Understanding Bipolar Disorder

Understanding Bipolar Disorder Image by: Eden Pictures

 Bipolar disorder (which used to be known as bipolar affective disorder, manic-depressive disorder or manic depression) is a type of mental illness (specifically a mood disorder) characterized by episodes of an elevated or agitated mood known as mania that often alternates with episodes of depression.

The symptoms can be subtle and confusing. Many people with bipolar disorder are overlooked or misdiagnosed – resulting in unnecessary suffering. With proper treatment and support, however, an individual with bipolar disorder can lead a rich and fulfilling life. So what is bipolar disorder and what can we do about it?

What is Bipolar Disorder?  

An individual with bipolar disorder has serious shifts in mood, energy, thinking and behaviour – from the highs of mania on one extreme, to the lows of depression on the other. These shifts are more than just a fleeting good or bad mood – the cycles of bipolar disorder can last for days, weeks or even months. Unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they impair the individual’s ability to function in ordinary life.

During a manic episode, a person might impulsively quit a job, charge up huge amounts on credit cards or feel rested after sleeping two hours. During a depressive episode, the same person might be too tired to get out of bed and be full of self-loathing and hopelessness over being unemployed and in debt.

Diagnosing Bipolar Disorder

Bipolar disorder falls into the category of Mood Disorders.

All mood disorders are diagnosed according to which of the four mood episodes are manifested: major depressive episode, manic episode, mixed episode and hypomanic episode. These mood episodes cannot be diagnosed as separate entities, but serve as the building blocks for diagnosis. Each type has a unique set of symptoms.

Major Depressive Episode

At least 5 of the following symptoms over a period of at least two weeks:

  • Depressed mood most of the day, nearly every day.
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day.
  • Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
  • Insomnia or hypersomnia (sleeping all the time) nearly every day.
  • Psychomotor agitation or retardation nearly every day.
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  • Diminished ability to think or concentrate or indecisiveness nearly every day.
  • Recurrent thoughts of death, recurrent suicidal thoughts without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Manic Episode

A distinct period of abnormally and persistently elevated, expansive or irritable mood with at least 3 (4 if the mood is only irritable) of the following symptoms over a period of at least one week:

  • Inflated self-esteem or grandiosity.
  • Decreased need for sleep (e.g. feeling rested after only three hours of sleep).
  • More talkative than usual or pressure to keep talking.
  • Flight of ideas or subjective experience that thoughts are racing.
  • Distractibility (i.e. attention too easily drawn to unimportant of irrelevant external stimuli).
  • Increase in goal-directed activity (either socially or sexually) or psychomotor agitation.
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained spending sprees, sexual indiscretions or foolish business investments).

Mixed Episode

The criteria are met for both a major depressive episode and a manic episode nearly every day for a period of one week.

Hypomanic Episode

A distinct period of persistently elevated, expansive or irritable mood lasting at least four days, that is clearly different from the usual non-depressed mood. At least 3 (or 4 if the mood is only irritable) of the following symptoms have persisted and been present to a significant degree:

  • Inflated self-esteem or grandiosity.
  • Decreased need for sleep (e.g. feeling rested after only three hours of sleep).
  • More talkative than usual or pressure to keep talking.
  • Flight of ideas or subjective experience that thoughts are racing.
  • Distractibility (i.e. attention too easily drawn to unimportant of irrelevant external stimuli).
  • Increase in goal-directed activity (either socially or sexually) or psychomotor agitation.
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained spending sprees, sexual indiscretions or foolish business investments).

Types of Bipolar Disorder

Based on the mood episodes, described above, there are 3 types of bipolar disorder:

Bipolar I Disorder

For a diagnosis of Bipolar I disorder, a person must have at least one manic episode. Mania is sometimes referred to as the other extreme to depression. Mania is an intense high where the person feels euphoric, almost indestructible in areas such as personal finances, business dealings, or relationships. They may have an elevated self-esteem, be more talkative than usual, have flight of ideas, a reduced need for sleep and be easily distracted.

The high, although it may sound appealing, will often lead to severe difficulties in these areas, such as spending much more money than intended, making extremely rash business and personal decisions, involvement in dangerous sexual behaviour, and/or the use of drugs or alcohol. Depression is often experienced as the high quickly fades and as the consequences of their activities become apparent, the depressive episode can be exacerbated.

Bipolar II Disorder

Similar to Bipolar I disorder, there are periods of highs as described above, often followed by periods of depression. Bipolar II disorder, however, is different in that the highs are hypo-manic, rather than manic. In other words, they have similar symptoms but the symptoms of Bipolar II disorder are not severe enough to cause marked impairment in social or occupational functioning and typically do not require hospitalization in order to assure the safety of the person.


