, thought processes and the ability to function in day-to-day activities. While psychotherapy can be very useful in helping individuals with the disorder medication is generally the first line of treatment.
The primary symptom of this disorder is significant mood swings that range from the depths of depression to the highs of euphoria. For most people, these shifts in mood are infrequent - occurring only a few times a year. However some individuals known as “rapid cyclers,” may experience multiple mood shifts a week and, in rare, cases daily.
While most people cycle infrequently, this does not mean bipolar disorder does not have serious consequences for the individual. Anxiety over the next mood shift is common. People who live with bipolar disorder often have to deal with problems associated with behavior that occurred during one of their mood states.
There is no specific pattern to the mood shifts. Some individuals may experience depression or mania then level out before experiencing the opposite state. Others may shift from one to the other before leveling out. Still others may shift from one to the other and back to the first mood state before leveling out. Bipolar disorder presents very differently in children and adolescents.
There are three conditions within this category that differ primarily in the severity and duration of symptoms:
Bipolar I or “manic depression” reflects full-blown manic episodes with at least one major depressive episode.
Bipolar II refers to hypomanic (less disruptive than mania) episodes with at least one major depressive episode.
Cyclothymia refers to a continuous period of hypomania-like and major depressive-like episodes that don’t meet the criteria for either mood state.
While many assume that bipolar I is the most debilitating form of the disorder, all three conditions cause severe impairment in different ways. While symptoms of bipolar disorder can be devastating, it has been linked to unparalleled creativity. Some of the most famous artists have suffered from the disorder, including Vincent Van Gogh, Mark Twain, Edgar Allen Poe, Georgia O’Keefe and Ludwig van Beethoven.
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Statistics (Adults)
In a given year, the number of newly-diagnosed individuals with bipolar I disorder has been estimated at 0.6%, and for bipolar II 0.8%. Since many people with cyclothymia do not seek treatment, incidence rates for cyclothymia are not reported. Men and women are believed to experience similar rates of bipolar I and cyclothymic disorders while rates of bipolar II are slightly higher for women. However, since those with bipolar II spend more time in depressive mood states - which women are more likely to report - this gender difference may be due to reporting bias.
Co-Occurring Disorders
Co-occurrence is the rule rather the exception in individuals with bipolar disorder, which further complicates an already-complex illness. At Abilene, we understand how difficult the experience of bipolar disorder can be. Our staff is skilled at treating the variety of symptoms that occur when someone is suffering from this complex syndrome.
The most common disorders that co-occur with bipolar disorder include:
- Substance use disorders
- Anxiety disorders
- Eating disorders
- Attention deficit disorder (ADHD)
- Personality disorders
Causes of Bipolar Disorder
It is generally agreed that while there is support for various casuals factors, these factors combine to lead to the development of the disorder. Bipolar disorder may result from different combinations for different individuals.
Genetic: It has long been realized that bipolar disorder runs in families. Individuals who have a first-degree relative with bipolar disorder are more likely to develop the disorder than those without a family history of the disorder. Current thinking suggests that the genetic influences are complex and involve an interaction of several different genes.
Biological: Imaging studies have suggested that the pre-frontal cortex in people with bipolar disorder are smaller and less functional than in individuals without bipolar disorder. This area of the brain is responsible for decision-making, problem-solving and the ability to control emotional impulsivity. Lowered activity in the pre-frontal cortex has been connected to emotional regulation. It is thought that there is an inborn physiological predisposition for the disorder. This predisposition does not guarantee that the individual will develop the disorder as environmental factors and life stressors are thought to interact with this predisposition to determine outcome.
Signs and Symptoms of Bipolar Disorder
The symptoms of the two general mood states found in bipolar disorder are listed below:
Manic/Hypomanic symptoms - the two types of symptoms differ by degree of severity)
- Abnormal, continuous elevated mood
- Irritability
- Continuously increased goal-related activity that is out of the individual’s normal skill set
- Increased energy
- Increased self-esteem
- Delusions of grandeur
- Significantly decreased need for sleep
- Pressured speech or increase in vocal output
- Racing thoughts
- Flight of ideas
- Inability to maintain attention or severe distractibility
- Psychomotor agitation
- Excessive involvement in activities with a high propensity to result in harm (e.g. bad investments, sexual promiscuity, driving at high speeds)
Major Depressive Symptoms: must occur minimally over a two week period
- Depressed mood
- Lack of enjoyment in previously enjoyed activities
- Lack of enjoyment in practically all activities, all day nearly every day
- Weight loss when not dieting or weight gain
- Decreased or increased appetite
- Sleeping significantly more or less than usual
- Psychomotor retardation or agitation
- Fatigue, lack of energy
- Lack of motivation to engage in goal-directed activities
- Feelings of worthlessness, shame or excessive guilt without cause nearly every day
- Trouble thinking, concentrating, paying attention and/or making decisions
- Memory problems
- Frequent thoughts of death
- Suicidal thoughts, creation of a plan or making a suicide attempt
Effects of Bipolar Disorder
The ramifications of bipolar disorder include all areas of a person’s life – interpersonal, occupational, negative effects on family members, functional capacity, caregiver burden and finances. Other effects include:
- Overall disability
- Inability to function normally in your day-to-day life
- Loss of important relationships
- Occupational disruptions or inability to maintain employment
- Debt
- Family strain
- Increased likelihood of involvement in the criminal justice system
- Caregiver burnout
- Sense of hopelessness and helplessness
- Divorce or marital problems
- Loss of a sense of self and increased dependency on others
Sources
1American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed. text revision). Washington, DC; Author.
2 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (Fifth ed.). Washington, DC; Author.