Bipolar Disorder: Everything you need to know (A guide)

In this brief guide, we will explore the meaning and symptoms of Bipolar disorder, the causes of bipolar disorder, and the treatment options available for bipolar disorder.

Bipolar Disorder: Meaning

Bipolar disorder is a type of mental illness where the person experiences periods of extreme euphoria or mania, and then cyclically experiences bouts of intense depression, and for the diagnosis of Bipolar disorder, it is necessary that the person experiences at least one episode of both mania and depression that happen one after another.

Typically, the manic episode in Bipolar disorder lasts for a few days to a week or two weeks, and the depression tends to last longer, ranging anywhere between 2 weeks to a month or two.

Because Bipolar disorder involves shifts in mood, both manic and depressive episodes are extremely intense, but it has been observed over time that the depression experienced in bipolar disorder is much worse than that experienced in Major Depressive Disorder or other subtypes of depression.

It has also been noticed that Bipolar Disorder is not uncommon in the least, in fact about 2.5 % of the population in the United States alone, which is approximately 5 million people, may be suffering from bipolar disorder, and that obviously does not take into account those people who have not sought treatment or gotten diagnosed officially.

Bipolar disorder can also put the sufferer at greater risk for self-harming behavior as well as suicide, both in manic episodes as well as depressive, and there may sometimes also be psychotic features that manifest during either of the two episodes, though they may be more common in the manic phase.

Bipolar Disorder: Symptoms in the ICD 10

The International Classification of Mental and Behavioral disorder is a manual for diagnoses of mental illnesses and syndromes, and it is created by the World Health Organization.

The ICD 10 criteria for Bipolar disorder symptoms is:

  • At least two episodes each of mania and depression as described under Hypomania and Major Depressive Episode
  • The current episode must be marked along with whether there are psychotic symptoms or not.

To understand the symptoms of Bipolar disorder one must first look at the symptoms of mania and depression.

According to the ICD 10, these are the symptoms of a manic episode or Hypomania, in some cases:

“Hypomania is a lesser degree of mania, in which abnormalities of mood and behavior are too persistent and marked to be included under cyclothymia (F34.0) but are not accompanied by hallucinations or delusions.”

“There is

  • Persistent mild elevation of mood (for at least several days on end), 
  • Increased energy and activity
  • Marked feelings of well-being and both 
  • Physical and mental efficiency. 
  • Increased sociability, talkativeness
  • Overfamiliarity
  • Increased sexual energy
  • Decreased need for sleep is often present but not to the extent that they lead to severe disruption of work or result in social rejection. 
  • Irritability, conceit, and boorish behavior in place of the usual euphoric sociability. 
  • Concentration and attention may be impaired, thus diminishing the ability to settle down to work or to relaxation and leisure
  • The appearance of interests in quite new ventures and activities, or mild over-spending.”

According to ICD 10, a Manic episode may be marked by all of the symptoms mentioned above, as well as the following:

  • “The mood is elevated out of keeping with the individual’s circumstances and may vary from carefree joviality to almost uncontrollable excitement. 
  • Elation is accompanied by increased energy, resulting in overactivity, the pressure of speech, and a decreased need for sleep.
  • Normal social inhibitions are lost, attention cannot be sustained, and there is often marked distractibility. 
  • Self-esteem is inflated, and grandiose or over-optimistic ideas are freely expressed.
  • Perceptual disorders may occur, such as the appreciation of colors especially vivid (and usually beautiful), a preoccupation with fine details of surfaces or textures, and subjective hyperacusis. 
  • The individual may embark on extravagant and impractical schemes, spend money recklessly, or become aggressive, amorous, or facetious in inappropriate circumstances. 
  • In some manic episodes, the mood is irritable and suspicious rather than elated.”

These manic episodes occur with the same symptoms in bipolar disorder, with the addition of a depressive episode that follows or precedes, and the following symptoms may be seen:

  • “depressed mood, loss of interest and enjoyment, and reduced energy leading to increased fatiguability and diminished activity. 
  • Marked tiredness after the only slight effort
  • Other common symptoms:
    • reduced concentration and attention;
    • reduced self-esteem and self-confidence;
    • ideas of guilt and unworthiness (even in a mild type of episode);
    • bleak and pessimistic views of the future;
    • ideas or acts of self-harm or suicide;
    • disturbed sleep;
    • diminished appetite.”

In addition to these symptoms, the patient may also suffer from intense loss of motivation and a steep drop in the desire to be with other people or just to do anything at all.

According to ICD 10, depression may also involve the following somatic symptoms:

  • “loss of interest or pleasure in activities that are normally enjoyable; 
  • lack of emotional reactivity to normally pleasurable surroundings and events; 
  • waking in the morning 2 hours or more before the usual time; 
  • depression worse in the morning; 
  • objective evidence of definite psychomotor retardation or agitation (remarked on or reported by other people); 
  • marked loss of appetite; 
  • weight loss (often defined as 5% or more of body weight in the past month); 
  • marked loss of libido.”

Bipolar disorder Causes

There are no specific causes of Bipolar disorder but there are theories that speculate on why this disorder may come about, which are discussed below:

Neurochemical Changes 

Neurochemical changes in the brain involving neurotransmitters and structures of the brain responsible for emotions can often be the cause of Bipolar disorder.

It has been seen that there is much lower serotonin activity in patients suffering from depression, and there may be hyperactivity of the Basal Ganglia and Cingulate Cortex in Mania, which are both centers that regulate emotion in the brain and the anterior cingulate cortex, in particular, is responsible for causing feelings of excitement and euphoria, which is relevant to mania.