Cyclothymia is a milder form of bipolar disorder that consists of cyclical mood swings for a period of at least two years. The symptoms are less severe than full-blown mania or depression.

Myths and Facts About Bipolar Disorder

Myth: People with bipolar disorder can’t get better or lead a normal life.

Fact: Many people with bipolar disorder have successful careers, happy family lives and satisfying relationships. Living with bipolar disorder is challenging, but with treatment, healthy coping skills and a solid support system, they can live fully while managing their symptoms.

Myth: People with bipolar disorder swing back and forth between mania and depression.

Fact: Some people alternate between extreme episodes of mania and depression, but most are depressed more often than they are manic. Mania may also be so mild that it goes unrecognized. People with bipolar disorder can also go for long stretches without symptoms.

Myth: Bipolar disorder only affects mood.

Fact: Bipolar disorder also affects your energy level, judgment, memory, concentration, appetite, sleep patterns, sex drive and self-esteem. Additionally, bipolar disorder has been linked to anxiety, substance abuse and health problems such as diabetes, heart disease, migraines and high blood pressure.

Myth: Aside from taking medication, there is nothing you can do to control bipolar disorder.

Fact: While medication is the foundation of bipolar disorder treatment, therapy and self-help strategies also play important roles. You can help control your symptoms by exercising regularly, getting enough sleep, eating right, monitoring your moods, keeping stress to a minimum and surrounding yourself with supportive people.

What Causes Bipolar Disorder?

If you or someone you love is suffering from bipolar disorder it is only natural to ask the question “Why?” It is important to bear in mind, however, that knowing the cause of your mood disorder does not cure it, nor is it necessary for managing it. The treatment approaches for bipolar disorder do not depend on knowledge of the cause to be effective.

It is important to be wary of the idea that there is any one cause for bipolar disorder and that by removing that cause, the disorder will be cured.

Bipolar disorders are brought on by a variety of causes working on numerous different levels. These levels include heredity, biology, family background and upbringing, conditioning, recent stressors, your self-talk and personal belief system, your ability to express feelings and so on.

Generally, the thinking today is that predisposing factors and precipitating factors influence each other and result in bipolar disorder, which is then maintained by various other factors. This theory is known as the ‘Diathesis – Stress Model’ and for more information on this model please read my article called ‘Understanding Mental Disorders’

An outline of the causes of bipolar disorder is presented below:

I) Long-Term, Predisposing Factors

A. Heredity (It appears that certain people are genetically predisposed to bipolar disorder, yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause.)

B. Childhood Circumstances

C. Cumulative stress over time

II) Biological Factors

A. Neurotransmitter imbalances – Some research points to neurotransmitter imbalances.

B. Medical conditions that can cause mood disorders – Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to abnormal thyroid function, circadian rhythm disturbances and high levels of the stress hormone cortisol.

III) Short-Term, Precipitating (Triggering) Factors. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

A.Stressors that precipitate mood changes – stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes, either good or bad, such as getting married, going away to college, losing a loved one, getting fired or moving.

B. Illness in self or loved one.

C. Drugs and medications that cause depression – certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids and thyroid medication.

D. Stimulants and recreational drugs – while substance use and/or abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the Illness. Drugs such as cocaine, ecstasy and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.

E. Seasonal Changes – episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer and depressive episodes more common during the fall, winter and spring.

F. Sleep Deprivation – loss of sleep, even as little as skipping a few hours of rest, can trigger an episode of mania.

IV) Maintaining Causes

A. Avoidance of social support and activities

B. Lack of support system

C. Self-talk

D. Mistaken beliefs

E. Withheld feelings

F. Lack of assertiveness

G. Lack of self-nurturing skills

H. Depressants and other dietary factors

I. High-stress lifestyle

J. Legal and/or financial difficulties

K. Job difficulties

L. Drugs and medications that cause depression

M. Lack of meaning or sense of purpose  

Who Gets Bipolar Disorder?

  • Bipolar disorder is common – affecting about 1% of the population in South Africa and 3% of the population worldwide.
  • Men and women are equally affected.
  • While the disorder has been seen in children, the usual age of onset is late adolescence and early adulthood. Mania occasionally appears for the first time in the elderly and when it does, it is often related to another medical disorder.
  • Bipolar disorder is not restricted to any social or educational class, race or nationality.
  • Although an equal number of men and women develop the illness, men tend to have more manic episodes while women experience more depressive episodes.
  • The disorder is the sixth leading cause of disability worldwide

Prognosis for Bipolar Disorder

Please be aware that bipolar disorder can look very different in different people. There are varying degrees of this illness – the symptoms vary widely in their pattern, severity and frequency. Some people are more prone to either mania or depression, while others alternate equally between them. Some have frequent mood disruptions, while others experience only a few over a lifetime.

