What is bipolar disorder?
In our last post we blogged about how the term ‘depressed’ can often be used to describe a wide range of feelings, from temporary bad mood to intense and longer bouts of low mood that interfere with various aspects of functioning. This week we’re looking at a similarly overused term – bipolar.
In some instances the term 'bipolar' can be used to describe fleeting mood swings, at other times to refer to more prolonged and intense fluctuations in mood that has a marked impact on functioning.
Depression, or unipolar depression, relates to experiencing just the low end of the mood continuum, however bipolar means that both the lows and the highs are experienced.
When it comes to bipolar and related disorders there are three labels that are perhaps the most commonly encountered. These are Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder.
First up, let’s take a closer look first at Bipolar I Disorder. The criteria for a diagnosis of Bipolar I Disorder are as follows [1]:
Criteria have been met for at least one manic episode
The occurrence of the manic and major depressive episodes are not better explained by another disorder (e.g. Schizoaffective disorder, Delusional disorder etc)
So for a person to meet the criteria for Bipolar I, they need to have met criteria for a Manic episode, and may also meet criteria for a Hypomanic episode, as well as a Major Depressive Episode. To refresh your memory on some of the symptoms that make up a Major Depressive Episode, refer to our post on depression here.
The criteria for a Manic episode are [1]:
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal directed activity or energy lasting at least one week and present most of the day nearly every day.
During the period of mood disturbance and increased energy or activity three or more of the following symptoms are present to a significant degree, and represent a noticeable change from usual behaviour:
(i) Inflated self esteem or grandiosity;
(ii) Decreased need for sleep;
(iii) More talkative than usual;
(iv) Flight of ideas or subjective experience that thoughts are racing;
(v) Distractibility;
(vi) Increase in goal-directed activity or psychomotor agitation;
(vii) Excessive involvement in activities that have a high potential for painful consequences (e.g. shopping sprees, sexual indiscretions, unsound business investments)
The mood disturbance is severe enough to cause marked impairment in social or occupational functioning, or to require hospitalisation to prevent harm to self or others, or there are psychotic features
The episode can’t be attributed to the effects of a substance (e.g. drug abuse) or another medical condition.
A Hypomanic episode may produce very similar symptoms to those of a Manic episode, but symptoms are only required to be present for four consecutive days rather than one week, for a diagnosis to be made.
In Australia at least one in every 100 people will experience Bipolar Disorder at some point in their lives. The condition is experienced fairly evenly between men and women, with half of those who will develop Bipolar Disorder doing so by their mid twenties[2].
To meet a diagnosis of Bipolar II Disorder, it is necessary to meet both the criteria for a current or past Hypomanic episode and criteria for a current or past Major Depressive Episode.
Sometimes an individual may experience similar symptoms to those described above, but their symptoms do not meet the criteria for either a Hypomanic episode or a Major Depressive episode. For these individuals, their symptoms may also have been present for a longer time. In such a case, a diagnosis of Cyclothymic Disorder may apply, and the criteria for this diagnosis includes [1]:
For at least 2 years there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode, and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
During the 2 year period, the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
Criteria for major depressive, manic or hypomanic episodes have never been met, and the symptoms are not better explained by another disorder, a substance or a medical condition.
The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
Bipolar and related disorders can be difficult to diagnose, with one recent study showing an average delay of 12.5 years between the symptoms first appearing, and a correct diagnosis of a Bipolar disorder being made [3].
For this reason, if some of the symptoms listed above sound familiar, either for yourself or for someone you know, the most useful next step can be to consult a mental health professional. Effective treatments do exist – both pharmacological and psychological – but getting an accurate diagnosis is a necessary first step to getting the treatment that’s right for you.
You can read about treatment options for depression and bipolar disorders here.
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REFERENCES
[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
[2] Kapczinski, F, et al. (2014). Staging systems in bipolar disorder: an International society for bipolar disorders task force report. Acta Psychiatrica Scandinavica, 130, 354-363.
[3] Berk, M., Dodd, S., Callaly, P., Berk, L., Fitzgerald, P., de Castella, A.R., & Kulkarni, J. (2007). History of illness prior to a diagnosis of bipolar disorder or schizoaffective disorder. Journal of Affective Disorders, 103, 181-186
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