Genetics

Both depression and mania have a strong correlation with genetics, which means that people with bipolar disorder in their family are at more risk for developing the disorder.

Environment

Environmental reasons for bipolar disorder may include problems with a person’s job or their living conditions. Depression may often result from bad living conditions and if the individual’s mind tries to cope with this and goes the other extreme way they may start experiencing a manic episode instead.

Psychosocial Factors

Psychosocial factors or causes of bipolar disorder may include things like:

  • Relationship troubles
  • Family problems
  • Poor Self-Esteem
  • Narcissistic Personality
  • Unhealthy childhood or parental relationships
  • Physical or sexual abuse.

Bipolar Disorder: Treatment

The treatment of Bipolar disorder involves the management of symptoms with medicines and psychotherapy.

Usually, the manic episodes in Bipolar disorder may be treated with antipsychotics like Olanzapine or Risperidone, and for the typical Depressive episodes, the usual antidepressants like SSRIs or atypical antidepressants may be used, which may include the commonly well-known drugs like Prozac.

For more extreme cases of mania or depression in bipolar disorder, where there is a high risk of suicide or there have been suicidal attempts, Electro-Convulsive therapy may be suggested, and though it is becoming more and more uncommon it has been shown to have significant improvement in people with mania or suicide risk.

Psychotherapy for Bipolar disorder may involve any of the main types of psychotherapies like Behavioral, Cognitive, Interpersonal, or Psychodynamic, and often it depends on the current episode the individual is suffering from.

Behavioral Therapy 

In behavioral therapy for Bipolar disorder, the focus may be on reducing harmful behaviors that lead to adverse circumstances for the individual.

Behavioral therapy for manic episodes will usually focus on reducing the excitation levels by not reinforcing the excitatory tendencies, and instead of trying to channel the mania into more constructive outlets so that the individual does not go looking for any alternative methods to get rid of the excess energy which may lead to problems.

Behavioral therapy for depression will usually involve getting the individual moving again and may employ techniques like behavioral activation and calling upon the person’s social support system to get them involved in their surroundings.

Cognitive Therapy 

Cognitive therapy for depression is very common and involves looking for the problems in the person’s thinking process, and teaches them to look at their negative thoughts and learn to separate them from the negative emotions they may cause.

For mania, it may be a little trickier to approach the individual’s thought process as they are consumed with their energy, but since they are currently experiencing a high degree of emotionality the therapist may try to get them to harvest some of their grandiose ideas and put them down in a tangible form so that they may discuss them and also use them later in the depressive phase.

The biggest problem that psychotherapy needs to tackle during the manic phase is simply ensuring the patient’s adherence to the medical regimen, because they may try to skip their doses often during the mania phase.

Psychodynamic Therapy

Psychodynamic therapy lasts for a very long time and may focus on approaching the basis of the individual’s disorder, what underlies the mania and depression, and focus on removing that, instead of just focusing on the symptoms.

Psychodynamic theory may involve techniques like Dream Analysis, Free Association, or transference, although transference may not be too frequently used when the patient is suffering from mania.

Conclusion

In this brief guide, we explored the meaning and symptoms of Bipolar disorder, the causes of bipolar disorder, and the treatment options available for bipolar disorder. 

Bipolar disorder can be a very misunderstood condition and may often go undiagnosed because people may write the patient off as weird or moody, but it can be a very threatening condition and needs treatment and necessary attention.

Please feel free to reach out to us with any questions or comments you have about bipolar disorder, and leave us any suggestions of what else you would like to see covered in the future,

Frequently Asked Questions (FAQs): Bipolar Disorder

What is a person with bipolar like?

A person with bipolar disorder may have recurrent episodes of extreme, intense, and disturbing emotional states known as depressive episodes which may be cyclical with bouts of extreme happiness or excitement (mania).

Mania and melancholy (depression) make up most of the Bipolar disorder, and there may be brief periods of normalcy between the two phases.

What are the 4 types of bipolar?

The 4 types of Bipolar disorder according to the American Psychiatric Association are: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar disorder due to another medical or substance abuse disorder.

What are 5 signs of bipolar?

5 signs of Bipolar disorder may include:

Brief periods of anger and aggression.
Periods of Grandiosity and overconfidence.
Recurring tearfulness and frequent sadness that eventually goes away
Needing little sleep for rest
Uncharacteristic impulsive behavior or recklessness
Moodiness or sadness
Confusion and inattention.

Is Bipolar 1 or 2 worse?

Bipolar 1 may be worse than Bipolar 2, as Bipolar 1 involves a Manic episode, while Bipolar 2 involves a lesser degree of mania, in the form of a hypomanic episode.

While both mania and hypomania may be found in Bipolar 1 and 2, Bipolar 1 is more serious because mania can involve more intense feelings of euphoria that may often be hard to deal with.

Citations

https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961

International Classification of Mental and Behavioral Disorders

https://www.webmd.com/bipolar-disorder/guide/psychotherapy-bipolar-disorder#1

https://www.healthline.com/health/bipolar-disorder#:~:text=Bipolar%20disorder%20is%20a%20mental,bipolar%20disease%20or%20manic%20depression.

Divya is currently a Clinical Psychology Trainee in a Master of Philosophy program and holds a Master’s in clinical psychology. She has a special interest in Personality studies and disorders, having researched the subject before, and Neuropsychology; with an additional interest being Mood disorders. She likes to write about Psychiatric issues, having worked in multiple specialty setups during her time as a clinical psychology student, and in her free time she likes to cook and read.