In this series, I discuss some of the psychological diagnoses or terms that have filtered out to the public consciousness, and gotten twisted up along the way. The important thing to keep in mind is that this website, like any website, cannot tell you whether you actually do or do not have a mental illness or whether you do or do not need mental health treatment. My goal is to cut down on the miscommunications that can happen between client and therapist. As always, my disclaimer applies.
What is Bipolar Disorder
Once called Manic Depressive disorder, Bipolar disorder is either a mood or affective disorder, depending on how stuck-up you are.
Bipolar disorder is characterized by a person who experiences periods of a major depressive episode along with periods of a manic or hypomanic episode. There are two types of Bipolar Disorder, creatively named Type I and Type II. Type I means you have had at least 1 full-blown manic episode, Type II means you have only had a hypomanic episode. There is also a related condition called Cyclothymia, which includes periods of symptoms of hypomania, and periods of symptoms of depression, but neither of which mean criteria for a hypomanic or major depressive episode.
I’m not going to run through all the criteria that you have to meet to diagnose a major depressive episode, and I will talk about why you don’t have Major Depressive Disorder another day, but for now suffice to say that there’s low mood, and then there’s depression, and then there’s Major Depression, and you have to have Major Depression for this to be Bipolar Disorder. Mania is basically the total opposite of depression: where depression leads to less activity, mania leads to wild (or manic) activity. Where depression has a low mood, mania has a highly elevated mood, which can range anywhere from exuberance to irritability. Both depressive and manic periods have to last at least one week to qualify, and generally you’re going to see disruptions in sleep, energy and appetite for each. One of the best indicators for mania is days with no or minimal sleep and still a high energy level. Cyclothymia has these symptoms at a lower level, but the course of the illness has to last more than 2 years for a diagnosis, so it could be considered a more chronic and less acute disorder.
Bipolar disorder is one of the more “romantic” mental health conditions. Many many famous people, particularly artists, musicians and celebrities, have claimed to have Bipolar, or been retrospectively diagnosed by others. The popular image of the tortured artist who has fits of crazed productivity, producing painting after painting or composing an entire symphony, then crashing out to suicidal depression when the craze has passed, does have some basis in reality. People with bipolar disorder do tend to gravitate towards creative fields, and writers, dancers and photographers are more likely than the general population to have Bipolar Disorder.
What’s missing in this picture is the connection between Bipolar disorder and creative success. The connection between Bipolar disorder and creativity and the presence of a lot of highly successful people with Bipolar can make it look like this might actually be a good diagnosis to have, but the reality is that Bipolar is a devastating, disabling condition. Remember that just about every mental health diagnosis comes with the caveat that it must cause clinically significant distress and/or a significant impairment in functioning. If you have periods of high productivity that make you feel great, where you’re spending days at a time without sleep, and then you crash out for a week or two and don’t really want to leave the house, that doesn’t necessarily mean you have Bipolar Disorder. If you do this, and you also spend your entire life savings during the manic period, then try to kill yourself during the depressed period, that might be Bipolar Disorder.
Why You Don’t Have Bipolar Disorder
At a yearly prevalence rate of about 1.5%, Bipolar Disorder is among the less common disorders. Bipolar II (0.3%) is a little less common than Bipolar I (0.4%), although I’ve seen places that list the prevalence as high as 2.3%. So, as with any given mental illness, most people don’t have it. There’s a strong genetic loading for Bipolar Disorder as well, so if none of your parents, grandparents or aunts and uncles have it, then it’s likely you don’t have it either. And this isn’t a disorder that easily goes undiagnosed, so Crazy Aunt Edna that seems like she goes on wild gambling benders every few months but has never ended up in a jail or psych hospital for it probably doesn’t count.
Bipolar Disorder can also easily get mistaken for a lot of other conditions. Obviously the biggest overlap is with Depression, and a lot of people with chronic depression can suddenly have a period where they’re ok, and it’s so weird and unexpected for them that they think it must be mania. I might be in danger of being overly broad here, but in order for it to be mania (or even hypomania), it has to cause problems for you.
Anxiety disorders can also seem like a manic episode, for their tendency to disrupt sleep and lead to a lot of nervous, agitated energy. The key difference here is the episodic nature of manic episodes, whereas anxiety tends to either be steadier or have specific triggers. Drug use can also be really tricky to tease out in Bipolar Disorder, as both manic and depressive episodes can be causes and effects of drug use. It becomes a chicken and the egg question – did the cocaine make you manic, or did you take cocaine because you were manic?
The absolute worst – as in least helpful – diagnostic indicator is mood swings. Mood swings could mean a whole bunch of different things. You could have really bad coping skills. You could just be biologically prone to intense emotional experiences. You could have any number of other disorders that cause emotional reactivity. You could be watching the Star Wars saga.
Remember that Bipolar is about extremes. The highest of highs and the lowest of lows.
What if you do have Bipolar Disorder?
Bipolar Disorder is one of the mental health disorders that we never really say goes away, but rather goes into remission. This is a life-long condition that is never likely to be cured, but can be effectively managed.
As a therapist, I don’t think I ever let someone with Bipolar Disorder go without at least talking to a psychiatrist about a medication consult. Medication is an important part of Bipolar Disorder treatment. There is a particular class of medications termed mood stabilizers that can help even out the highs and lows of each episode. Severe episodes can come with psychotic symptoms (hallucinations, delusions), so antipsychotics are sometimes prescribed as well. Antidepressant medications can be tricky, because they can help improve depressive episodes but they can also stimulate a manic episode.
There are some psychotherapeutic options available as well. CBT for Bipolar works on basically the same principals as CBT for Depression and CBT for anxiety – learning to identify and change the problematic thought patterns that are worsening your mood while engaging in behaviors that can counteract that mood. So when you’re depressed, you check yourself on your overly negative, self-denigrating thoughts and engage in more stimulating pleasant activities, and when you’re manic you check yourself on your more paranoid, anxious thoughts and engage in more relaxing activities. Interpersonal and social rhythm therapy is a way of encouraging overall stability by enhancing the stabilizing influences in your life, like disciplined sleep and eating schedules and lots of interpersonal contact.
Bipolar disorder can become severe enough that long term residential treatment can be needed as well. Family therapy can be helpful whether or not the person with Bipolar stays in the home, mostly because of the toll that dealing with the condition can take on everyone in the family. The NIH did a study a few years back that had the absolutely jaw-dropping result that more intensive therapy leads to better results, but the major takeaway is that treatment can both shorten the problematic episodes and decrease their frequency. And no, it won’t make you into a superhero.