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Caitlin Gallagher
January 31, 2019 12:32 pm

Maybe you’ve seen characters with bipolar disorder in movies and TV shows, like Pat in Silver Linings Playbook or Carrie Mathison on Homeland. Or maybe you’ve heard someone refer to your moody friend to as “bipolar.” Whatever your level of familiarity with the term, we’d like to clear up a few misunderstandings and really answer the question, what is bipolar disorder?

Bipolar disorder is a mood disorder and is defined by shifts in mood and energy levels. As the National Institute of Mental Health (NIMH) notes, these changes can range from extreme ups (manic episodes) to extreme downs (depressive episodes). Bipolar was formerly referred to as manic-depressive disorder, but that term is now considered outdated.

Based on data from 2001-2003, NIMH reports that 4.4% of adults in the U.S. will experience bipolar disorder at some point in their lives. When asked how bipolar disorder affects their functionality in their social, family, and work/school lives, 82.9% reported serious impairment—the highest level of impairment of any mood disorder.

To help end the stigma surrounding this mental illness and spread some awareness, psychologist Dr. Hayden Finch answered all the questions HelloGiggles had to ask. Dr. Finch has a psychology practice in Iowa and uses her web presence to give people “practical facts” about mental illness. As she says in her educational YouTube videos, “The more you know about your mental illness, the more you can actively participate in your recovery and treatment plan.” So whether you have bipolar, know someone who does, or just want to increase your understanding, below are Dr. Finch’s answers to all the questions we had about bipolar disorder.

What is bipolar disorder?

“There are several different mental health conditions in the ‘bipolar disorders’ class. They all involve distinct periods of major mood fluctuations—from euphoria to depression.”

What are the different types of bipolar disorder?

“According to the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), there are five main types of bipolar disorder: Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, Substance/Medication-Induced Bipolar Disorder, and Bipolar Disorder Due to Another Medical Condition.

Bipolar I disorder requires that the person has had a manic episode, which is a distinct period of abnormally and persistently euphoric, larger-than-life, or irritable mood when the person is also involved in tons of activities. This must last most of the day for at least seven consecutive days and usually also includes the person believing they’re unrealistically awesome, sleeping very little but still feeling rested, being very chatty, bouncing from one idea to another, being distracted by irrelevant things, and becoming involved in activities that can be painful or dangerous. A person doesn’t have to ever have depression to be diagnosed with bipolar I disorder (though most people do also have depression), just an episode of mania.

Bipolar II disorder requires that the person has had a hypomanic episode AND a major depressive episode. A hypomanic episode is similar to a manic episode, but the symptoms only have to be present most of the day for four consecutive days. And a major depressive episode is a period when the person feels abnormally depressed for two weeks and at the same time experiences some of the following symptoms: doesn’t want to do anything; loses or gains a significant amount of weight or eats too little or too much; can’t sleep or sleeps too much; feels agitated or slowed down; feels fatigued or without energy; feels worthless or excessively guilty; can’t concentrate or make decisions; or repeatedly thinks about death or suicide.

Cyclothymic disorder is similar to bipolar II disorder, but the symptoms are less severe. For this condition, the person experiences numerous periods with hypomanic symptoms but either doesn’t have enough of the symptoms or the symptoms don’t last long enough to count as a full hypomanic episode AND the person experiences numerous periods with depressive symptoms but either doesn’t have enough of the symptoms or the symptoms don’t last long enough to count as a major depressive episode. This has to keep going on most of the time for two full years. But if a person has ever had a full manic, hypomanic, or major depressive episode, they wouldn’t have cyclothymic disorder.

Certain medications and drugs can cause bipolar-type symptoms. Substance/medication-induced bipolar disorder is when a person has the symptoms noted above that started during or soon after they used a drug/medication or went through withdrawal from using a drug/medication that is capable of producing those symptoms.

Finally, certain medical conditions can cause the symptoms noted above, which would be called bipolar disorder due to another medical condition.”

What is the difference between calling it “bipolar disorder” or “manic-depressive illness”? Is one term preferred over the other?

