Bipolar Disorder Defined

Bipolar disorder, or manic-depression, is a mental condition that manifests as periods of mania (an overly joyful or overexcited state) along with periods of depression (extreme sadness or hopelessness). The “swings” between mania and depression can be very abrupt and will vary in intensity from patient to patient. The swings can affect mood, energy, activity level, and the ability to carry out daily tasks.Although the incidence of bipolar disorder in men and women are largely equal, the first onset of the disorder appears most often in individuals between the ages of 15 and 25.

Although the cause of bipolar disorder remains unclear, studies have shown that heredity may play a major role. Imaging studies of the brain using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have shown that the brains of people suffering with bipolar disorder may be different than healthy brains.

Bipolar disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). There are four types of bipolar disorder, each characterized by an increasing intensity of the symptoms. The most mild form, cyclothymia, involves the least severe swings between hypomania and mild depression over the course of at least two years. Hypomania is defined as increased levels of energy and impulsiveness, but nowhere near as extreme as full-blown mania. Many patients who have cyclothymia, or mild bipolar disorder, are often misdiagnosed as suffering from depression.

Type II bipolar disorder is the next most severe form of the disease; these patients typically never experience a full-fledged manic episode. Instead, people suffering from type II bipolar disorder experience hypomania with alternating periods of depression. However, the intensity of the mood swings are more pronounced than in cyclothymia. Like those with cyclothymia, however, type II bipolar patients are often misdiagnosed as having only depression.

The most severe form of bipolar disorder, or type I, manifests in at least one full manic episode lasting at least seven days (or so severe that the patient needs immediate medical treatment), coupled with periods of major depression. People with full-blown type I bipolar disorder are also referred to as “manic-depressive.”

The final type of bipolar disorder is called bipolar disorder not otherwise specified (BP-NOS) and is the diagnosis given when symptoms are not long enough, frequent enough, or numerous enough to meet the criteria for any of the other types of bipolar disorder.

People with rapid-cycling bipolar disorder have four or more episodes of major depression, mania, hypomania, or mixed (symptoms of both mania and depression at the same time) in any given year. Some experience more than one episode per week or even within a single day. Rapid-cycling bipolar disorder is more common in those with severe bipolar disorder and is typically found in patients who experienced their first episodes at a young age; the disorder is found more often in women than in men.

Although researchers have yet to discover precisely why someone with bipolar disorder goes from normal mood to mania to depression (or vice versa), there has been some success in determining the most common things that trigger the episodes. For instance, major life changes such as childbirth, divorce, death, or job loss can trigger a bipolar flare up. Ingesting antidepressants, steroids, recreational drugs, or alcohol can also destabilize a bipolar patient.

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