Bipolar and related disorders are a chapter in the DSM 5, once a part of mood disorders, now its own category. The disorder involves shifts between depressive and manic (or milder hypomanic) episodes, the disorder was once even called manic-depressive disorder. Anxiety is also a part of this disorder for many people. The frequency, duration, and intensity of the shifts between these two types episodes will vary. Often overlooked, people with this disorder will often not be in either episode and functioning much like people with the diagnosis.
This disorder is largely biologically based and runs in families. Head injuries have also been linked to issues with mood imbalances. However, learned behaviors, conditioning, behavioral and life choices, and substance use can all play a roll in BP disorder.
Over the last several years, BP has become a very trendy diagnosis for adolescents. After reading the criteria for BP, it is easy to see how an adolescent could be confused for having this disorder as their hormones are running wild! While many teens do have BP, it is likely that many are being misdiagnosed. It can also be confusing because the shifts in mood over the course of the year can mimic bipolar as seasons, holidays, work schedules, and more can influence a person’s mood and functioning.
As a person who has BP disorder, I can safely say that there are many misconceptions about what BP disorder is. While moods are a big part of the diagnosis, BP feels like so much more than just a mood imbalance. Energy, functioning, productivity, relationships, and self-worth seem more at the fore-front of the diagnosis. It is far more than being happy or sad, it feels to encompass your entire being.
People often assume that Bipolar means that your moods shift rapidly and with great intensity, while true for some, BP “mood shifts” are much larger scale than losing your temper. The shifts from manic to depressive episodes will happen a couple times a year for most people, at most. Seasonal trends will likely occur as well with depressive episodes more likely in the fall and winter, and manic episodes more likely in spring and summer. The duration, frequency, and intensity will vary with each individual person. The variability of symptoms can be extremely different from person to person. Some people won’t be impacted much at all, others struggle to function at all and have total life impairment.
Understanding what these two types of episodes is the key to getting a better understanding of what Bipolar disorder is. The DSM5 is the book used to make the diagnosis and the following criteria are from the manual (American Psychiatric Association, 2013).
Depressive Episode- During this time of at least 2 weeks a person must encounter a shift from previous functioning. People will experience many of the symptoms associated with depression, but people with Bipolar have symptoms that are more intense, frequent, and have more symptoms. People must demonstrate 5 of the following symptoms:
- Have a depressed mood most of the day. This can include sadness, being hopeless, worthless, etc.
- Loss of interest in activities that were once enjoyable. Example, not wanting to go biking or hiking, writing, etc. for a person enjoys those activities)
- Weight fluctuation. Some people gain weight, others lose weight.
- Sleep Issues. Some people deal with insomnia, others sleep too much.
- Appears frigidity or restless. Antsy, can’t sit still sometimes called psycho-motor agitation.
- Low energy levels or fatigue. Unmotivated and often unproductive
- Feels worthless, guilty or helpless.
- Struggles to concentrate or focus. Will often appear distracted or disengaged from what is going on. Can appear in relationships, work, school, etc.
- Thoughts of death or suicidal ideation. This could be internal, or the person could talk about the issues.
- Causes impairment in every day functioning or life. A person’s life will likely be disrupted in some way or another as a results of this episode.
Depressive episodes can be difficult to deal with. There is often a lot of self-doubt, negativity, and sadness. Feeling unmotivated, lazy, unproductive, worthless, dark, and wanting to be dead are all feelings that people can experience. These episodes can last for weeks and even months.
Manic and Hypomanic Episode-Often when people think about BP disorder they think that a manic episode involves feeling happy. This is not the case. Mania is defined as a week or more of “elevated, expansive, or irritable mood” (American Psychiatric Association, 2013). For some people this can manifest as anxiety, stress, irritability. People in this episode will often report feeling like they want to get out of their own skin and escape their mind. A manic episode is more severe, whereas a hypomanic episode is less severe. The rest of criteria for this disorder is as follows, 3 or more of the following:
- Increase in Self Esteem or grandiose thinking.
- Needs very little sleep to function
- Highly talkative, speech is rushed and fast.
- Racing and fast thoughts.
- Easily Distracted and restless.
- Increase in goal-directed activity and behaviors.
- High risk activity (spending, recklessness, sexual promiscuity, bad financial decisions).
- Causes a marked impairment in life functioning (work, school, relationships, etc.).
More people commit suicide during manic episodes than depressed episodes. For many people these types of episodes are awful and something that you just need to survive. The inability to sleep causes disruptions in a person’s entire functioning and can have significant negative impacts on overall functioning. Manic episodes can be very scary for a person as they often do not see the potential for consequences and are reckless. It can almost appear (for some people) like they are on cocaine or another stimulant.
Bipolar disorder impacts a vast majority of people’s lives. BP will impact many areas of functioning and is often misunderstood by people.