It is easy to misdiagnose bipolar disorder because of its similarity to other mood disorders. For less severe forms, medication and psychotherapy is more than adequate in terms of treatment. For more severe cases, the prognosis is poor in terms of ‘curing’ the illness, as most people need to remain on medication for the rest of their lives.

With medication, the illness can be kept at a minimum level, with some people not experiencing any overt symptoms for months and even years.

Manic episodes may slow down as a result of the natural aging process.

Treatment for Bipolar Disorder

If you spot the symptoms of bipolar disorder in yourself or someone else, don’t wait to get help. Ignoring the problem won’t make it go away; in fact, it will almost certainly get worse. Living with untreated bipolar disorder can lead to problems in everything from career to relationships to health. Diagnosing the problem as early as possible and getting treatment can help prevent these complications.

If you’re reluctant to seek treatment because you like the way you feel when you’re manic, remember that the energy and euphoria come with a price. Mania and hypomania often turn destructive, hurting you and the people around you.

Understanding the Basics of Bipolar Disorder Treatment

Bipolar disorder requires long-term treatment. Since bipolar disorder is a chronic, relapsing illness, (around 85% of people who have a first episode of bipolar disorder will have another), it’s important to continue treatment even when you’re feeling better. Most people with bipolar disorder need medication to prevent new episodes and stay symptom-free.

There is more to treatment than medication. Medication alone is usually not enough to fully control the symptoms of bipolar disorder. The most effective treatment strategy for bipolar disorder involves a combination of medication, therapy, lifestyle changes and social support.

It’s best to work with experienced psychiatrists and psychologists. Bipolar disorder is a complex condition. Diagnosis can be tricky and treatment is often difficult. For safety reasons, medication should be closely monitored and a psychiatrist who is skilled in bipolar disorder treatment can help you manage your medication most effectively. In the same way experienced psychologists will be able to offer you the most effective therapy.

Bipolar depression is more than regular depression. In the past, bipolar depression was lumped in with regular depression, but a growing body of research suggests that there are significant differences between the two, especially when it comes to recommended treatments. Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worse, triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.

Self-Help for Bipolar Disorder

While coping with bipolar disorder isn’t always easy, it doesn’t have to ruin your life. In order to successfully manage bipolar disorder, you have to make smart choices regarding your lifestyle and daily habits as they will have a significant impact on your moods. Some of the things you can do include:

Get educated - Learn as much as you can about bipolar disorder. The more you know, the better you’ll be at assisting your own recovery.

Keep stress in check - Avoid high-stress situations, maintain a healthy work-life balance, and try relaxation techniques such as meditation, yoga or deep breathing.

Seek support - It’s important to have people you can turn to for help and encouragement. Try joining a support group or talking to a trusted friend. Reaching out is not a sign of weakness and it won’t mean you’re a burden to others. In fact, most friends will be flattered that you trust them enough to confide in them and it will only strengthen your relationship.

Make healthy lifestyle choices - Healthy sleeping, eating and exercise habits can help stabilize your moods. Keeping a regular sleep schedule is particularly important.

Monitor your moods - Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.

Monitor your substance use - Be very careful about ‘everyday’ use of small amounts of alcohol, caffeine and some over-the-counter medications for colds, allergies or pain. Even small amounts of these substances can interfere with sleep, mood or your medicine. It may not seem fair that you have to deprive yourself of a cocktail before dinner or morning cup of coffee, but for many people this can be the "straw that breaks the camel's back".

Bipolar Disorder and Suicide

The depressive phase of bipolar disorder is often very severe and suicide is a major risk factor. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. Furthermore, their suicide attempts tend to be more lethal.

The risk of suicide is even higher in people with bipolar disorder who have frequent depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide or an early onset of the disease.

The warning signs of suicide to look out for include:

  • Talking about death, self-harm or suicide
  • Feeling hopeless or helpless
  • Feeling worthless or like a burden to others
  • Acting recklessly, as if one has a “death wish”
  • Putting affairs in order or saying goodbye
  • Seeking out weapons or pills that could be used to commit suicide

Please note: It’s very important to take any thoughts or talk of suicide seriously. If you or someone you care about is suicidal, call the South African Depression and Anxiety Group (SADAG) Suicide Crisis Line on 0800 567 567 or SMS 31393  / www.sadag.co.za