What You Need to Know About Bipolar Disorder

Bipolar disorder is a complex mental illness that causes unusual, persistent and intense changes in mood. These alterations usually affect a person's energy level, judgment, daily behavior, sleep patterns and ability to function.

"Unlike common mood swings, people with this disease experience depressive episodes alternating with hypomanic or manic episodes," said Eglée Iciarte Lavieri, Ph.D., a psychiatrist and former associate professor at the University of Alcalá, Spain.

She added that it's a chronic, recurrent and disabling disorder, which causes functional and cognitive impairment.

The mental health condition usually manifests its first symptoms in late adolescence or early adulthood. In many cases, bipolar disorder can seriously interfere with academic and work performance, personal relationships, and quality of life. It can even lead to increased mortality, especially from suicide.

"Fortunately, nowadays, people suffering from this disorder can receive an effective and safe treatment," Iciarte Lavieri said.

Although bipolar disorder has no cure, the disabling symptoms of this disease can be managed through a combination of mood-stabilizing drugs and certain psychological interventions.

The various stages of bipolar disorder

This mental disorder ranges from the depressive pole to the manic pole, which means the person's mood fluctuates between various stages. These stages or "mood episodes" of bipolar disorder are classified as mania, hypomania, depression and mixed episodes.

Mania

This condition can be identified by the patient's "emotional exaltation." It is an abnormal, disproportionate, hyperactive mood that can last a few days or longer—anywhere from five days to a few weeks. It should be noted that not all people who enter a manic phase feel happy, euphoric or invincible. In many cases, individuals may feel irritable, angry and aggressive.

The problem is that many patients in a state of mania do not perceive the emotional alteration they are in, according to Llynier Tobía, a psychiatrist with her own practice in Valencia, Venezuela.

"Usually, patients stop believing they are sick and get involved in activities that imply important risks," she explained. "The individual is likely to engage in dangerous or inappropriate behaviors, such as spending money in excess, being part of unnecessary sprees, committing sexual indiscretions or driving recklessly."

Mania generates psychosocial dysfunction and may include psychotic symptoms, such as delusions or hallucinations.

Hypomania

Technically, the term hypomania is used to describe less severe and overt forms of mania. Often during this episode, individuals are both socially and occupationally functional. Hypomanic symptoms usually persist for four consecutive days and always for less than a week.

"It is common for the person during hypomania to experience increased energy, improved self-confidence and an exaggerated sense of well-being," Tobía said, adding that some individuals function very well.

It is important to note the brain of a person with bipolar disorder may differ in many respects from the brain of an individual without this condition.

However, hypomania often becomes a problem when the patient loses perspective of risky behaviors and potential harm.

Depression

In general, bipolar depression manifests itself in a similar way to major depression.

"The person experiencing a depressive mood presents feelings of emptiness, apathy and hopelessness." Iciarte Lavieri said. "The individual may lose interest in daily activities and in things that are normally pleasurable."

Mixed episodes

A mixed episode meets the criteria for both the manic episode and the depressive episode. In this context, patients experience abrupt changes from euphoria to sadness. A "bombardment of stimuli" generates great anxiety and irritability.

Mixed states are difficult to diagnose and the risk of suicide during these episodes is very high, according to a 2013 study published in The American Journal of Psychiatry.

Types of bipolar disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, contains the formal requirements for the classification and diagnosis of more than 100 mental illnesses. In the fifth edition, bipolar disorder has seven distinct diagnoses. The three primary types are bipolar I, bipolar II and cyclothymic disorder.

Bipolar I

This is characterized by alternating episodes of mania, depression and mixed phases.

"In general, [bipolar I] is defined by the presence of at least one complete manic episode, in which the mood is severely and persistently elevated, for at least seven days," Tobía said.

The patient usually requires hospital care. It is also common for a person with bipolar I to present depressive episodes that can last up to two weeks.

Bipolar II

This presents exclusively as hypomanic and depressive episodes. The depressive episodes are usually severe and may last for a considerable time. It should not be classified as an attenuated form of the disease.

Cyclothymic disorder

This is a mild form of bipolar disorder, consisting of a succession of euphoric and mild depressive phases.

"In cyclothymia, people have mood swings for at least a period of two years," Tobía said. "Such emotional alterations make it difficult for patients to have stability in their lives."

The other four diagnoses include:

• Substance/medication-induced bipolar and related disorder
• Bipolar and related due to another medical condition
• Other specified bipolar and related conditions
• Unspecified bipolar and related disorder

According to the International Classification of Diseases, bipolar disorder is classified as a mental and behavioral disorder. In this regard, Tobía explained that bipolar disorder causes a clinical alteration in the regulation of emotions and cognition, and the normal functioning of individuals.

It is important to note the brain of a person with bipolar disorder may differ in many respects from the brain of an individual without this condition.

A 2017 study carried out by the Keck School of Medicine at the University of Southern California took MRI scans of 6,503 people, including 2,447 adults with bipolar disorder. Research indicated a thinning of gray matter in the brains of those with bipolar disorder. The largest deficits of gray matter were discovered in the frontal and temporal regions, the parts of the brain that control inhibition and motivation

Facts, stats, and myths and misconceptions

Based on statistics collected by Our World in Data in 2019, 39.55 million people worldwide suffer from this mental health condition. The balance is roughly 45 percent men and 55 percent women. Harvard Medical School estimated in 2007 that 2.8 percent of American adults have a diagnosis of bipolar disorder.

The National Depressive and Manic-Depressive Association published a study in 2000 that indicated nearly 70 percent of bipolar patients are misdiagnosed at the outset.

According to World Health Organization (WHO) Statistics from 2004, mental disorders such as depression, bipolar disorder, schizophrenia and alcohol use disorders are among the 20 leading causes of disability.

In contemporary society, there is still a lot of confusion and a lack of education about bipolar disorder. Let's dispel some common misconceptions.

Myth: Mental health problems are rare.

Mental health problems, much like physical illnesses, are common. In 2020, 1 in 20 Americans lived with serious mental illnesses, such as schizophrenia, bipolar disorder or major depression.

Myth: Bipolar disorder is easy to diagnose.

Actually, bipolar disorder is a mental illness with a high rate of misdiagnosis.

"In mental health, there are many illnesses with similar symptoms," Tobía said. "Commonly, bipolar disorder is confused with other mental disorders."

Myth: Children do not experience problems with bipolar disorder.

Bipolar disorder can occur at any age. Even children as young as 4 years old can show signs.

Myth: There is little hope for people with bipolar disorder.

Despite the challenges of the disease, proper clinical management can help control the disabling symptoms.

Myth: Bipolar disorder presents the same for everyone who has it.

The type of bipolar disorder and the intensity of the symptoms differ from one person to another.

"It must be taken into account that each episode has a specific symptomatology, but obviously each human being is going to experience this disorder according to his or her own nature," Tobía said. "Each person is unique."