Remember, everyone is different, and symptoms will vary between people. The chart below identifies feelings and behaviors that a person may experience when in an episode.
|
Manic/Hypomanic Episodes |
Depressed Episodes | |
| Energy level | Excessive, motivated, goal directed, active, fast paced, everything seems sped up | Minimal activity level, lazy, unproductive, slow moving, everything seems slowed down |
| Common feelings | Elated, anxious, high, jumpy, excited, irritable, racing thoughts, easily distracted (almost ADD/ADHD like) | Sad, depressed, worried, worthless, helpless, unable to concentrate or focus |
| Sleep/Diet | Minimal needed, some people go days with very little if any sleep, getting sleep is paramount, even if just resting, minimal need for food and often people will lose significant weight during an episode, eating protein is essential | Many people will sleep excessively, some people will struggle with insomnia because of depressed thoughts, some people eat substantial amounts of food and gain weight, others will lose their appetite |
| View of Self | Often elevated, grandiose, inflated, invincible | Very low, abysmal view of self and value to the world |
| Risk | Excessive spending, sex, substance use, losing job, higher suicide risk or death of dying from poor decision | Lower risk of suicide compared to manic, but still at a high risk, relationships or jobs could be lost |
| Length | Generally a few days, but can be a few weeks, people will burnout and usually crash pretty hard | Minimum of two weeks and up to several months |
Mixed Episode/Features
While it may seem like depressive and manic episodes are highly dissimilar. Yet, they can blend into one another, it impacts almost half all people with BP. This is, “bipolar disorder with mixed features in which a person will simultaneously experience depression and mania. While this may seem contradictory—to have a manic and depressed state all at the same time—it is more common than you may think” (Purse, 2018).
This can manifest in a variety of ways. For example, a person who has a significant amount of energy, yet is really sad, depressed, and lonely. Someone may appear to be crying, yet claim to be in the happiest best place of their life.
How often will people cycle?
Most people will experience 1-2 episodes a year. People who experience more than four episodes a year are said to be rapid cycling. Everyone’s cycles are unique, “Typically, someone with bipolar disorder experiences one or two cycles a year, with manic episodes generally occurring in the spring or fall.” (Read, 2018)
People often refer to those with Bipolar as having very rapid (like hourly swings) as Bipolar. This may occur in people, however, the cycles of people with are usually much slower and almost more seasonal. BP is not being moody, but rather having times where body chemistry will drastically shift from depressive to manic, not necessarily an instantaneous shift.
Charting seasonal cycles and patterns is highly important. This can allow a person to better understand and prepare for shifts. Cycles can also occur not just because of the time of the year, but also because of life triggering events. An unfortunate circumstance, negative event (hurt, life stressor, etc.) can cause a person to go into a cycle.
Chemicals and Bipolar
There are multiple brain chemicals and neurotransmitters associated with Bipolar. Thinking about the chemical aspects of BP, it is really about an irregulation of chemicals. Sometimes as an abundance are released, other times not enough that lead to episodes. Disruptive life events (relationship issues, abuse, loss of job, trauma, sleep issues, etc.) can cause a flood or cessation of chemical releases that facilitate the mood shifts (Nemade and Dombeck, 2018).
- Dopamine
- Serotonin
- Norepinephrine
- GABA
- Endorphins
- Oxytocin
Suicide and Bipolar
The biggest risk with Bipolar Disorder is suicide. People are more likely to commit suicide during manic episodes as opposed to in depressive episodes.
Statistics are sobering: As many as 15 percent of people with bipolar disorder will die by their own hands, half will attempt to, and nearly 80 percent will contemplate doing so.
Michelle Bloomquist
Treatments for Bipolar Disorder
The best approach to treating Bipolar is likely from a holistic standpoint. There is not one singular “cure” for BP, including medicine. Rather many lifestyle changes that can help to minimize and even eliminate the symptoms of Bipolar.
If a person chooses to take psychotropic medication, it is a starting point. Be aware of the side effects and risks of the medication. This does not mean that all your problems will go away. Rather, it gives you a chance to make the changes needed to be happy and health. Self care still needs to be priority one.
Personally, I believe medication should be a last resort for treating Bipolar. People (like myself) are navigating the disorder without medication, but it is not always easy. If medication is used, counseling, improved diet, exercise, hobbies, art, journaling, and other healthy choices should be implemented.
- Positive Psychology
- Psychotropic medications (Abilify, Zeprexa, Lithium, and more)
- Talk Therapy/Counseling
- Improving Diet (Nuts, veggies, lean proteins)
- Exercise
- Art and Creativity
- Time with Animals
- Fish oil/herbs/supplements
- Mood Metering Charting (keeping a log of your moods to recognize patterns)
- Writing/Journaling
- Support Groups
- Hobbies or other interests
- Yoga/Meditation/Relaxation Skills
- Behavioral Modification
- Spending time with friends and family
- Self Awareness
As a person with Bipolar, it is interesting that the way to approach and handle a manic episode and a depressive episode are similar. A person needs self care above all else. A manic episode requires a person occupying their time and staying busy, active, exercising, and being engaged with people. A person in a depressive episode needs to also be active, engaged, exercise and eat healthy.
It is all about self care to survive and thrive with Bipolar disorder. Self care is important for everyone, people with BP it can be a matter of life or death. Know yourself, stay active, and don’t be ashamed that you have this disorder!
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders-5th edition.
Bloomquist, M. (2018). Bipolar Disorder and the Risk of Suicide. Everyday Health.
Mikita, D. (2017). Diagnostic Criteria for Depression. Free Psychology Help.
Nemade, R., Dombeck, R. (2016). Bipolar and Neurochemistry. Grace Point Wellness.
Purse, M. (2018). Mixed Features in Bipolar Disorder: When Manic and Depressive Symptoms Co-Occur. Very Well Mind.
Read, K. (2018). How Often Do People With Bipolar Disorder Cycle? Very Well Mind.