Bipolar Disorder – What It Is and What It Isn’t

How many times have you heard someone say “she’s bipolar!” about a person that seems to be moody or emotional? Along with other mental health terminology, the word “bipolar” has come to mean something very different in common parlance from what it means within the mental health treatment community. Read on to gain an accurate understanding of just what bipolar disorder is and what it isn’t.

Manic Depression

The name for this disorder changed from “manic depression” to “bipolar disorder” several decades ago. Manic depression helped people understand what was special about this illness: that the patient suffered from both depressed phases (low moods, sadness, perhaps even suicidal depressions) and manic phases (times of increased energy, agitation or irritability, elevated mood and grandiosity). In some cases, these two mood states can exist at the same time (you may have heard the term “irritable depression”), and when that happens it is referred to as a mixed state: evidence of both depression and mania coexist.

Diagnosing Bipolar disorder is a complex process, as there are multiple types of this illness, categorized based on whether or not manic symptoms are present and which phase (depressed or manic or “hypomanic”) dominates the clinical presentation at the time of the initial interview. Very basically, bipolar disorder can be subcategorized based on whether the patient is mostly depressed (Bipolar II) or mostly manic (Bipolar I).

Let’s take a closer look at just what depressed and manic really mean. To be diagnosed with any form of bipolar disorder, the patient must meet criteria for a major depressive episode. This means that five out of the following nine symptoms must be present most of the time, over the past two week period:

  • Low mood or sadness
  • Loss of pleasure in activities you used to enjoy
  • Fatigue
  • Suicidal thoughts (not necessarily intent or planning to commit suicide, but any thoughts about death, such as thinking that loved ones would be better off if you died)
  • Feeling of low self worth
  • Either speeded up or slowed down motor activity (e.g. fidgeting, foot tapping, or other “nervous” activity, or moving as if pushing through cold molasses)
  • Inability to concentrate
  • Problems with sleep (either can’t sleep at all, or can’t stop sleeping)
  • Changes in weight and appetite (either loss of appetite and weight loss or increase in appetite with weight gain)

This is not just a bad mood, or normal sadness in response to a loss. This is a real change form baseline or normal, and completely takes over your life, rendering you unable to function normally. And notice that to qualify as a depressive episode, it has to last for two full weeks. If you have a terrible day where you meet all nine of these criteria, but you bounce back within a day or two that is by definition not depressive episode and thus not bipolar disorder.

A manic episode is defined as an intensely elevated or expansive or irritable mood that lasts at least seven days. During this time, decreased need for sleep is a key factor.

Additional symptoms include:

  • Racing thoughts
  • Pressured speech
  • Impulsive risky behavior such as shopping sprees (buy 17 lamps when you only need two) or sexual promiscuity
  • Inflated sense of self worth or grandiosity

A word about grandiosity: this isn’t just feeling a little pleased with a job well done, for example – grandiosity is when you truly believe that you are smarter than Einstein and have unlocked the secret to the universe, or that you can win a marathon today despite the fact that you haven’t trained at all. Grandiosity takes a grain of potential and zooms it up to absurd levels, but while you are in the manic state it feels normal and right. In addition, both the manic and depressed phases can be accompanied by psychotic symptoms, such as auditory or visual hallucinations, delusions, or other forms of thought disorder.

Again, it is important to consider that if you meet criteria for one or two days, you don’t meet criteria for a manic episode. Think about how lightly people toss around the accusation that someone is bipolar because they have unstable or shifting moods. Clearly this illness is much more serious and more debilitating than a day or two (or an hour or two!) of bad moods.

Diagnosing Bipolar Disorder

The first steps of diagnosing bipolar disorder include ruling out all other possible medical causes for these mood states. While there is no blood test or other laboratory test for bipolar, your doctor may order blood tests to rule out other conditions. In addition, if the mood states were caused by recreational or illegal drugs, then bipolar disorder cannot be diagnosed. The depression and manic states must be “endogenous” or caused by something in you, not something you took. And the impact of these moods must be severe enough to impact daily functioning: bipolar can’t be diagnosed if you have “mood swings” but your functioning at home, school, or work isn’t really negatively impacted.

Bipolar disorder can be a very dangerous disease. The intensity of both phases, or “poles,” can lead to extremely risky or self harming behavior. The irrational thinking that often accompanies both mania and depression can lead to severely disregulated behavior: angry outbursts, fights, substance abuse, domestic violence, and suicide. If you or someone you love shows real signs of bipolar disorder, seek help. Call a suicide hotline if necessary, use a hospital emergency room, or speak with a doctor. Bipolar disorder is treatable and seeking help is the first critical step in regaining control and stability.

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