Bipolar disorder: What is it?

Symptoms of Bipolar Disorder

We’ve talked about depression which is an important concept when talking about bipolar disorder because Bipolar Disorder is characterized by mania or hypomania and severe depression. It used to be called manic-depressive illness. The symptoms of Bipolar I are called mania. The symptoms of Bipolar II are referred to as hypomania. In order to have Bipolar Disorder a person must have mania or hypomania at least once in their life and then depression. Approximately 4% of the population has a diagnosis of Bipolar I or II and both women and men are equally affected. People can have repeated cycles of mania and then depression or they can go years without any symptoms.

Essentially, there are two types of Bipolar Disorder. They are referred to as Bipolar I and Bipolar II.  Bipolar I is the more serious form of Bipolar Disorder. Below, I have emboldened the differences between Bipolar I and Bipolar II.

Bipolar I

Bipolar I is characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently goal-directed behavior or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). The symptoms impair the person’s ability to function cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are psychotic features. The episode is not attributable to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or another medical condition. May people who have Bipolar use substance to try to control their symptoms, but sometimes substances can contribute to symptoms of Bipolar Disorder. According to the DSM-5 Bipolar I, it is also required to have at least four of the following symptoms:

• “Inflated self-esteem or grandiosity”
• “Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) for at least 4 days”
• “More talkative than usual or pressure to keep talking”
• “Flight of ideas or subjective experience that thoughts are racing”
• “Increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation”
• “Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)”
• “Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)”  (DSM 5, 2013).

Bipolar II

Bipolar II has similar symptoms. It is a distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment). During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

• “Inflated self-esteem or grandiosity”
• “Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) for at least 4 days”
• “More talkative than usual or pressure to keep talking.”
• “Flight of ideas or subjective experience that thoughts are racing”
• “Increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation.”
• “Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)”
• “Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)”  (DSM5)

Cyclothymia

Cyclothymia is part of the family of Bipolar Disorders. It is a disorder where a person’s mood goes up and then down repeatedly, but it is not as extreme.

The Depression

The depression in Bipolar Disorder is often more extreme than unipolar depression. In Bipolar Disorder, the Depression is often so severe people just wish to die.  People with depression, as you may recall, withdraw from others, and experience guilt, anxiety, and hopelessness. They have difficulty with concentration and cannot feel pleasure (anhedonia). Depending on the person, a person may be more or less likely to eat and therefore gain and lose weight. Sleep is often disturbed and sleep too much or too little. They might not sleep well at night and then sleep all day long and still be fatigued.

Below is a few minute clip which is from a documentary about Bipolar I disorder called Being Bipolar. Notice the gentleman she talks with and pay attention to what he says. Although you can’t see every symptom he most likely exhibits, he is a good example of what it means to be “grandiose” or have “grandiosity.” He also at times has racing thoughts which is manifested by his fast speech at times.

What Contributes to Bipolar Disorder?

Bipolar Disorder is believed to be caused by a number of things and relates back to the age old question of nature versus nurture. In other words, is it genetic or environmental? The answer is yes! It is both. In identical twins, if one twin has Bipolar Disorder, the other twin has approximately 85% chance of having Bipolar Disorder. If a parent has Bipolar Disorder there is a 5-12% greater chance than the general population that a child will have it as well.

Environmentally, those who have experienced trauma or early life stressors, been exposed to substances early in their lives or in utero, have early head injury, premature or low birth weight, or prenatal exposure to infection are at higher risk for Bipolar Disorder. Although there is not one factor which can predict Bipolar Disorder, a combination of these factors can be helpful when watching for the disorder.

Next time I will explain what is happening in the brain of someone with Bipolar Disorder.