“Bipolar I disorder represents the current understanding of what was called manic-depressive disorder in the 1800s. We no longer use the term manic-depressive disorder and use bipolar I disorder instead. The only difference between the two is that bipolar I disorder doesn’t require that a person has experienced hallucinations/delusions and doesn’t require that the person has ever had major depression, whereas manic-depressive disorder did have these requirements.”

How are manic episodes defined?

“According to the DSM-5, a manic episode is ‘a distinct period of abnormally and persistently elevated, expansive, or irritable mood AND abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day.’

During that period, at least three of the following symptoms are present to a significant degree and represent a noticeable change from usual behavior:

Inflated self-esteem or grandiosity. Not just high self-esteem and feeling good about oneself, but the person thinks they are the absolute bomb, there’s never been anything better. This can border on delusional.

Decreased need for sleep. Like feeling completely rested after about three hours of sleep without needing coffee to wake oneself up.

More talkative than usual or pressure to keep talking. Not just chatty, but can’t stop talking if one had to.

Flight of ideas or subjective experience that thoughts are racing. Again, the person is not just having ideas, their thoughts are going so fast they can’t keep up with them, and the people they are talking to probably think they are not making any sense.

Distractibility. This is different than normal distraction. Here we’re talking about bouncing from idea to idea to idea indiscriminately and problematically. The person can’t get anything done because they are so distracted by everything.

Increase in goal-directed activity. The person isn’t just busier than usual, they are an abnormal level of busy, and much of their activity might be nonsensical or purposeless.

Excessive involvement in activities that have a high potential for painful consequences. For example, wildly reckless spending, sexual promiscuity, or foolish investments.

The symptoms are bad enough that they either cause major disruption in how the person is functioning or require hospitalization.”

How are depressive episodes defined?

“According to the DSM-5, a major depressive episode is when a person has five or more of the following symptoms for two whole weeks, which is a difference from how they normally function:

  • Depressed mood most of the day, nearly every day.
  • Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day.
  • Significant weight gain or weight loss (more than 5% of your body weight in a month) or major change in your appetite.
  • Feeling super agitated or slowed WAY down.
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  • Diminished ability to think or concentrate OR indecisiveness nearly every day.
  • Recurrent thoughts of death, recurrent suicidal ideation, a suicide attempt, OR a specific plan for committing suicide.

At least one of the symptoms has to be depressed mood or loss of interest or pleasure (the first two symptoms).”

What are the differences between bipolar disorder and mood swings?

“There are four major indicators that distinguish between bipolar disorder and mood swings.

The first is how intense the symptoms are. In bipolar disorder, you may hear a person referring to being a major celebrity or owning a major company, they may sleep for only a couple of hours a night, and they may engage in dangerous behavior (like jumping off a building because they suddenly believe they can fly, or having sex indiscriminately).

When someone has a manic episode, they aren’t just happy, they’re ‘on top of the world’ and almost appear (and feel) to be intoxicated. The mood change is easily recognized as excessive, and the person appears to have almost haphazard enthusiasm. The person with bipolar disorder gets involved in lots of projects—but not just doing things they’ve been planning to do, doing things they have little knowledge of and doing things that might be out of their ability range. They might start writing a novel, seeking publicity for an invention, or engaging in other self-aggrandized behavior without any notable experience or talent. They don’t have insomnia—rather, they feel entirely rested and full of energy with several hours less sleep than is typical. They aren’t just chatty, they are loud, difficult to interrupt, intrusive, and irrelevant. They might shift abruptly from topic to topic, and their speech can be disorganized and their thoughts so crowded that they become distressed by the difficulty expressing everything they’re thinking. The distractibility is so severe they almost can’t hold a conversation at all. They become involved in activities that are not typical for their personality—things like giving away their possessions, engaging in indiscriminate sexual encounters with strangers, etc. Importantly, the symptoms by definition have to ‘represent a noticeable change from usual behavior.’ If you pretty much always have mood swings, you probably don’t have bipolar disorder.

