What is Bipolar Disorder?
What is Bipolar Disorder? Most of us have heard of Bipolar Disorder before however there are many misconceptions, generalisations and myths surrounding this often serious and debilitating disorder. So what does Bipolar Disorder really look like? And just how much of an impact can it have on a person’s life?
It is firstly important to recognise that there are actually two forms of Bipolar Disorder; namely Bipolar 1 and Bipolar 2. Bipolar 1 Disorder is what most people refer to and is characterised by major depressive episodes alternated with manic episodes (we will get into what these episodes refer to soon). For a manic episode to be considered separate there must be a symptom free period for at least two months between them, otherwise one episode is seen as a continuation of the last.
Bipolar 2 Disorder is similar, however instead of the presence of manic episodes, they instead alternate between major depressive episodes and hypomanic episodes. So what do the terms mania, hypomania and depressive episode really mean?
A manic episode is a period of abnormally elevated or irritable mood that lasts for at least one week. During this time energy and self-esteem drastically increase and there is a greater involvement in risky behaviour and activities.
An episode of mania must involve a sustained abnormal mood plus three of the following features (or four features if mood is irritable rather than elevated) to meet the DSM 5 criteria:
Inflated self esteem or grandiosity
Increased talkativeness
Decreased need for sleep
Easily distracted by irrelevant stimuli
Flight of ideas, accelerated speech which abruptly shifts from one topic to another
Increase in goal directed activity or restlessness.
Excessive involvement in high risk activities e.g. drug and alcohol abuse or spending money recklessly
If psychotic features are present or hospitalisation is required the episode is automatically classified as manic.
A depressive episode is a period of depressed mood, loss of interest in once enjoyable activities and feelings of low self-esteem and worthlessness. A major depressive episode is defined by five or more of the following symptoms present at the same time for at least a two-week period. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure:
Depressed mood for most of the day, nearly every day
Markedly reduced interest or pleasure in all, or almost all, of the day’s activities, most of the day and nearly every day
Insomnia or hypersomnia
Feelings of worthlessness, excessive or inappropriate guilt nearly every day
Significant weight loss when not dieting, or weight gain or a decrease in appetite
Psychomotor agitation or retardation nearly every day
Decreased ability to think or concentrate and indecisiveness
Recurrent thoughts of death or suicide
Hypomania is similar to mania however this episode is not severe enough to cause major impairment in social or occupational functioning or require hospitalisation (as it is in mania).
The onset of bipolar disorder is often quite young, with the average onset of Bipolar 1 being between 15 and 18 and the average onset of Bipolar 2 being between 19 and 22. Self-harm and suicide rates are unfortunately high for people with bipolar disorder, with suicide attempts approximately 20% higher in people with the disorder compared to people without it, making it essential that we understand both the causes and treatment options for people with this disorder in order to prevent these outcomes.
What causes bipolar disorder?
While there is no one specific cause of bipolar disorder it appears that biological and environmental factors may cause a predisposition to it. One of the strongest risk factors for developing bipolar disorder is having a family history of the disorder. Twin studies suggest that if one twin has bipolar disorder then the other twin is more likely to develop it than is another sibling suggesting a genetic component to this disorder.
On a neurological level, it has been found that there is often too much activity in the emotional centres of the brain such as the amygdala and too little in the frontal cortex which is said to assist in impulse control, judgment and problem solving/decision making skills. While evidence for environmental causes is not as substantiated it does appear that environmental causes such as stressful life events or alcohol and drug use may trigger an episode in a person with a genetic predisposition.
Are there treatment options available for people with bipolar disorder?
Yes. The research available on bipolar disorder suggests that a combination of both medication and psychotherapeutic treatments are often best. Medication such as lithium has been proven to be an effective course of treatment; mood stabilisers and even anticonvulsants may also be viable treatment options depending on the individual.
In terms of talk therapies, CBT may be effective in both challenging and learning to change inappropriate or negative thought patterns. Psycho-education is also useful to teach people experiencing bipolar disorder (and their loved ones) about this disorder and assisting them to recognise their triggers and when they are becoming unwell. This may assist in the prevention of the occurrence of a manic or depressive episode.
So while bipolar disorder can often be a complex, unpredictable and unsettling disorder for those experiencing it as well as for their friends and families, there are a range of treatment options available. By receiving the proper services many people with this disorder are able to learn to manage their symptoms and live a high quality of life while achieving their goals and needs.