What is Bipolar Disorder?

Bipolar Disorder, as the name suggests, causes two-poles, one of extreme low (depression) and the other of extreme highs (mania, hypomania, or excitement). Both poles are clinically diagnosed, and patients may or may not have normal moods between extreme mood swings or episodes.  

Previously known as manic depression, bipolar disorder is a type of mood disorder that can be further divided into two types – Bipolar I and Bipolar II. 

What is the Difference between Bipolar I and Bipolar II?                                

So, what exactly is the difference between the two types of bipolar disorders?

• Bipolar I disorder requires at least 1 manic episode, which can be preceded or followed by hypomanic and/or major depressive

Diagnostic Criteria for Bipolar I Disorder

To be diagnosed with bipolar I disorder, it is necessary to meet the following criteria that define a manic episode:

Manic Episode

1. Persistent period of abnormally elevated or irritable mood and unusually increased goal-directed activity or energy. This period should last at least 1 week and be constantly present through most of the day, nearly every day,
2. During this period of unusual behavior, erratic moods and increased energy levels, 3 or more of the bipolar symptoms should be significantly present. These symptoms include inflated self-esteem or grandiosity, decreased need for sleep, excessive talkativeness or pressure to keep talking, flight of ideas or racing, distractibility or easily drawn to irrelevant external stimuli, increase in goal-directed activity or psychomotor agitation (i.e., non-goal-directed activity), over involvement in high-risk activities or bad decisions.
3. Mood disturbances are severe enough to cause noticeable impairment in social or occupational functioning or to require hospitalization to prevent harm to self or others. Such abnormal changes in mood are usually accompanied by psychotic features such as hallucinations, delusions and/or loss of touch with reality.
4. Manic episode is not attributable to the physiological effects of a substance (e.g., a drug abuse, a medication, other treatment) or to another medical condition

Note: A manic episode comprises criteria 1-4, and at least 1 manic episode is required for the diagnosis of bipolar I disorder.

• Bipolar II disorder requires at least 1 major depressive episode and at least 1 hypomanic episode, but no manic episode.

Diagnostic Criteria for Bipolar II Disorder

To be diagnosed with bipolar II disorder, it is necessary to meet the following criteria that defines a hypomanic episode as well as the criteria for a current or past major depressive episode:

Hypomanic Episode

1. Period of abnormally and continuously elevated, expansive, or irritable mood and increased activity or energy. This period should last at least 4 consecutive days and be persistently present through most of the day, nearly every day.
2. During this period of mood disturbance and high energy levels, 3 (or more) of the following symptoms should be persistent and showcase a noticeable change from usual behavior: inflated self-esteem or grandiosity, decreased need for sleep, rapid speech or pressure to keep talking, flight of ideas or racing thoughts, distractibility, increase in goal-directed or non-goal-directed activity, and overindulging in high-risk activities with painful consequences.
3. A hypomanic episode is associated with an unequivocal change in functioning and behavior that is uncharacteristic of the individual. The disturbance in mood and the change in functioning are observable by others.
4. Episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. There are no psychotic features. If there are psychotic features, the episode is, by definition, manic.
5. Hypomanic episode is not attributable to the physiological effects of a substance (e.g., drug abuse, medication or other treatment)

Note: A hypomanic episode comprises criteria 1-5. A hypomanic episode along with major depressive episode should have occurred, no manic episode should have ever occurred, and there should be no psychotic features for the diagnosis to be bipolar II disorder.

Major Depressive Episode

1. 5 or more of the following symptoms occurring during the same 2-week period and representing a change from previous functioning with at least 1 of the symptoms being depressed mood or loss of interest or pleasure:
   1. Depressed mood through most of the day, nearly every day. This includes feeling sad, empty, or hopeless and are observable by others, and may also include an irritable mood in children.
   2. Reduced interest or pleasure in almost all activities through most of the day, nearly every day.
   3. Significant weight loss without dieting or weight gain or marked change in appetite nearly every day.
   4. Insomnia or hypersomnia nearly every day.
   5. Psychomotor agitation, restless or retardation nearly every day that is distinctly observable by others
   6. Fatigue or loss of energy nearly every day.
   7. Feelings of worthlessness, excessive or inappropriate guilt nearly every day
   8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
   9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, a specific plan for committing suicide, or a suicide attempt,
2. Above symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. Depressive episode is not attributable to the physiological effects of a substance or another medical condition.

Note: Criteria 1-3 constitute a major depressive episode

While there are several differences between the types, the main differentiating factor is the severity of the mania or hypomania episodes. This means bipolar type I requires a manic episode while for bipolar type II, no manic episode should have occurred. Also, bipolar II does not have any psychotic features such as hallucinations, delusions or loss of touch with reality.

However, bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be more severe and dangerous, individuals with bipolar II disorder can experience longer periods of depression, causing significant impairment.

What are the Symptoms of Bipolar Disorder?

Symptoms can vary from person to person, and over time. There are three main symptoms of bipolar disorder are mania, hypomania, and depression.

During a manic phase, patients can experience extreme euphoria, happiness, excitement, inflated self-esteem, high levels of energy and haphazard enthusiasm for interpersonal, sexual, or occupational interactions. Such behavior includes irrational shopping sprees, over-indulgence in sex, change in dressing/personal appearances to be more flamboyant, drug use, gambling, jumbled thoughts, hyperactivity, poor judgement that could lead to involuntary hospitalization, difficulties with the law, serious financial difficulties. Sometimes, rapid and sudden shifts in mood can occur from euphoria to dysphoria, irritability, anger or depression.