The second is what triggers the symptoms. A person with bipolar disorder can move in and out of manic, hypomanic, and major depressive episodes with no perceptible trigger. Often, symptoms are exacerbated by increased stress, and sleeplessness can trigger manic episodes. Antidepressant use can also trigger manic episodes in people prone to bipolar disorder. By contrast, people with mood swings tend to be triggered by an acute event—they’re irritable immediately when their husband criticizes them, they’re devastated immediately when they make a mistake, etc. The mood change in people with ‘mood swings’ is abrupt and typically relatively short-lived, whereas the mood change in people with bipolar disorder is somewhat less abrupt (erupts over a period of days) and longer-lived.

The third is how long the symptoms last. For a manic episode, the person feels ‘up’ and has many of those symptoms listed above for an entire week. For a hypomanic episode, it’s four days. And for a major depressive episode, it’s two entire weeks. By contrast, people with mood swings describe feeling ‘up’ or irritable for a few minutes or hours at most and feeling ‘down’ for a day or two. If the symptoms haven’t lasted for a super long time, it’s not bipolar disorder.

The fourth is how much the symptoms interfere with a person’s ability to function. In bipolar disorder, the symptoms have to cause major distress or major problems at work, at home, or in your relationships. The symptoms are obvious to just about anyone who comes into contact with the person. With mood swings, the symptoms are problematic, and their family can certainly notice, but they’re typically not at risk of losing their job, they can typically still get most things done around the house, and they’re not jeopardizing the major progress they’ve made in their lives. They’re moody but still basically functional.”

Are people with bipolar disorder dangerous or violent?

“Most people with bipolar disorder are not violent. However (as in people without bipolar disorder), some can be dangerous or violent. The risk for people to be violent is higher during the manic phase of the illness and when the person is also using alcohol or drugs.”

How is someone diagnosed with bipolar disorder?

“People can be diagnosed with bipolar disorder by a licensed psychiatrist or a licensed psychologist. The process should include a lengthy clinical interview that gathers a detailed history from the person regarding how their symptoms developed and how they have changed over time.”

Are there other mental disorders that may seem like bipolar disorder?

Diagnosis is complicated because there are many other mental health conditions that can resemble bipolar disorder. For example, people with major depressive disorder can also have hypomanic or manic symptoms. Worrying in generalized anxiety disorder can be mistaken for racing thoughts, and efforts to reduce anxiety can be mistaken for impulsivity. Children with attention-deficit/hyperactivity disorder (ADHD) may speak quickly, have racing thoughts, be distractible, and have less need for sleep, so that can be misdiagnosed as well. Borderline personality disorder includes mood instability and impulsivity. Really, any mental health condition for which prominent irritability is a major symptom can be mistaken for bipolar disorder. The difference is that for bipolar disorder, the person must have had a distinct period of irritability of a specific duration, with this irritability being clearly different from how they normally function and being accompanied by the other symptoms noted above.”

I think I may have bipolar disorder. What are some signs that I need to speak to a professional?

“If your symptoms are 1) causing problems in your relationships with your family, friends, or coworkers, 2) keeping you from getting your work done, or 3) keeping you from being able to take care of yourself effectively, speak to a professional.”

Is it common to have other mental disorders accompany bipolar disorder? If so, what are they?

“The most common mental health conditions that accompany bipolar disorder are anxiety disorders (panic attacks, social anxiety disorder, phobias), ADHD, and substance use disorders.”

How can bipolar disorder impact a person’s day-to-day life?

“In acute manic episodes, bipolar disorder impacts almost all areas of a person’s life and can make it difficult to continue to work or go to school or maintain relationships. This is because the person’s mind is racing so quickly they cannot focus on a project for any productive length of time or even hold a meaningful conversation. They also tend to have difficulty thinking clearly. Most people with bipolar disorder return to a ‘normal’ level of functioning between episodes of mania/hypomania and depression.”

Do we know what causes bipolar disorder? Is it genetic?

