What to know about bipolar disorder

A person with bipolar disorder will experience changes in mood, energy, and activity levels that can make day-to-day living difficult.

Bipolar disorder can cause severe disruption to a person’s life, but the impact varies between individuals. With appropriate treatment and support, many people with this condition live a full and productive life.

According to the National Alliance on Mental Illness (NAMI), bipolar disorder affects over 10 million people in the United States or around 2.8% of the population.

On average, a person will receive a diagnosis around the age of 25 years, but symptoms can appear during the teenage years or later in life. It affects males and females equally.

What is bipolar disorder?

The National Institute of Mental Health describe the main symptoms of bipolar disorder as alternating episodes of high and low mood. Changes in energy levels, sleep patterns, ability to focus, and other features can dramatically impact a person’s behavior, work, relationships, and other aspects of life.

Most people experience mood changes at some time, but those related to bipolar disorder are more intense than regular mood changes, and other symptoms can occur. Some people experience psychosis, which can include delusions, hallucinations, and paranoia.

Between episodes, the person’s mood may be stable for months or years, especially if they are following a treatment plan.

Treatment enables many people with bipolar disorder to work, study, and live a full and productive life. However, when treatment helps a person feel better, they may stop taking their medication. Then, the symptoms can return.

Some aspects of bipolar disorder can make a person feel good. During an elevated mood, they may find they are more sociable, talkative, and creative.

However, an elevated mood is unlikely to persist. Even if it does, it may be hard to sustain attention or follow through with plans. This can make it difficult to follow a project through to the end.

Symptoms

According to the International Bipolar Association, symptoms vary between individuals. For some people, an episode can last for several months or years. Others may experience “highs” and “lows” at the same time or in quick succession.

In “rapid cycling” bipolar disorder, the person will have four or more episodes within a year.

Mania or hypomania

Hypomania and mania are elevated moods. Mania is more intense than hypomania.

Symptoms can include:

• impaired judgment
• feeing wired
• sleeping little but not feeling tired
• a sense of distraction or boredom
• missing work or school
• underperforming at work or school
• feeling able to do anything
• being sociable and forthcoming, sometimes aggressively so
• engaging in risky behavior
• increased libido
• feeling exhilarated or euphoric
• having high levels of self-confidence, self-esteem, and self-importance
• talking a lot and rapidly
• jumping from one topic to another in conversation
• having “racing” thoughts that come and go quickly, and bizarre ideas that the person may act upon
• denying or not realizing that anything is wrong

Some people with bipolar disorder may spend a lot of money, use recreational drugs, consume alcohol, and participate in dangerous and inappropriate activities.

Depressive symptoms

During an episode of bipolar depression, a person may experience:

• a feeling of gloom, despair, and hopelessness
• extreme sadness
• insomnia and sleeping problems
• anxiety about minor issues
• pain or physical problems that do not respond to treatment
• a sense of guilt, which may be misplaced
• eating more or eating less
• weight loss or weight gain
• extreme tiredness, fatigue, and listlessness
• an inability to enjoy activities or interests that usually give pleasure
• difficulty focusing and remembering
• irritability
• sensitivity to noises, smells, and other things that others may not notice
• an inability to face going to work or school, possibly leading to underperformance

In severe cases, the individual may think about ending their life, and they may act on those thoughts.

Psychosis

If a “high” or “low” episode is very intense, the person may experience psychosis. They may have trouble differentiating between fantasy and reality.

According to the International Bipolar Foundation, psychosis symptoms during a high include hallucinations, which involve hearing or seeing things that are not there and delusions, which are false but strongly felt beliefs. A person who experiences delusions may believe they are famous, have high-ranking social connections, or have special powers.

During a depressive or “low” episode, they may believe they have committed a crime or are ruined and penniless.

It is possible to manage all these symptoms with appropriate treatment.

Types of bipolar disorder

A person may receive a diagnosis of one of three broad types of bipolar disorder. According to NAMI, symptoms occur on a spectrum, and the distinction between the types is not always clear-cut.

Bipolar I disorder

For a diagnosis of bipolar I disorder:

• The individual must have experienced at least one manic episode.
• The person may have had a previous major depressive episode.
• The doctor must rule out other disorders, such as schizophrenia and delusional disorder.

Bipolar II disorder

Bipolar II disorder involves periods of hypomania, but depression is often the dominant state.

For a diagnosis of bipolar II disorder, a person must have had:

• one or more episodes of depression
• at least one hypomanic episode
• no other diagnosis to explain the mood shifts

A person with hypomania may feel good and function well, but their mood will not be stable, and there is a risk that depression will follow.

People sometimes think of bipolar II disorder as a milder version. For many, however, it is simply different. As NAMI indicate, people with bipolar II disorder may experience more frequent episodes of depression than people with bipolar I disorder.

Cyclothymia

The National Health Service (NHS) in the United Kingdom note that cyclothymia has similar features to bipolar disorder, but the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) classifies it separately. It involves hypomania and depression, but the changes are less intense.

Nevertheless, cyclothymia can impact a person’s daily life, and a doctor can provide treatment.

Diagnosis

A medical professional will diagnose bipolar disorder using criteria set out in the DSM-5.

The National Institue of Mental Health (NIMH) explain that in order to receive a diagnosis of bipolar I disorder, a person must have had symptoms for at least 7 days, or less if symptoms were severe enough to need hospitalization. They may also have had a depressive episode lasting at least 2 weeks.

To receive a diagnosis of bipolar II, a person will have experienced at least one cycle of hypomania and depression.

A doctor may carry out a physical examination and some diagnostic tests, including blood and urine tests, to help rule out other causes.

It can be challenging for a doctor to diagnose bipolar disorder, as people are more likely to seek help with a low mood than a high mood. As a result, it can be hard for them to distinguish it from depression.

If the person has psychosis, a doctor may misdiagnose their condition as schizophrenia.

Other complications that may occur with bipolar disorder are:

• use of drugs or alcohol to cope with symptoms
• post-traumatic stress disorder (PTSD)
• anxiety disorder
• attention-deficit hyperactivity disorder (ADHD)

NIMH urge healthcare providers to look for signs of mania in the person’s history, to prevent misdiagnosis. Some antidepressants can trigger mania in susceptible people.

A person who receives a diagnosis of bipolar disorder has a lifelong diagnosis. They may enjoy long periods of stability, but they will always live with the condition.