Making Sense of Bipolar Disorder
First things first, I can tell you what bipolar disorder is not...
It is not a character flaw, nor is it a sign of personal weakness. If your preconceived notion of bipolar disorder is somewhere along these lines, then I wouldn’t blame you: the conversations about this disorder all too often will focus on the severity of it, its debilitating nature, and how destructive it can be for those who suffer from it (and their loved ones).
In order to fully understand the complexities of this condition, we first need to look at the condition itself and why it takes so long to make an accurate diagnosis.
What Is Bipolar Disorder?
Presenting as extreme changes in mood, thought, energy, and behaviour, bipolar disorder is a mental condition in which a person’s psychological state alternates between mania (highs) and depression (lows) lasting for hours, days, weeks, or even months.
Symptoms of Bipolar Disorder
How severe the symptoms are can vary from individual to individual. A person may have distinct manic or depressed states but may also have extended periods (months or even years) without experiencing any extreme mood states at all. During these severe manic and depressed states, symptoms can range from hallucinations and delusions to suicidal thoughts and an inability to function in day-to-day life. It is because of these psychotic symptoms that bipolar disorder is often wrongly misdiagnosed as schizophrenia.
Here is a general look—this is by no means an exhaustive list—at what manic and depressed mood states entail:
- Being full of new and exciting ideas
- Shifting quickly from one thought/idea to the other
- Hearing voices
- Behaving out of character (spending large sums of money, using drugs or alcohol, gambling, or engaging in casual sex)
- Low mood
- Loss of energy
- Feeling negative and hopeless
- Difficulty concentrating
Just to further complicate matters, there are different types of bipolar disorder.
There Are Many Types of Bipolar Disorder
Bipolar I Disorder
In order to be diagnosed, you will have to have had at least one manic, mixed, and major depressive episode. These episodes last for at least one week, but may continue for months. Bipolar I disorder is the most severe form of the illness.
Bipolar II Disorder
Is characterised by predominately depressive episodes accompanied by occasional hypomanic episodes. These hypomanic episodes are milder than manic episodes, although they can still impair functioning. Between episodes, there may be periods of normal functioning. The risk of suicide is higher in type II than it is in type I.
Bipolar I or Bipolar II Disorder With Mixed Symptoms
Symptoms of mania and depression will occur at the same time. This can be referred to as a “mixed bipolar state,” where you may feel sad and hopeless while simultaneously experiencing restlessness and high energy. This mixed state is a lethal combination with a very real risk of suicide.
Bipolar I or Bipolar II Disorder With Rapid Cycling
Rapid cycling means you will have had four or more depressive manic episodes in a 12-month period.
Bipolar I or Bipolar II Disorder With Seasonal Pattern
In this type, the manic and/or depressive episodes may be affected or coincide with seasonal changes. For example, this can mean that you might have a depressive episode each winter, but your mania does not follow a seasonal pattern.
The lows and highs are less severe but are constantly fluctuating between periods of hypomania and mild depression. Even though these mood swings are shorter, less severe, and separated by periods of normal mood, they can still create havoc for the sufferer and their close ones. Some people with cyclothymia may develop a more severe form of bipolar, while others may deal with it as a chronic (ongoing) condition.
Cause(s) of Bipolar Disorder
The actual cause of bipolar disorder is not clear. However, research suggests that it is more likely to be a combination of factors, rather than just one single trigger.
Bipolar disorder is often inherited, with genetic factors accounting for approximately 80% of the cause of the condition. This doesn’t necessarily mean that there is a "bipolar gene" and that all family members will be affected.
Symptoms are often treated with certain psychiatric medications that act on the neurotransmitters (messenger chemicals) in the brain. It is thought that bipolar disorder might be related to problems with how different centers of the brain communicate with each other. Some research does support this theory. However, it is not known for certain what these problems are or what causes them.
By the time we reach adulthood, the majority of us have learned to regulate our emotions. If severe emotional stress is experienced during childhood, however, this can severely stunt a person’s ability to carry out this regulation. Neglect, sexual or physical abuse, and traumatic events (like the loss of a loved one) may be the culprit behind an adult’s onset of bipolar disorder.
Depression and Low Self-Esteem
Some researchers believe that the manic phase could be a way to escape from feelings of depression and low self-esteem. Again, there is little research that has been undertaken to support the theory, though it can act as a contributing factor when paired with other possible causes.
Spring for most of us is the time of year we look forward to; those longer hours of sunshine are like a tonic after the gloom of winter. Interestingly, though, research suggests that spring plays a crucial role in the onset of bipolar disorder. Rather than aid in lifting low moods and thoughts, increased hours of bright sunshine can act as a trigger for depression and mania in bipolar-predisposed individuals by affecting the pineal gland (which is responsible for the release of melatonin).
Because of the varying symptoms, the possible types of bipolar disorder, and the undefined causes, accurately diagnosing someone's condition is often a great challenge that can take months and years.
"It’s hard to let go of the demons inside. They were holding you when no-one else would."
Once diagnosed, the search for the correct treatment begins. Even though treatment is tailored for the individual and their particular set of symptoms, what works for one person may not for another. Becoming accustomed to the medication itself and their effect on your mind and body takes time and perseverance.
This is the core treatment and involves a combination of mood stabilisers, antipsychotic drugs and anticonvulsants. Antidepressants are sometimes used in conjunction but never alone.
Counselling and Psychotherapy
These are used along with medication. They help you learn ways to manage your illness and prevent relapse.
Cognitive Behavioural Therapy
This type of therapy involves changing how you perceive and evaluate situations around you and your reactions to them.
Interpersonal and Social Rhythm Therapy
This helps you to establish healthy daily routines, especially regarding sleep. Disruptions to a routine can potentially trigger mania so it is important to stick to them as much as possible.
Family Focused Therapy
It is vital that family members and other support networks educate themselves on the complexities of this mental illness. Therapy focuses on education and strengthening communication skills. It also teaches the development of problem solving strategies which reduces the risk of relapse.
It takes monumental courage and strength to live life battling bipolar disorder. It is worth knowing that those who love you are not fooled by the dark images you hold about yourself. They remember your beauty when you feel ugly, your strength when you are broken, and your purpose when you are confused.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2018 Lorna Lamon