Bipolar Disorders

What Are Bipolar Disorders?

Bipolar disorders are mental health disorders that involve noticeable changes in behavior and mood that significantly impact an individual’s functioning. Mood changes may include very high and very low moods, which can be challenging to manage.

Bipolar disorders include depressive episodes, which can make it difficult to participate in one’s typical activities, and might include suicidal ideation. They also often include a manic or hypomanic episode, which includes changes in behaviors, thought processes, overall mood, and increases in energy. Sleep and appetite are frequently affected as well.

A common misconception regarding bipolar disorder is that it is a rapid cycling of changing moods from mania to depression, resulting in many people with bipolar disorder falsely stigmatized as being unstable. However, many people with this condition experience very long periods of stable moods, but these long stretches of normalcy are punctuated by distinct episodes of mania, depression, or hypomania that can last for weeks or longer. 

Symptoms of bipolar disorder tend to have a significant impact on one’s overall ability to function in everyday life. They specifically affect one’s social, interpersonal, physical, academic, occupational, and self-care areas of functioning.

Why Is Bipolar Disorder No Longer Called Manic-Depressive Illness?

In the past, bipolar disorder was called manic-depressive illness. However, the previous name was changed to reduce stigma.

Currently, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) uses the terms Bipolar I Disorder and Bipolar II Disorder to name these diagnoses. There are other bipolar-related diagnoses included in the DSM-5 as well, including cyclothymic disorder, other specified bipolar and related disorders, and unspecified bipolar and related disorders.

Types Of Bipolar Disorders

There are several subtypes of bipolar disorders, which can add to the challenge of an accurate diagnosis. Knowing more about the differences between the bipolar disorder subtypes can help those who are exhibiting symptoms of bipolar disorder and who want to gain a better understanding of what they might be experiencing.

Bipolar I Disorder

Bipolar I disorder is marked by mania.

According to the DSM-5, bipolar I disorder requires having at least one manic episode lasting at least 7 days in duration or severe enough to require hospitalization. It is possible for people with bipolar type I to experience mania without depression. Bipolar I disorder can be diagnosed without depressive episodes, even though many individuals experience them.

Manic Episodes

Manic episodes consist of significant mood changes, including elevated, expansive, or irritable moods, significant energy increases, and increased goal-directed activity. They typically last more than one week.

Symptoms of manic episodes include:

• Inflated self-esteem
• Grandiose thinking
• Decreased need for sleep
• Being much more talkative than usual
• Racing thoughts
• Increase in risky behaviors

Furthermore, manic episodes significantly impact social, interpersonal, academic, and occupational functioning.

Major Depressive Episodes

Major depressive episodes typically last at least two weeks and include noticeable changes in thoughts and behavior as well. During these episodes, a person’s thoughts and perspectives are usually very negative. Feelings of guilt or shame might also be present.

People who experience depressive episodes are rarely interested in participating in activities they usually enjoy doing. They might also experience changes in sleep, such as sleeping more than usual or being unable to sleep. Appetite changes might also occur. Lastly, suicidal ideation might be present as well. These symptoms must significantly impact one’s functioning to meet the criteria for such an episode.

Bipolar II Disorder

Bipolar II disorder is a subtype of bipolar disorder characterized by episodes of major depression and hypomania. Unlike mania, hypomania is less severe and does not meet the criteria for a manic episode. Although bipolar II disorder is generally considered less severe than bipolar I disorder, it can still significantly affect a person’s daily life and overall functioning.

The symptoms of bipolar II disorder are similar to those of bipolar I disorder, particularly because both conditions can involve depressive episodes and distinguishing hypomania from mania can be challenging. Hypomanic episodes typically do not have as severe of an impact on individuals as manic episodes do, but they are still challenging to navigate.

Bipolar-Related Diagnoses

Some other diagnoses that are similar to bipolar disorder include cyclothymic disorder, other specified bipolar and related disorders, and unspecified bipolar and related disorders.

Cyclothymic disorder also includes ups and downs in mood, but they are not nearly as severe as they are in bipolar I and bipolar II disorders.

Other specified bipolar and related disorders and unspecified bipolar and related disorders are very similar to bipolar disorder but are given as a diagnosis when one does not meet the full criteria for a diagnosis of bipolar I disorder or bipolar II disorder.

What Causes Bipolar Disorder?

It can be challenging to determine the exact cause of bipolar disorder, as many factors play a part. Genetics play a role, so there is a biological component that can cause bipolar disorder. One’s environment and the level of stress they have experienced can also contribute to the cause of bipolar disorder and make symptoms more noticeable and challenging to those who experience them.

Whether or not someone has healthy support systems as well as access to resources can also play a significant role in the severity of one’s symptoms and their ability to manage and cope.

Who Is Affected By Bipolar Disorders?

While anyone can be affected by bipolar disorders, certain factors make it more likely for someone to experience it, including:

• Those with a genetic predisposition to bipolar disorders
• Those who have experienced high levels of significant stress
• Those who have experienced childhood trauma

A combination of one’s genetics and one’s environment usually has the biggest impact on whether a person will experience and be diagnosed with bipolar disorder.

Furthermore, it has been found that in the past, women were more likely to go undiagnosed despite experiencing symptoms of bipolar disorder. However, the number of women receiving a bipolar disorder diagnosis is on the rise. Women are more likely to experience rapid cycling, or switching from low to high moods quickly, and have more suicide attempts than men.

Lastly, it is important to highlight the fact that those who love and care for someone with bipolar disorder are impacted as well, as they may need to assist their loved ones with managing symptoms, attending treatment and therapy appointments, managing medications, and other important aspects.