Delusions are common in a manic phase and some individuals can become hostile, physically threatening and assaultive to others and/or suicidal as they lose touch with reality. Psychotic symptoms, such as delusions, can occur in episodes of mania as well as depression, but not hypomania. A severe mood disorder with psychotic symptoms can sometimes even be misdiagnosed as schizophrenia.

In the relatively milder, hypomanic phase, patients can be erratic, edgy and impulsive. Impulsivity can contribute to suicide attempts and substance use disorders. Anxiety and overexcited, attention deficiency, difficulty in sleeping, and heightened levels of creativity are common symptoms of hypomania. In fact, an individual’s attachment to heightened creativity during hypomanic episodes may contribute to ambivalence about seeking treatment or undermine adherence to treatment.

Other symptoms include depression, feelings of hopelessness, sadness, weariness, loss of energy, irregular eating and sleeping patterns, forgetfulness, worthlessness, melancholy, aggression and suicidal thoughts.

Studies show women with bipolar disorder are more likely to experience milder mania episodes and longer/more depressive episodes. They are also at a higher risk of thyroid disease, obesity, migraines, anxiety, and alcohol use. Additionally, bipolar disorder symptoms can be difficult to identify in children and teenagers, because of normal mood swings, caused by hormonal changes, stress, or trauma.

What does it feel like to have Bipolar I versus Bipolar II?

While bipolar disorder is linked with periods of “ups” and “downs,” it isn’t just a change in mood from happy to sad but rather periods of severe depression and extreme unrealistic euphoria (mania). Bipolar disorder can include a combination of other emotions such as rage and delusion.

During manic episodes in bipolar I, you tend to feel an unlimited and haphazard sense of happiness that occurs due to delusions and loss of touch with reality. Other abnormal, erratic behavior occurs in both manic and hypomanic episodes, though the intensity of the mood may vary in each case. You may also experience extreme “lows” or depression in both bipolar I and II.

What are the Causes of Bipolar Disorder?

Genetics is the main known cause of bipolar disorder. People who have a first-degree relative, such as a sibling or parent, with the condition, are more likely to get bipolar disorder.

There are at least 15 different variants of bipolar disorder on gene analysis. Most severe types can be accompanied with delusions, hallucinations, and abnormal behavior while the milder types can be present with periods of elevated mood, increased productivity and irritability, and periods of depression. Some mild forms of bipolar type 2 often go undiagnosed because the sufferers can often manage their lives, maintain their jobs and fulfill their responsibilities successfully.

There are several external factors that increase or exacerbate the risk of bipolar disorder. Exacerbations include extreme stress, sleep deprivation, malnutrition, traumatic experiences such as loss of a loved one, drug or alcohol abuse, certain prescription medication, physical illness, hormone shifts such as during pregnancy, childbirth, menopause.

There are no differences in the risk of bipolar disorder associated with ethnicity, education, marital status, or income.

Is Bipolar Disorder Hereditary?

Yes, bipolar disorder can be passed from parent to child. Research suggests that people who have a relative with the disorder, have up to a 10 times higher chance of developing the disease than those without any family history of the condition.

While genetics clearly play a role in bipolar disorder, it is important to remember that most people with family history, or relatives who have the disorder, do not develop it. In addition, not everyone with bipolar disorder has a family history of the disease.

How do I know if I have Bipolar Disorder?

Bipolar disorder doesn’t look the same in each person with bipolar disorder.

Diagnosing bipolar disorder can be difficult. This is because symptoms such as ADHD and schizophrenia can occur without the disorder, and diagnosis in women can often be complicated due to reproductive hormones.

A combination of tests should be done by a doctor or a licensed professional to know if you are diagnosed with bipolar disorder:

• Physical exam – This includes blood and urine tests as well as recording your medical and family history
• Mental health evaluation – Visiting a psychiatrist who knows how to look for signs of the illness
• Mood journal – Keeping a journal to track your moods and chart how you feel and how long these feelings. Doctors may even advise to record sleeping and eating patterns that could cause behavioral changes.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines symptoms for mental health illnesses, including bipolar disorder. Doctors follow these criteria to confirm if you have bipolar disorder.

Remember that bipolar disorder symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in everyday life tasks or in maintaining relationships. See a Doctor if you are experiencing any abnormal behavior, major mood swings, or significant changes in everyday life activities.

Why do people with Bipolar Disorder sometimes experience Stigma?

Most people do not know what bipolar disorder means. The term ‘bipolar’ has been casually thrown around to describe any type of irrational, or unpredictable behavior. However, bipolar disorder is a specific mental health condition, in which a person experiences periods of depression and periods of elevated mood that lasts for days. People with bipolar disorder do not typically have variable mood swings throughout a day, and are usually not irrational or erratic, except during the extremes of a depression or mania episode.

You can overcome the social stigma around mental health illness and mood disorders, by understanding the illness and be in control of it.

Is Bipolar Disorder Treatable?

Yes. Bipolar disorder is treatable but is not curable. Bipolar disorder is a lifelong illness that does not have a known cure. However, you can reduce the symptoms and manage your mood swings through a series of treatment options.

In most cases, symptoms of bipolar disorder are treated with medications and psychological counseling, but a detailed treatment plan is individualized based on your specific symptoms.

Treatments