Bipolar disorder is a ‘mental health’ condition which affects a person’s mood, someone suffering from Bipolar disorder may have rapidly changing moods which may swing from one extreme to another. Typically speaking a person may go from a state of mania to a major depressive episode or my constantly cycle through different moods depending on their illness; quite literally like a roller coaster, going up and down through differing mood states.
Bipolar disorder can occur at any age although it seems to develop and become prevalent between the ages of 18 and 24. Men and women from all backgrounds are equally likely to develop bipolar disorder. On average it takes 10.5 years to receive a correct diagnosis for bipolar in the UK and before bipolar is diagnosed there is a misdiagnosis an average of 3.5 times (Bipolar UK; Online).
What is mania, hypomania and a depressive episode?
The core difference to Bipolar disorder and Depression (as we know it) is the presence of the person being in a state of mania. Mania or manic episodes is referred to as an elevated mood, feeling high; sometimes feeling exciting and fun but can also be unpleasant and distressing.
Someone experiencing a manic episode may feel; extremely happy, euphoric, uncontrollably excited, often speaks faster, can become irritable and agitated, they may have increased sexual energy, their thoughts may be racing, may perceive to be very confident, adventurous and in some way ‘special’. The person during this state may be; more active than usual, speaking quickly, often making little sense, saying or doing things which are out of character/inappropriate, sleeping very little or not at all, being rude or aggressive, misusing alcohol/drugs, spending excessively, loss of social inhibitions and acting provocatively.
Hypomania is similar to mania but, this state is not as ‘extreme’ as full-blown mania. Hypomania quite literally means ‘less than mania’. A person experiencing hypomania may have similar symptoms and behaviour too mania as outlined above. Yet, these symptoms and behaviours will be lesser than that of a manic episode. Compared to mania, hypomanic symptoms are likely to feel more manageable and last for a shorter period of time.
A major depressive episode is exactly the same as I have previously outlined
with my posts about Depression (click on the picture to go to that post). Briefly a person experiencing a depressive episode may feel; down, upset, tired, sluggish, may not find enjoyment in previously enjoyed things (anhedonia), experience feelings of guilt or worthlessness etc.
Types of Bipolar
The best way of trying to explain the differences of certain types of bipolar disorder is through the use of line graphs. The blue line at the top of the graph indicates ‘mania’, the red line in the middle indicates a ‘normal’ level of mood, the purple line in between ‘normal’ and ‘mania’ indicates ‘hypomania’ and the green line at the bottom indicates a ‘depressive episode’.
This form of Bipolar is dependant upon the person experiencing atleast one episode of mania which has lasted longer than one week. The person may also have experienced depressive episodes but it is not dependant upon this diagnosis. Statistics from Perala et al (2007) suggests that 1-3 people in every 100 will experience Bipolar I.
A person may have Bipolar II if they have experienced both; one episode of severe depression but also symptoms of hypomania. The difference here is that the person doesn’t have to hit a manic episode. However, the person must experience hypomania for 4 consecutive days for the majority of the day (DSM-5).
A person who has experienced both hypomanic and depressive mood states over the course of two years of more and there symptoms aren’t severe enough to meet the criteria for diagnosis of Bipolar I or II they may be diagnosed with Cyclothymia. This is where a person cycles through hypomania and low grade depression.
Similar to cyclothymia a person will cycle through differing mood states however will be on the ‘depressive’ end of the spectrum rather than manic. This is referred to as a low grade depression.
Causes of Bipolar Disorders
Currently the cause for Bipolar disorders is very much misunderstood. Research has focused on the genetics and biology of the brain but many researchers also feel the social factors may also play a part in the development of this condition.
Childhood Trauma; Evidence suggests that a person may be more likely to develop Bipolar disorder if they have experienced severe emotional distress as a child. Such as; traumatic events, sexual or physical abuse, neglect or the loss of a parent. Experiencing trauma at such a young age can cause a large amount of distress and may have an impact on the child’s ability to regulate emotions effectively.
Stressful life events; The start of Bipolar symptoms can be linked to stressful periods within a person’s life; relationship breakdown, traumatic loss and or poverty. Lower levels of stress are unlikely to ’cause’ bipolar. They can trigger an episode of mania or depression.
Self-esteem problems; Researchers believe that a manic episode can be a way of escape from feeling depressed or having low self-esteem. It is believed that when a person is extremely self-critical or feels very bad about themselves mania increases their self-confidence to help them cope.
Brain Chemistry; Evidence shows that bipolar symptoms can be treated with certain psychiatric medications which are known to act upon the neurotransmitters within the brain. This infers that people with bipolar disorder may therefore have problems with the neurotransmitters functions.
Genetic Inheritance; If you experience Bipolar disorder you are more that likely to have a family member whom is also suffering from bipolar mood or symptoms. This therefore shows that their may be a strong genetic link to bipolar disorder. However, it may be also due to environmental factors which both members of the family may be experiencing rather than a ‘bipolar gene’.
The National Institute for Health and Care Excellence suggest that treatment of bipolar disorder should include both talking treatments and pharmocotherapy (medication). However, treatment tends to depend upon the episode the person is currently in.
Depressive Episode? A person suffering from a depressive episode may be offered medication and structured psychological treatment such as CBT.
Manic or Hypomanic Episode? Again you are likely to be offered medication but you are unlikely to be offered a talking therapeutic treatment.
*I plan on doing an in-depth post discussing treatment for Bipolar disorder.
Many people often use the term bipolar as a adjective to describe their mood or situation e.g. the weather- being sunny one minute and raining the next. This often can negate the seriousness of such a condition and can lead to higher levels of stigmatising attitudes.The social impact of receiving a diagnosis of Bipolar disorder can be extremely distressing. As with any mental illness people still fear the unknown and much of the media stories which is the main way of disseminating information to the general public is often negative and can draw negative associations and inaccurate depictions of a person suffering from Bipolar disorder. Which can impact on the person suffering from this condition seeking appropriate medical help and concealing their illness.
Treatment plans can be extremely challenging for a person experiencing Bipolar disorder as the person may struggle taking medication that can affect their elevated mood. Often when a person is experiencing mania they may feel on top of the world and being euphoric they may refuse medical treatment as that mood feels so good to them. On the flip side a person whom is experiencing mania may be putting themselves in unsafe positions and therefore may need medical treatment. Again, depression can make a person struggle to get out of bed in the morning therefore seeking treatment outside of their comfort zone can be challenging.
Although Bipolar disorder can have very negative associations often people whom have this disorder have been found to be more creative than those without it. When a person is experiencing a manic episode they may have extremely high levels of creativity which can also lead to greater productivity in their working lives.
Perala et al (2007) ‘Lifetime prevalence of psychotic and bipolar I disorders in a general population‘ Archives of general psychiatry, 64:19-28