How Common Is Bipolar Disorder?

It has been found that approximately 3%-5% of the population experiences bipolar disorder. This percentage could be higher, as many people might not report their symptoms or diagnoses. Furthermore, because bipolar disorders are rather difficult to diagnose, this could impact the accuracy of these numbers as well. Noticeable symptoms typically begin in early adulthood, but for some, they develop in adolescence.

Diagnoses

A mental health therapist, psychologist, or psychiatrist can conduct a diagnostic assessment to diagnose bipolar disorder. A diagnostic assessment consists of asking many questions about the symptoms that one is experiencing as well as questions about their history and background information, such as how they grew up and whether they experienced any trauma.

After collecting this information during the interview part of the assessment, and with the help of the DSM-5, the provider will make a well-informed diagnosis. Neuroimaging strategies are also becoming more developed and well-known, and research shows that they can help providers make more accurate diagnoses.

Because bipolar disorders are challenging to diagnose accurately, the idea that these disorders are better defined as a continuum of affective disorders is becoming more prevalent.

How Is Bipolar Disorder Treated?

There are many mental health treatment options available for bipolar disorder, including psychotherapy, brain stimulation therapies, and medication.

Psychotherapy

Mental health therapy for bipolar disorders can include individual, family, or group therapy. During these sessions, psychotherapy techniques are often used and include:

• Cognitive-behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Mindfulness strategies
• Eye movement desensitization and reprocessing (EMDR)

Eye movement desensitization and reprocessing therapy is particularly helpful for those with bipolar disorders who have experienced trauma.

What Medications Are Used To Treat Bipolar Disorder?

Medication management through a primary care provider or psychiatrist is another treatment option for bipolar disorder. There are many medications prescribed to treat bipolar disorders, including mood stabilizers, antipsychotics, and antidepressants.

Lithium is one of the most commonly prescribed mood stabilizers for bipolar disorder. Other mood stabilizers include valproate (which works well to curb depressive lows), lamotrigine (which helps with depressive lows), and carbamazepine (which helps calm acute manic episodes).

Antipsychotic medications such as quetiapine, aripiprazole, lurasidone, and cariprazine are also prescribed to treat bipolar disorders.

Antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), are sometimes prescribed for bipolar disorders as well. However, antidepressants should always be paired with a mood stabilizer or antipsychotics because, if used alone, they can trigger mania, hypomania, or rapid mood cycling.

It is not uncommon for a person to try several medications before finding the option(s) that works for them, and a psychiatrist or other prescribing provider specializing in this area can help them do so.

Brain Stimulation Therapies

Newer brain stimulation therapies, including electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and light therapy are becoming more common in the treatment of bipolar disorders.

Electroconvulsive therapy is a procedure that consists of brain stimulation and can help to reduce severe symptoms of bipolar disorder. This treatment option might be considered when one’s symptoms have not responded to other types of treatment, such as psychotherapy and medication.

Repetitive transcranial magnetic stimulation (rTMS) is another brain stimulation procedure used to treat bipolar disorders. As the name suggests, rTMS uses magnetic waves to reduce depression symptoms and is completed over multiple sessions. Although rTMS is not as powerful as ECT, it is still a great option to consider, as one does not need to go under general anesthesia to receive it.

Lastly, light therapy is used to treat symptoms of depression and can be helpful for those experiencing symptoms of bipolar disorders.

What Lifestyle Changes Can Help With Bipolar Disorder?

Making healthy nutritional choices, exercising, getting involved in your community, using healthy coping strategies, and having a positive attitude toward one’s health can have great benefits for those diagnosed with bipolar disorder and decrease the risk of experiencing comorbid or multiple diagnoses.

Furthermore, it is important to encourage those with bipolar disorder to participate in choosing which strategies they feel best using to help manage symptoms and live healthily, as this can be motivating and empowering.

Can Bipolar Disorder Be Prevented?

Research suggests that bipolar disorder is chronic, meaning that symptoms last over time. Therefore, the sooner one gets assessed for a possible diagnosis of bipolar disorder, the sooner they can access the treatment options and coping strategies that can help them manage their symptoms better. Building a solid foundation of skills and coping strategies early on can help those with bipolar disorder feel more confident in their abilities to manage their symptoms.

What’s The Difference Between Borderline Personality Disorder And Bipolar Disorder?

Bipolar disorder and borderline personality disorder (BPD) sometimes get confused with one another, as several characteristics of BPD and bipolar disorder overlap.

While both disorders often involve noticeable changes in impulsivity, depressive symptoms, anxiety symptoms, irritability, suicidal ideation, and history of childhood trauma, there are some noticeable differences. For example, research suggests that those diagnosed with BPD tend to experience more negative thoughts and feelings regarding others and themselves, so they usually have more conflict within relationships. BPD is marked by identity disturbances, increased risk of self-harm, strong fear of abandonment, and unstable relationships.

Furthermore, because BPD is a personality disorder, it cannot be officially diagnosed until one is 18 years of age or older. In contrast, bipolar disorder can be diagnosed earlier (though it is often not diagnosed until adulthood).

It is important to receive an assessment by a qualified provider to get an accurate diagnosis and start a mental health treatment plan that fits individual needs.

When Should I See My Healthcare Provider About Bipolar Disorder?

If you or a loved one are experiencing any of the characteristics of bipolar disorders described above, reach out to your healthcare provider to discuss your questions and concerns and find out more about what assessment options are available to you. If you or a loved one already received a bipolar disorder diagnosis and feel as though your symptoms have increased or your treatment does not feel like the best fit for you, it is important to reach out to your healthcare provider to get assistance and additional support.