What is Bipolar Disorder?

Individuals with bipolar disorder have “low” and “high” periods, called depression and manic episodes.  The depressive episodes, where a person feels intense, almost constant sadness and hopelessness, alternate with mania, in which a person feels abnormally elated and outgoing.  Individuals who suffer from Bipolar Disorder have significant mood swings that are much more severe than the daily ups and downs most people experience.  While a disappointment during the day may leave a person upset, bipolar disorder often causes individuals to have out-of-control feelings and leads them to act in inappropriate or self-destructive ways.

Bipolar disorder is not as common as depression.  It is estimated that 1% of the adult U.S. population suffers from bipolar disorder.1  Bipolar disorder typically develops in late adolescence or early adulthood and is most frequently diagnosed between the ages of 18 and 24.1 However, some people have their first symptoms during childhood, and there are documented cases of bipolar disorder in children as young as 12 years of age. 

How is Bipolar Disorder Diagnosed?

There are three types of bipolar disorders: bipolar I, bipolar II and cyclothymic disorder.  Diagnosis depends on severity and number of manic symptoms a person exhibits.  The symptoms of a manic episode are listed below:

Manic Episodes:

• A distinct period of persistently elevated, elated or irritable mood.
• Talking very fast and more often than usual.
• Jumping from one idea to another and/or losing thoughts completely.
• Easily distracted.
• Increasing goal-directed activities, such as taking on new projects.
• Being restless.
• Sleeping less.
• Having an unrealistic amount of self-esteem.
• Behaving impulsively, taking part in a lot of pleasurable yet high-risk behaviors.

Bipolar I is diagnosed when a person experiences at least one manic episode, which is defined when a person exhibits three or more manic symptoms.  This person will most likely experience one or more depressive episodes as well (please see Depression for further explanation of depressive episodes).2

Bipolar II is diagnosed when at least one depressive episode has occurred but no manic episodes have occurred. Instead, people with bipolar II experience hypomania, a more mild experience of manic symptoms. Hypomania is usually identifiable but does not hinder a person’s functioning; it has a shorter duration and has fewer manic symptoms.

Cyclothymia is characterized by alternating episodes of hypomania and low-level depression.   The depressive episodes may resemble dysthymia (please see Depression for a definition of dysthymia).  Cyclothymia lasts longer or is more chronic than the other bipolar disorders but it is less severe.  No depressive episodes or full-blown manic episodes can be present for this diagnosis.

Some bipolar disorders fall into one of two subtypes: psychotic and rapid cycling. Psychotic is assigned when the person is experiencing hallucinations or delusions during his/her most recent manic or depressive episode. Rapid cycling can be added to the diagnosis if a person is experiencing depressive and manic episodes very frequently and in close secession.

What Causes Bipolar Disorder?

Experts have yet to pinpoint the direct causes of bipolar disorder, but it is believed to be a combination of social, environmental and biological factors. 

Genetics play a much bigger role in the development of bipolar disorder than in depression.  Research on heredity in families has found that genetic factors substantially contribute to the risk of developing bipolar disorder.  Studies on identical versus non-identical twins have helped experts understand the biological development of bipolar disorder.  These studies have shown that identical twins have a .69 concordance rate compared to .19 for fraternal twins, meaning that in .69 of the identical twins, if one twin had bipolar disorder the other did as well.1  The rate is higher for identical twins indicating genetics influence the development of bipolar disorder.2

Bipolar disorder is also associated with changes in how parts of the brain communicate with one another.  The brain uses chemical “messengers” called neurotransmitters to send electrical signals between brain cells; dopamine, serotonin, and norepinephrine are examples of neurotransmitters.  There is evidence that individuals with bipolar disorder may have more or less of some of these neurotransmitters available in their brains than people without bipolar disorder, and neurotransmitters may function differently in their brains.  It is not yet known if these changes may be causes of bipolar disorder or the result of bipolar disorder. 1

Bipolar disorder may also be influenced by the surrounding environment. Studies show that manic episodes may be triggered by positive life events that are abnormally stressful.1   A person’s social atmosphere can also make symptoms better or worse and recovery faster or slower. If someone’s family is not supportive, recovering from bipolar disorder may be more difficult. 

How are Bipolar Disorders Treated?

Untreated, bipolar disorders can lead to personal relationship issues as well as career and financial difficulties. Because bipolar disorders are more genetically based and less environmentally influenced, it is generally considered a life-long illness. However, there are numerous ways to stabilize the extreme mood swings and to provide symptom relief that may lead to a healthier lifestyle.

The most effective way to treat bipolar disorders is with a combination of medication and therapeutic techniques.  Below is a list of the types of treatment that have been proven effective for bipolar disorder.  Please see Treatment for further explanations.

Types:

Cognitive Behavioral Therapy (CBT)

Client-Centered Therapy

Psychoanalysis

Formats:

Interpersonal Therapy (IPT)

Couples/Family Therapy

Group Therapy

Physical Treatments:

Electroconvulsive Therapy (ECT)

Repetitive Transcranial Magnetic Stimulation (rTMS)

Medications:

SSRIs,Tricyclics, MAO-Is, Lithium, Anticonvulsant Medications

Family and friends’ support is also extremely important to help a person stabilize and maintain a healthy lifestyle.  Individuals with bipolar disorder often need to engage in maintenance activities between episodes in order to reduce the frequency and duration of future episodes.  These activities usually include continuing to take medication, living healthy with proper diet and exercise, and having social support.  In addition, keeping track of daily mood symptoms, treatments, sleep patterns, and life events may help people cope with bipolar disorder and help their families to better understand the illness. This tracking system can also be used by the doctor to help treat the individual’s symptoms more effectively.

1 Oltmanss, T. & Emery, R. (2007). Abnormal Psychology (5^th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

2 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4^th ed.). Washington DC: American Psychiatric Association.