Bipolar disorder has been in the headlines quite a lot recently. More than once this mental health disorder has been associated with erratic behavior from those in the public eye. But what Is bipolar disorder? How is it diagnosed?
Let’s take a look at this complex mental health issue, and answer some of the questions you may have about the disorder.
What is bipolar disorder?
One of the defining characteristics of bipolar disorder is extreme mood swings that range from emotional highs (called mania or hypomania), and emotional lows (depression). The Mayo Clinic explains:
When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy, or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior, and the ability to think clearly.
Let’s look at mania and depression individually.
Mania
Mania is the term for a period of emotional high. The Cleveland Clinic says:
Mania is a condition in which you have a period of abnormally elevated or irritable mood, as well as extreme changes in emotions, thoughts, energy, talkativeness, and activity level. This highly energized level of physical and mental activity and behavior is a change from your usual self and is noticeable by others.
While this doesn’t necessarily sound like a dangerous scenario, it is not uncommon for people in manic states to be incredibly reckless. They may spend money in dangerous ways, excessively shopping or gambling. They may take physical risks like driving too fast or participating in dangerous activities. They may say things on social media that they would prefer to have kept quiet.
Sometimes the manic state escalates to the point of psychosis. The Cleveland Clinic explains that these “psychotic symptoms, such as delusions and hallucinations,” may “cause difficulties in distinguishing bipolar disorder from other disorders such as schizophrenia or schizoaffective disorder.”
Some people may experience less disruptive manic episodes, known as “hypomania.” These tend to be shorter in duration and less severe than manic episodes.
The Mayo Clinic lists symptoms of manic (and hypomanic) episodes as including:
- Abnormally upbeat, jumpy, or wired
- Increased activity, energy, or agitation
- An exaggerated sense of well-being and self-confidence (euphoria)
- Decreased need for sleep
- Unusual talkativeness
- Racing thoughts
- Distractibility
- Poor decision-making — for example, going on buying sprees, taking sexual risks, or making foolish investments
Depression
Bipolar disorder is also characterized by emotional lows. The diagnostic criteria for a major depressive episode (a key distinction in bipolar diagnoses) include five or more of the following symptoms in two weeks:
- Depressed mood most of the day, nearly every day
- Loss of interest or pleasure in all, or almost all, activities
- Significant weight loss or decrease or increase in appetite
- Engaging in purposeless movements, such as pacing the room
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt (DSM-5)
Diagnosis will depend on the frequency and severity of the manic and depressive episodes.
Types of Bipolar Disorder
Part of what makes bipolar disorder complicated is that there is more than one type. All of these types can be highly disruptive, but they are slightly different in their core characteristics. Let’s break them down one at a time.
Bipolar 1 Disorder:
Bipolar 1 is defined by a combination of manic and depressive episodes. The Mayo Clinic says that Bipolar 1 can be diagnosed if “You’ve had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).”
Bipolar 2 Disorder:
Bipolar 2 can be diagnosed if an individual has had at least one major depressive episode, and at least one hypomanic episode–but has never had a true manic episode.
Cyclothymic Disorder:
Some individuals have periods in which they have many episodes of hypomania, and/or depressive episodes. If a person experiences these more rapid swings over the course of two years, and if they do not meet the diagnostic severity of manic or major depressive episodes, a clinician may diagnose a cyclothymic disorder.
When making a diagnosis, clinicians consider the duration, severity, and relative disruption of the episodes over time. It’s important not to think of these as “more serious” or “less serious” than one another. All of these types of bipolar disorder can have drastic consequences on the lives of those who experience them.
What can we do about bipolar disorder?
Often those experiencing manic or depressive episodes have a hard time recognizing the severity of their symptoms. In fact, as the Mayo Clinic describes, “if you’re like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal, or relationship trouble.”
If you or a loved one is experiencing any of the symptoms described above, it’s a good idea to talk to a mental health professional right away. And, if you or a loved one is experiencing thoughts of suicide or self-harm, or signs of psychosis, it’s best to seek emergency help.
While bipolar disorder is a life-long condition, therapy and medication can often help even the most disruptive cases.
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