What is Bipolar Disorder?

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Understanding the Realities of a Frequently Misunderstood and Trivialized Mental Health Condition

As mental health conditions become more commonly seen and spoken about in the media public discourse, it is not unusual to hear references to certain conditions. Anxiety disorder, depression, and eating disorders are often mentioned in news reports, research publications, and even schools. There has been a concerted effort by members of the healthcare community in the United States and beyond not only to destigmatize these conditions but also provide factual resources for those seeking to learn more about them.

One mental health condition, however, remains widely misunderstood: bipolar disorder. Unlike anxiety, depression, or eating disorders, bipolar disorder is still often used as an insult or joke in conversation. How often have you heard someone accuse someone else of being “totally bipolar” when they display heightened, sudden emotions or are prone to mood swings?

Bipolar disorder is not a joke. In fact, it is associated with one of the highest mortality rates among all mental health conditions, with approximately 25% of individuals diagnosed with bipolar disorder attempting suicide and 11% of individuals dying from it.[1] Challenging the misconceptions and misunderstanding about what bipolar disorder is, how it affects those who are struggling with it, and how it can be treated or managed is essential to removing the mockery and veil of stigma that surround this extremely serious condition.

Mood Swings vs. Bipolar Disorder

One of the most common mistakes people make when discussing or conceptualizing bipolar disorder is that it manifests in individuals mainly as mood swings. This is not the case. 

Mood swings are simply a noticeable change in a person’s mood or emotional state. Everyone gets mood swings, and they are a normal and natural part of life. It would be extremely unusual to stay in the same mood for an entire lifetime – each of us expects to regularly transition between happiness, sadness, fear, jealousy, satisfaction, pride, etc., depending on the events in our lives. 

At times, mood swings can be more intense: the change in emotion can be quicker than usual, or the depth of the emotion can seem stronger. These mood swings are often noticeable by others and can lead to conflict at times, but they are not an indication of bipolar disorder. More intense mood swings are often brought on by external stressors such as sleep deprivation, hunger, anxiety surrounding work, new social or physical environments, or physical exhaustion.[2]

By contrast, bipolar disorder is characterized by chronic affective instability, meaning regular and prolonged emotional instability that results in cognitive deficits and a major impediment to daily life.[3] 

Symptoms of Bipolar Disorder

Where routine mood swings can come and go at random intervals, bipolar disorder is diagnosed in individuals who display at least five of the following symptoms during the same two week period:

  1. depressed mood most of the day, nearly every day (sadness, feelings of emptiness, and tearfulness); 
  2. marked, diminished interest or pleasure in almost all activities; 
  3. significant weight loss, weight gain, or fluctuations in appetite; 
  4. insomnia or hypersomnia; 
  5. agitation nearly every day; 
  6. fatigue or loss of energy; 
  7. feelings of worthlessness and/or inappropriate guilt; 
  8. inability to concentrate, think, and make decisions; and 
  9. recurrent thoughts of death and/or suicidal ideations.[4]

In more casual language, bipolar disorder is characterized by the  regular alternation between hyper, energetic, positive mood states known as mania, and fatigued, slow, negative mood states known as depression. The intensity of the switch between these two extremely detrimental states of mind causes significant disruption to a person’s life.[5]

When experiencing a mania, individuals are likely to make rash and outlandish decisions, take irresponsible risks with their lives, money, and relationships, and engage in dangerous activities while believing that they are incapable of coming to harm. On the other hand, when experiencing a depression, individuals with bipolar disorder find it nearly impossible to socialize with others, or even leave the house, and are frequently besieged with thoughts of dying or committing suicide. 

Bipolar I vs. Bipolar II

Another misconception around bipolar disorder is that it is a unilateral diagnosis that appears the same in everyone who is struggling with it. In fact, there are two main types of bipolar disorder: bipolar I and bipolar II. These are differentiated by psychologists and researchers to better distinguish between the intensity of the symptoms experienced and the likelihood of risk to the individual.

Bipolar I is typically more severe and involves very intense periods of mania which last a week, often require psychiatric hospitalization, and have debilitating effects on a person’s ability to maintain working or daily routines. Bipolar II is less severe and involves periods of hypomania, which last approximately four days and do not necessarily cause disruption to daily life. Bipolar II, on the other hand, involves more frequent and prolonged periods of depression than Bipolar I.[6]

Treating Bipolar Disorder

To those around individuals who have been diagnosed with bipolar disorder, these behaviors can be extremely alarming, upsetting, and even off-putting. The intensity of the symptoms of bipolar have led to the stigma surrounding it, which has in turn informed our somewhat casual use of it as a punch line or insult. Challenging this stigma and allowing individuals with BPD the space to speak honestly about their experiences is the only way to begin understanding how this mental health condition can be treated and managed over a lifetime.

Treatment for BPD remains a complicated issue, as bipolar disorder is often associated with co-occurring disorders such as substance abuse disorder (SUD) and other psychiatric conditions. Certain medications such as lithium have proven to be effective in managing the intensity of the condition but are not good long term treatment options.[7] There has been a great deal of interest in recent years as to how bipolar is likely to be inherited genetically: research has shown that 85% of risk is determined by genetic factors.[8]

Developing a better understanding of what bipolar disorder is, how it affects individuals, and how it can be managed is only possible if we begin to untangle it from our cultural notions of comical mood swings and annoying unreliability.

If you or someone you love is struggling with bipolar disorder, contact our team today about treatment and recovery options. We are here to help.

Sources

[1] Hilty, D.M. et. al., (2006) A Review of Bipolar Disorder in Adults. Psychiatry, Sept; 3(9): 43-55. PMID: 20975827

[2] Grohol, J.M. (2016) All About Mood Swings. PsychCentral. May 17, https://psychcentral.com/lib/all-about-mood-swings#1.

[3] DelBello, M.P. and Strakowski, S.M. (2009) Bipolar Disorder. Encyclopedia of Neuroscience.

[4] Rick D. Kellerman MD. (2021) Depressive, Bipolar, and Related Mood Disorders. Conn’s Current Therapy, 2021.

[5] Gaissert, A. (2022) Bipolar I vs. Bipolar II- What’s the difference? International Bipolar Foundation. https://ibpf.org/articles/bipolar-i-vs-bipolar-ii-whats-the-difference/

[6] Smith, D.J. and Ghaemi, S.N. (2012) Neurobiology of Psychiatric Disorders. Handbook of Clinical Neurology.

[7] Baldessarini R. J. (2002). Treatment research in bipolar disorder: issues and recommendations. CNS drugs, 16(11), 721–729. https://doi.org/10.2165/00023210-200216110-00001

[8] Nurnberger, J.I. (2011) A High-Risk Study of Bipolar Disorder. Archives of General Psychiatry. Oct; 68(10): 1012-1020. doi: 10.1001/archgenpsychiatry.2011.126

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