“There are four main causes of bipolar disorder. One of the strongest and most consistent predictors that a person will develop bipolar disorder is if they have a close blood relative with bipolar disorder or schizophrenia (these conditions seem to have a similar genetic origin). Also, abnormal functioning of certain areas of the brain, beliefs about your relationships or your expectations about your ability to control things in your life, and major stresses in your life can also make you more vulnerable to bipolar disorder.”

What are some common treatments?

“The most common treatments are a combination of medications and psychotherapy, and research shows most people do best when they are taking their medications and are in therapy. Medications help the person’s mood stay more even at a biological level and help reduce the likelihood of future manic or depressive episodes. Therapy helps the person develop strategies for coping with stress, improve their functioning at school or at work, deal with co-occurring mental health conditions, improve relationships, and otherwise manage the condition.”

What should I look for in a therapist?

“There are two main things that are important in selecting a therapist or psychologist. One is that the person is competent in treating your condition (i.e., they have training and experience) and the other is that you feel a strong connection to the person. It is important you find someone you can trust and someone whom you believe can help you reach your goals.”

How can medication help bipolar disorder? What types are there?

“People who have bipolar disorder have a high likelihood of having future manic or depressive episodes. Medication reduces the likelihood of recurrences and reduces the rate of hospitalizations. It also reduces the likelihood that a person with bipolar disorder will die by suicide. The main goals of medication are to control and resolve a manic or depressive episode that is currently happening, delay future episodes and minimize how severe they are, and improve the person’s functioning between episodes. People with bipolar disorder are often treated with a mood stabilizer (like Depakote, Lamictal, lithium), an atypical antipsychotic (Zyprexa, Seroquel, Risperdal, Abilify, Geodon), and sometimes antidepressants (but usually only when combined with a mood stabilizer or antipsychotic).”

Are there ways to manage my bipolar disorder on my own?

“It can be very difficult for a person with bipolar disorder to manage the condition independently. However, a good therapist or psychologist may be able to teach you the skills you need to manage your mental health condition more effectively on your own.”

I’m worried I may hurt myself or others. What should I do?

“If you are worried you may hurt yourself or others, call 911 or go to your nearest emergency room. Managing suicidal or homicidal thoughts in the long term is best done with the assistance of a psychiatrist and psychologist.”

Will I always live with bipolar disorder?

“Many people, especially those with the most severe forms of the condition, continue to receive treatment throughout their lives to correct the biological factors that cause the symptoms. However, with effective therapy and skills training, many people learn how to better manage their illness. It is very important to know that people with bipolar disorder go on to lead productive, meaningful lives despite having a major mental health condition.”

Are there things I should avoid if I have bipolar disorder?

“Avoid stopping your medications on your own. If you would like to try reducing or stopping your medication, work with your psychiatrist to do this. Otherwise, you may accidentally provoke another episode of mania or depression. Also, avoid drugs and alcohol, which can exacerbate symptoms.”

What should I do if I think a loved one is bipolar? How can I support a loved one who has been diagnosed?

“If you think a loved one has bipolar disorder, encourage the person to talk to his or her physician about their symptoms and possible treatment approaches, but avoid demanding or threatening them. Consider helping by developing a list of questions to ask the physician or by asking for permission to talk to their physician for them.

To support a loved one with bipolar disorder, consider attending a support group for families through the Depression and Bipolar Support Alliance or the National Alliance on Mental Illness. Educate yourself about the condition and remain a steady figure in the person’s life who offers encouragement, reassurance, and support. Monitoring symptom fluctuations is important, so offer to help with this or any other treatment assignments.”

I’m ashamed to talk about the fact that I have bipolar disorder. Is there any reason to feel embarrassed?

“There is no reason to be embarrassed about having bipolar disorder. It is no different than being diagnosed with diabetes, heart disease, or any other condition that requires long-term treatment. It is true there is a lot of stigma surrounding mental health conditions, so it is important to be mindful regarding whom you disclose to. However, bipolar disorder is not caused by a moral failing and does not mean there is something ‘wrong’ with the person. There is no difference between the brain-based biological mishaps that cause bipolar disorder and the heart-based biological mishaps that cause heart disease.”

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